In the review article, based on the results of modern clinical and experimental studies, gender and age-related features of the anatomy, physiology and pathophysiology of the lower urinary tract are considered. The features of the structure and functioning of the urothelium, myothelium, neurothelium and endothelium of the lower urinary tract in men and women are described in detail. A separate section of the review is devoted to the peculiarities of hormonal regulation of the lower urinary tract, depending on gender and age.

Congenital diverticulum of the distal urethra is extremely rare in urological practice, there are isolated descriptions of it in the literature, as a result every clinical observation is of interest. The aim of this study is demonstration of a rare clinical observation congenital diverticula of the distal urethra without infravesical obstruction (meatostenosis) in a teenager. The article describes a clinical case of treatment of congenital diverticula of the anterior urethra without signs of infravesical obstruction in a 13-year-old teenager. A case of surgical treatment of congenital urethral diverticulum without infravesical obstruction in a 13-year-old teenager is presented. Diverticulectomy with suture of the urethra was performed with good anatomical and functional results. A distal urethral diverticulum of a congenital nature is extremely rarely noted as an isolated condition without an anterior urethral valve or another variant of infravesical obstruction. The method of choice is to perform diverticulectomy with suturing of the urethra.

Хронический бактериальный простатит снижает репродуктивную функцию мужчин и ухудшает качество жизни. Нарушение иммунной системы при хроническом бактериальном простатите требует иммунокоррекции и обуславливает применение дополнительной иммуномодулирующей терапии. Целью настоящего многоцентрового двойного слепого рандомизированного плацебо-контролируемого клинического исследования было доказать эффективность и безопасность препарата рекомбинантного интерферона альфа-2b и высокоактивных антиоксидантов (витамины Е и С) в комплексной терапии хронического бактериального простатита. Мужчин в возрасте от 18 до 50 лет с диагнозом «хронический бактериальный простатит» категории II или IIIA (n = 140) рандомизировали в две группы. Пациенты основной группы (n = 70) получали интерферон альфа-2b, суппозитории ректальные, 1 000 000 МЕ (2 раза в сутки, 20 дней), группы сравнения (n = 70) – плацебо в том же режиме применения. Одновременно в качестве антибактериальной терапии пациенты в обеих группах получали левофлоксацин (500 мг/сут, 28 дней). Эффективность лечения оценивали по клиническим опросникам, бактериологическому и микроскопическому анализам, частоте рецидивов хронического бактериального простатита в течение 6 мес с начала лечения, ультразвуковому исследованию, урофлоуметрии. Оценку эффективности проводили после окончания дополнительной терапии, завершения антибактериальной терапии и через полгода после начала лечения. Клиническая симптоматика хронического бактериального простатита снижалась в обеих группах терапии уже в течение 20 дней после начала лечения. При этом дополнительная терапия препаратом интерферона альфа-2b с антиоксидантами способствовала снижению среднего числа лейкоцитов в секрете предстательной железы/третьей порции мочи в 2,6 раза (95% ДИ 1,6-4,4) после окончания интерферонотерапии, в 4,2 раза (95% ДИ 2,4-7,2) – после завершения антибактериальной терапии и в 5,4 раза (95% ДИ 3,4-8,3) – к концу наблюдения по сравнению с плацебо (p < 0,001). Доля пациентов с микрофлорой, обнаруженной в секрете предстательной железы, по завершении интерферонотерапии была на 20% ниже, чем в группе плацебо (p = 0,013). Таким образом, дополнительная иммунотерапия препаратом интерферона альфа-2b облегчала течение хронического бактериального простатита за счет ускорения элиминации бактериальной микрофлоры и снижения воспалительно-пролиферативных процессов в простате. Препарат интерферона альфа-2b не вызывал опасений по безопасности и хорошо переносился пациентами. Chronic bacterial prostatitis reduces the reproductive function of men and worsens the quality of life. Impairment of the immune system in chronic bacterial prostatitis requires immunocorrection and use of additional immunomodulatory therapy. The objective of this multicenter, double-blind, randomized, placebo-controlled clinical trial was to prove the efficacy and safety of the recombinant interferon alpha-2b preparation and highly active antioxidants (vitamins E and C) in complex therapy in patients with chronic bacterial prostatitis. Men aged 18 to 50 years with a diagnosis of chronic bacterial prostatitis of category II or IIIA (N = 140) were randomized into two groups. Patients in the main group (N = 70) received interferon alpha-2b, rectal suppositories 1,000,000 IU (20 days bid), and patients in the comparison group (N = 70) received placebo as described above. All patients received levofloxacin (500 mg/day, 28 days) as antibiotic therapy. The efficacy of treatment was assessed by clinical questionnaires, bacteriological and microscopic analyses, frequency of chronic bacterial prostatitis relapses within 6 months from the start of treatment, and by ultrasound and urodynamic testing. The efficacy was evaluated at the end of additional therapy, at the end of antibiotic therapy and six months after the start of treatment. Clinical symptoms of chronic bacterial prostatitis decreased in both groups within 20 days after the start of treatment. However, interferon alpha-2b therapy reduced the average number of leukocytes in the prostate secretion/third urine specimen by 2.6 (95% CI: 1.6-4.4) times by the end of interferon therapy, by 4.2 (95% CI: 2.4-7.2) times by the end of antibiotic therapy and by 5.4 (95% CI: 3.4-8.3) times by the end of follow-up period compared to placebo (p < 0.001). The proportion of patients with prostate secretion microbiota was 20% lower in interferon alpha-2b compared to Placebo group (p = 0.013). Thus, complex interferon alpha-2b therapy improved chronic bacterial prostatitis resolution by accelerating the elimination of bacteria and reducing inflammatory and proliferative processes in the prostate. Interferon alpha-2b had no safety concerns and was well tolerated by patients.

