Vol 28, No 7 (2026): Women’s and men’s health

Background. Late radiation cystitis (LRC) is an incurable and constantly progressing disease. Cancer is a systemic disease, and radiation therapy is an effective method of combined treatment. However, the inevitable pathological reaction of the bladder becomes an independent and far-reaching medical and social problem. It is known that the immunohistochemical platform of post-radiation inflammation is incomplete, but what supports or even initiates it remains an unanswered question. One of the leading areas of modern urology is the verification of the diagnosis and treatment of LRC, but an important component of the diagnosis is the study of the barrier functions of the bladder wall involved in radiation damage. The assessment of the bladder's barrier functions should be conducted using visual, quantitative, and functional parameters, while also meeting the latest standards. What is possible through a combined assessment of barrier functions using 3D reconstructive techniques based on the results of highly informative research methods: positron emission tomography/computed tomography with 11C-choline, scanning electron microscopy and standard viewing cystoscopy. Multicomponent imaging allows for a more accurate morphofunctional assessment, including at the ultrastructural level, of the protective properties of the bladder wall in radiation damage.

Aim. To study 3D ultrastructural mechanisms of LRC formation.

Materials and methods. The paper presents the results of studying the possible role of the ultrastructural failure of the barrier functions of the bladder wall. As one of the causes of the formation of LRC in four women with varying degrees of visual manifestations of LRC.

Results. In the process of the conducted research, according to the results of scanning electron microscopy of the biopsy and positron emission tomography/computed tomography of the bladder with 11C-choline, based on the computer program developed by us, it was established that the tropism of the bladder wall to labeled molecules of 11C-choline (SUV_max) in the urine in various clinical and visual manifestations of LRC correlates with the severity of ultrastructural changes in it.

Conclusion. The ultrastructural mechanisms of the formation of LRC and the activity of its manifestations are highly likely to be associated with the failure of the bladder's barrier functions in relation to the biologically active molecules that make up the urinary filtrate.

The recent increase in the global incidence of benign prostatic hyperplasia (BPH) over the past three decades, combined with the anticipated aging of the population, underscores the urgent need for effective and pathogenetically grounded non-surgical treatment methods. Research has established that chronic inflammation is not merely an accompanying factor but a critical component in the pathogenesis of BPH. Specifically, inflammatory cells and the pro-inflammatory cytokines they produce initiate a series of pathological responses, including tissue remodeling and fibrosis, while also promoting the proliferation of both stromal and epithelial cells within the prostate. Furthermore, inflammatory cytokines have been shown to disrupt hormonal balance in the prostate gland, fostering tissue remodeling and hyperplastic growth. This inflammatory response in BPH often leads to a state of relative hypoxia, driven by the increased oxygen demands of proliferating cells. An additional insult is oxidative stress; the interplay of reduced antioxidant capacity, excessive reactive oxygen species, and chronic inflammation creates a vicious cycle that exacerbates hyperplastic changes. Standard therapies currently employed for BPH primarily focus on symptom relief without directly addressing oxidative stress or inflammation. Given the significant role chronic inflammation plays in BPH pathogenesis, an anti-inflammatory treatment strategy is particularly relevant. One promising approach involves the use of bioregulatory peptides known for their organotropic, anti-inflammatory, and immunomodulatory properties, which improve cell differentiation and proliferation and modulate apoptosis. Clinical studies have validated the effectiveness of peptide drugs such as Prostatex and Prostatex Plus in managing symptoms associated with lower urinary tract dysfunction and infravesical obstruction resulting from BPH, including cases with concurrent chronic prostatitis. These treatments aim to alleviate dysuria, enhance quality of life, and normalize urodynamic parameters. Prostatex Plus stands out as a unique combination therapy, integrating a prostate extract with an α-blocker, making it suitable for both the initiation and intensification of BPH treatment. It has also demonstrated efficacy following transurethral resection or prostate gland biopsy, offering a holistic approach to patient care in this domain.

Background. Among the forms of pelvic organ prolapse, cystocele occupies a leading position in terms of prevalence. The most common method of cystocele repair is anterior colporrhaphy; however, the recurrence rate after this type of surgical correction remains relatively high.

Aim. To evaluate the efficacy and safety of the developed method for cystocele correction using a vascularized pedicled flap created from the excess tissue of the anterior vaginal wall.

Materials and methods. The study included 23 patients with grade III–IV cystocele who underwent surgery using the proposed technique. Postoperative follow-up was performed at 2, 6, and 12 months and included vaginal examination, prolapse assessment according to the POP-Q system, and completion of questionnaires (PFDI-20, ICIQ-SF).

Results. All patients presented with grade III–IV anterior vaginal wall prolapse, grade II–IV apical prolapse, and grade II–IV posterior vaginal wall prolapse. In addition to the studied cystocele correction technique, all patients underwent sacrospinous uterine fixation using a synthetic mesh implant, posterior colporrhaphy, and perineoplasty. The mean operative time was 113±25 minutes. There was 1 (4.3%) case of intraoperative bladder injury, which did not affect surgical outcomes but required bladder drainage for 7 days. The mean intraoperative blood loss was 67±14 ml. Two (8.7%) cases of hyperthermia were recorded in the early postoperative period and were resolved with antibacterial therapy and nonsteroidal antipyretic drugs. During follow-up, 2 (8.7%) cystocele recurrences were detected; however, repeat surgical correction was not performed. The remaining patients demonstrated satisfactory outcomes. The most common early postoperative adverse event was urinary retention (13%). All patients reported improvement in quality of life based on questionnaire results. Cystocele correction was successful in 21 (91.3%) patients, and overall treatment satisfaction was 87%.

Conclusion. Cystocele correction using a vaginal flap is a safe and effective method for the treatment of anterior vaginal wall prolapse.

