Background The current war in Ukraine is associated with frequent applications of multiple-launch rocket systems and cruise missiles as well as other various high-energy weapons to cause severe injuries in military personnel including abdomen wounds, vascular injury, and limb amputations as well as genitourinary trauma. The aim of this report is to demonstrate a case of successful penile salvage by restoring its function in a combat patient with gunshot genitourinary trauma in conditions of an interrupted supply of medical equipment. Case presentation We describe a case of a 48-year-old male patient with a combined shrapnel gunshot wound to the penis with damage to the urethra and combined injury to the soft tissues of the left thigh. Several hours after the injury, the patient underwent primary surgical debridement of the left thigh, ligation of the great saphenous vein of the thigh, primary sutures on the penile urethra and navicular fossa, suturing of the rupture of the head and penis, drainage of the wound, catheterization of the bladder, and epicystostomy. An artificial erection was performed intraoperatively. The urethral catheter was removed 3 weeks after urethral suturing (May 4, 2022). The epicystostomy was removed 5 months after the injury (August 4, 2022) and 2 days after the restoration of spontaneous urination. At the follow-up of 7 months after the injury, the patient has normal urination with minor urinary dribbling, sufficient erection, and ejaculation. Conclusions We have shown that in a case of gunshot wounds to the penis and hanging part of the urethra, even in the presence of combined severe purulent lesions of non-urological localizations, it is possible to perform a primary reconstruction of urogenital injuries using a primary urethral suture and applying a negative pressure device. Findings from this case report shed new light on the management of penile gunshot injury in ongoing warfare as well as provide evidence of the possibility to perform adequate management for penile injury in conditions of limited medical resources, violation of international humanitarian law, and under frequent strikes of high-energy weapons.

Background: The choice of method of treatment of benign prostatic hyperplasia (BPH) in elderly patients with high operative risk is one of the pressing issues of modern urology. Selective arterial embolization (SAE) of the prostate -is a new method of treating lower urinary tract symptoms caused by benign prostatic hyperplasia. Materials and Method: 21 male patients with prostate volume larger than 40 ml, contraindications for traditional operations on the prostate, high level of operative-anesthesiological risk (III-IV on American Society of Anaesthesiologists scale) and normal PSA levels underwent SAE procedure under local anesthesia from one surgical approach through the right femoral artery. Patient`s levels of PSA total were monitored, a digital rectal examination was performed and an ultrasound investigation of the prostate was conducted, maximum urinary flow (Qmax) was measured, IPSS index and quality of life (QoL) subscore were determined. Results and discussion:The intervention was performed successfully in 19 patients (90,5%). Subsequent examination revealed significant improvement of IPSS on average by 12 points and QoL levels on average by 3 points, reduction of the volume of the prostate at mean by 35%, and increase of maximal urine flow at mean by 32%. First signs of clinical improvement were observed one week after the intervention. No significant complications connected to angiography or embolization, which needed surgery or long-term hospitalization, were registered. Conclusion: Our preliminary experience suggests that SAE is safe and effective for treatment of symptomatic BPH in elderly patients who have contraindications to traditional operations and high operative risk. TCM-GMJ September 2017; 2(2):P12-P15)