Introduction. Erectile dysfunction (ED) is a multifaceted and widely prevalent problem in modern medicine. The problem of erectile dysfunction has not only medical but also social significance – the presence of erectile dysfunction in men has a deleterious effect on their quality of life. One of the few pathophysiologically substantiated surgical methods of treatment for vasculogenic erectile dysfunction is penile revascularization. Objective. To evaluate the effectiveness of antegrade extraperitoneoscopic penile revascularization in patients with vasculogenic erectile dysfunction, to develop an algorithm for selecting patients with vasculogenic ED suitable for penile revascularization surgery. Materials and methods. From 2015 to 2022, 65 penile revascularizations were performed in patients with vasculogenic ED. All patients were divided into 2 groups. In the main group, antegrade extraperitoneoscopic penile revascularization was performed in 34 patients, while in the control group, penile revascularization was performed in 31 patients according to the Virag-Kovalev method. To assess the results of the treatment, we used the scales and questionnaires IIEF-5, QoL, and the evaluation of penile rigidity on the Erection Hardness Score (EHS) scale. We also compared the duration of surgery and length of hospital stay. Results. The duration of surgery in the main group was significantly shorter (p <0.01) than in the control group. Additionally, the length of postoperative hospital stay was significantly shorter (p <0.05) in the main group. When comparing patients, there was a significant statistical difference in IIEF-5, EHS, and QoL scores. Conclusions. Penile revascularization, particularly the antegrade revascularization method, is an effective method for treating ED. The proposed methodology, based on the shortcomings of previous methods, is the most effective and least invasive of all the presented options. The success of penile revascularization surgery directly depends on careful patient selection and surgeon experience.

Introduction. Many methods have been proposed for the surgical treatment of varicocele, the most of which is of historical significance. At present, there is no consensus in favor of one or another method of surgical treatment of varicocele, which determines the relevance of further research.Objective. To evaluate the effectiveness of a new minimally invasive method of surgical treatment of varicocele using the author's method.Materials & methods. The study enrolled 763 patients aged 18 – 46 years (mean age 26.3 years) with varicocele who underwent testicular vein subinguinal ligation according to the author's technique. Inclusion criteria: varicocele grades 1 – 3, aged ≥ 18 years, semen abnormalities according to semen analysis and dilated spermatic cord veins according to ultrasound, retrograde blood flow according to Doppler ultrasound. Exclusion criteria: previously operated patients with recurrent varicocele, patients with May-Thurner syndrome and bilateral varicocele. The examination included eight control points: before surgery and 3, 6, 12, 24, 36, 48, and 60 months after surgery. Physical scrotal examination with Valsalva test, semen analysis, and Dopper scrotal ultrasound were performed at the control dates.Results. The average surgery time was 15 min (10 – 30 min). All patients were discharged 1 to 2 days after surgery. At follow-up for 60 months, patients showed improvement in spermatogenesis / or no progression of semen abnormalities during follow-up after surgery based on clinical, laboratory and instrumental studies (semen analysis, ultrasound / Doppler ultrasound); no data on testicular hypotrophy, hydrocele were revealed. A scrotal haematoma was detected in one patient in the early postoperative period. Recurrent varicocele (1.4%) was detected in 11 patients during the follow-up period.Conclusion. The technique is effective, easily reproducible, characterised by a low rate of recurrence and postoperative complications.

Introduction. Chronic prostatitis (СР) is an actual problem of modern urology as it leads to significant deterioration of life quality of able-bodied male population. Frequent relapses of the disease in spite of timely prescribed therapy leads to the necessity to search for alternative drugs. Objective of the study. To evaluate efficacy and safety of Adenoprosin® in patients with CP/chronic pelvic pain syndrome (CРРS) of IIIA category according to USA National Health Institute classification. Materials and methods. The prospective observational study of efficacy and safety of Adenoprosin® was carried out from 10.2021 till 10.2022 on the basis of the Center of Urology and Andrology of the State Research Center named after Burnazyan, Federal Medical and Biological Center of the Russian Federation. Men aged 35 to 60 with diagnosed CKD (IIIA according to the US National Institutes of Health classification) took part in the study. Patients were divided into 2 comparable groups. The control group was treated with an alfa1-adrenoblocker (Tamsulosin 0.4 mg 1 once daily), antibacterial agent (Levofloxacin 500 mg 1 once daily) for 30 days. In the main group, in addition to the standard therapy, Adenoprosin® 150 mg, one suppository a day was administered rectally for 30 days. The study requirements were included 4 Visits: Visit 0-1 – the baseline visit; Visit 2 on Day 14 from the therapy start; Visit 3 on Day 30 from the therapy start; Visit 4 on Day 90 from the therapy start. Clinical monitoring was performed with standardized questionnaires «International system of summarizing prostate disease symptoms» (IPSS), «Chronic prostatitis symptoms index (NIH-CPSI)», WBC counting in prostate secretion. Results. Statistical analysis of NIH-CPSI, IPSS questionnaires, as well as WBC count in the prostate secretion before and after the beginning of treatment, showed that the therapy was significantly effective in both groups (p <0,05). In the main group (Adenoprosin® group) the results were statistically better (p<0,05) if all questionnaires and WBC count in the prostate secretion were evaluated after 90 days from the therapy start as compared to the control group. Conclusions. The results of investigation showed that Adenoprosin® preparation is effective and safe as a part of combination therapy of CP/CPTB and leads to significant improvement of urination and pain syndrome relief according to NIH-CPSI, IPSS questionnaires and decrease of WBC count in prostate secretion.