Fibroadenomas are the most common benign neoplasms of the mammary glands. Minimally invasive treatment is in demand in young women with multiple neoplasms due to the special interest in a good cosmetic effect. For a long time, the most common option for surgical treatment of fibroadenomas was sectoral resection, which was associated with the risk of breast deformation and other complications. The development of vacuum aspiration biopsy (VAB) under the control of ultrasound (US) has recently revolutionized the minimally invasive surgical treatment of benign breast tumors. This clinical case demonstrates the role and place of US in expanding the capabilities of VAB in the simultaneous removal of multiple fibroadenomas from both breasts in a 20-year-old patient. Preoperative marking and real-time ultrasound navigation allowed for the safe and effective removal of multiple fibroadenomas, while dynamic ultrasound scans in the postoperative period allowed for the assessment of the reparative processes in the bed of the removed neoplasms and the confirmation of the absence of residual tissue. In total, the patient had 8 fibroadenomas removed (4 in each breast). At the same time, due to the rational marking, only 2 points of robotic needle insertion were used for each breast, thus it was possible to resect two neoplasms from each point. The low invasiveness of surgical treatment in the postoperative period provided a good cosmetic effect and no complications, and the visual control of the removal of fibroadenomas throughout the operation – no recurrence and/or residual tissue. Important is the favorable prognosis for the patient in the aspect of preserving the function of the mammary gland in the implementation of breastfeeding, since minimally invasive resection of the neoplasms is not associated with gross cicatricial changes in the tissue, which was confirmed by dynamic ultrasound examinations. Despite the significant progress and prevalence of the WAB technique, which is widely used for the removal of single benign breast neoplasms, there is still potential for its improvement and expansion of its capabilities.

Background. In most cases cervical cancer (CC) is associated with persistent infection with human papillomavirus (HPV), and the effectiveness of screening and secondary prevention is largely determined by the informativeness of HPV-testing. A significant role in this case is played by the preanalytical stage, in particular, the quality of the collected material. In clinical practice, there is no unified approach to the choice of the tool for sampling in HPV polymerase chain reaction (PCR)-diagnostics.

Aim. To compare the effectiveness of HPV DNA detection using PCR-diagnostics in biomaterial samples collected using a urogenital probe type A and cytobrush (urogenital probe type D).

Materials and methods. A total of 54 women of reproductive age were examined at Voronezh City Clinical Polyclinic №1. For each patient, two samples were collected in parallel: one using the universal urogenital probe type A, and the other using a cytobrush (urogenital probe type D with nylon bristles). The material was collected by a physician from the exocervix and cervical canal, placed in an Eppendorf-type tube containing STOR-M transport medium, and both samples were sent to the laboratory within one hour. Analysis was performed by real-time PCR with fluorescent detection using the «DTlight» amplifier and the "Quant-21" test system, which evaluates sample adequacy (sample collection control, SCC), and provides qualitative and quantitative detection of DNA from 21 HPV types, including high-risk oncogenic types (16, 18, 26, 31, 33, 35, 39, 45, 51,52, 53, 56, 58, 59, 66, 73, 82) and low-risk types (6, 11, 40, 44).

Results. Comparative analysis showed that SCC, virus detection rate, and viral load logarithms were higher when using the cytobrush. Although the universal gynecological probe has its advantages, it often collects a smaller volume of cervical material, and the number of obtained cells may fall below the detection threshold required for diagnosing viral carriage.

Conclusion. The study revealed differences in the informativity of HPV-testing depending on the sampling tool used. When using a cytobrush, HPV was detected in 35,71% of the patients, while using a type A urogenital probe, it was detected in 30,36%. Inconsistency of results between the methods was noted in 5,35% of cases in favor of the urogenital probe type D. Despite sufficient control of the material collection in all samples, the cytobrush showed a higher diagnostic sensitivity and a greater number of detected types of the virus. The urogenital probe type A can be used for self-collection of biomaterial, however, when a medical collection is preferable, the use of a cytobrush.

The diagnosis and treatment of chronic bacterial prostatitis (CBP) remain significant challenges in uroandrology. The prevalence of this condition remains high, and its recurrent nature considerably impacts patients' quality of life. Antibacterial therapy is the cornerstone of CBP treatment; however, increasing resistance to antibacterial agents complicates the selection of optimal therapeutic options. This review aims to summarize current findings from clinical studies and meta-analyses regarding the antibacterial treatment of CBP. Emphasis is placed on the pharmacotherapeutic aspects of antibiotics used to address prostate infections, including their pathogenetic effects on the inflammation. A comprehensive literature search was conducted in the MEDLINE, PubMed, and EMBASE databases. The relevance of this study is underscored by the increasing incidence of CBP among men of reproductive and middle age, alongside the persistent challenges with selecting effective antibacterial regimens. Currently, there is a noticeable trend toward increased resistance among uropathogens to commonly used antibacterials, which correlates with a higher incidence of recurrent cases. The timely and precise selection of an antibacterial agent is crucial, requiring consideration of its spectrum of activity, pharmacokinetic characteristics, and ability to penetrate prostate tissue. The appropriate selection of medication not only influences the efficacy of treatment for inflammatory prostate diseases but also plays a pivotal role in patient prognosis, contributing to reduced relapse rates, the prevention of complications, and the enhancement of overall quality of life. A multimodal and individualized approach is preferred for the clinical management of patients with CBP. This article examines the evolution of antibacterial strategies in the treatment of CBP, evaluates the advantages and limitations of fluoroquinolones as first-line agents, and discusses the potential role of macrolides in light of escalating antibiotic resistance and mixed infection scenarios. Particular focus is given to the pharmacokinetic properties of josamycin, its effectiveness, safety profile, and significance in contemporary urological practice.