BACKGROUND: Bladder outlet obstruction caused by prostatic hyperplasia eventually leads to detrusor working hypertrophy, and its development is impossible without synchronous remodeling of its vascular bed. Taking into account the age-associated nature of the disease, bladder transformation occurs following involutive structural changes of both the organ and its vascular system due to natural aging. To date, morphological features of compensatory reactions of the vascular bed, taking into account background age-related changes in the bladder wall, is not fully disclosed. AIM: To investigate the structural transformations of the bladder and its vascular bed in elderly and senile persons with prostatic hyperplasia and to determine the significance of vascular restructuring in providing compensatory detrusor hypertrophy. MATERIALS AND METHODS: Autopsy material from 35 men aged 6080 years who died from diseases not related to urological and cardiovascular pathology was examined, as well as those from 25 men of the same age who had prostatic hyperplasia without signs of bladder decompensation. The control group included 15 men aged 2030 years who died as a result of injuries. A complex of histological, morphometric and immunohistochemical methods was used RESULTS: In patients with prostatic hyperplasia, there is a violation of the histoarchitectonics of the bladder, which is expressed in the development of focal detrusor hypertrophy, layering on the existing involutive changes, which are characterized by the atrophy of muscle fibers, sclerosis of the intermuscular stroma, defragmentation of the elastic frame, and neurodegenerative processes. A similar state of the detrusor is caused by sclerosis and hyalinosis of small arteries and arterioles, hypertrophy and hyperelastosis of large arteries associated with arterial hypertension, combined with atherosclerosis of extraorganic arteries. Moreover, a complex is formed in the vascular basin of the bladder that can regulate blood transport in conditions of increasing chronic ischemia and provide a normal blood supply to the preserved parts of the detrusor that can undergo hypertrophy with an increase in functional impairment. These structures include intimate muscles, muscular elastic sphincters, polypoid cushions of the conti arteries, muscle couplings, muscle rollers, and vein valves. CONCLUSIONS: Structural changes in the bladder are characterized by a combination of focal detrusor atrophy resulting from angiosclerosis and development of hypertrophy of preserved areas with an increase in functional load. The hypertrophic potential of the detrusor is attributed to vascular regulatory structures.

Objective - study of morphological rearrangements of the bladder and its vascular system in elderly and senile people.Material and methods. Autopsy material in the form of pieces of the bladder wall from 25 men aged 60-80 years was studied using a number of histological, morphometric and statistical techniques. As a control, we used material from 10 persons aged 20-30 years who died as a result of injuries.Results. It was shown that in men in the process of aging in the extraorganic arteries, atherosclerotic changes are revealed, leading to a narrowing of the lumen. In the intraorgan arteries, thickening of the media, hyperelastosis and hyalinosis are observed, which also lead to a reduction in blood flow and are markers of arterial hypertension. A reflection of the adaptation to hemodynamic disorders is the formation of the so-called "closing arteries" with a powerful intimate layer. Over time, in the media of the arteries, as well as in the intima of the "closing vessels", sclerosis grows. The veins of the bladder lose a powerful smooth muscle layer in the wall, undergo sclerosis, which leads to difficulty in blood outflow, aggravating chronic hypoxia. Remodeling of the vascular bed of the bladder leads to detrusor atrophy and degenerative-dysregenerative changes in the urothelium.Conclusion. In the vascular bed of the urinary bladder in elderly and senile men, atherosclerotic and angiotonic changes characteristic of arterial hypertension progress, followed by the development of detrusor atrophy and impaired urothelium regeneration.