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Significant opportunities to increase economic efficiency in health care are associated with increased planned approach to the management of the volume and structure of care and patient flow. In 2010, the Research Institute of Urology in conjunction with the Government of the Voronezh region developed a regional program "Urology". The main objectives of which were: the reduction of morbidity, complications and disability in pa-tients with urological profile, improving the quality and accessibility of urological care to the population area. The essence of the program is to organize medical urological care according to the principles of prevention, standardization, quality control of the organization of care, optimizing the financial costs of the state of health care. In our work we have tried to move away from the principle of "negotiability" and to focus on the active identification of complaints by the survey population. The concept of preventive health care, implemented in the sub-program "Urology" in full compliance challenges of the day – simple, effective, does not cost much. On the example of BPH, it was shown that the introduction of such a system in any branch of medicine will allow maximum transfer care to a new level , away from the provision of assistance in uptake, the majority of accident and emergency assistance on a "detection", routine medical care, and accordingly to plan state assignment for each specific type of care, and as a result, plan on spending on health care , which will lead to the rational use of finance to health care, improve the quality and availability of specialized and high-tech care.

Introduction. Upper urinary tract (UUT) obstruction remains a socially significant problem due to its high frequency and serious pathogenetic consequences. Dilation of calyx-pelvic system (CPS) remains one of the pathognomonic manifestations of this condition, which should be immediately corrected. Percutaneous puncture nephrotostomy, internal stenting, and ureteral catheterization are the most commonly used methods for draining the upper urinary tract. However, the problem of choosing a drainage method in a specific clinical situation based on the criterion of the effectiveness of elimination of CPS dilatation has not yet been resolved. Purpose of the study. Comparative analysis of the efficiency of drainage of the upper urinary tract under the conditions of the use of three alternative methods –распредеpercutaneous puncture nephrostomy, internal stenting and ureteral catheterization – followed by substantiation of the choice in a specific clinical situation according to the criterion of the effectiveness of correction of the dilatation of the CPS. Materials and methods. We included in this study 300 patients with obstruction of the upper urinary tract due to urolithiasis, oncourological and oncogynecological pathology. The presence and resolution of dilatation of the CPS was determined using ultrasound diagnostics and intravenous urography. Results. Percutaneous puncture nephrostomy is the most effective in treating upper urinary tract obstruction in terms of eliminating CPS dilatation, ureteral catheterization is less effective, and internal ureteral stenting occupies an «intermediate position». Conclusion. When planning and implementing the treatment of upper urinary tract obstruction, one of the main criteria should be taken into account the effectiveness of correction of the dilatation of the CPS. In a specific clinical situation in which dilatation of the PCS will be of the greatest importance, percutaneous puncture nephrostomy will be the optimal method of drainage.

Introduction. Lithokinetic therapy after remote shock wave uretero lithotripsy (SWL) is an obligatory stage in the postoperative management of patients with urolithiasis. In the postoperative period, it is extremely important to correctly determine the required drug, its dosage and frequency of administration. According to clinical guidelines, it is customary to use standard schemes of lithokinetic therapy, including non-steroidal anti-inflammatory drugs (NSAIDs) in combination with α-blockers. However, the effectiveness of this therapy does not always lead to success. In this regard, the use of herbal remedies is additionally recommended. One of the phytopreparations is the biologically active additive Renotinex, which is a combination of essential oil (anethole), 6 natural terpenes and an oil solution of vitamin E. Materials and methods. The study involved 100 patients with 4-10 mm ureteral stones after an SWL session. Patients were randomized into 2 groups: study and control, which included 50 patients each. The treatment was carried out for 28 days. Unlike patients in the control group, the patients of the main group, along with standard lithokinetic therapy (diclofenac, 1 suppository (50 mg) for pain, tamsulosin, 1 capsule (0.4 mg) in the morning), additionally received renotinex, 2 capsules 3 times a day. The effectiveness of the treatment was assessed 2 and 4 weeks after the start of therapy according to the data of ultrasound and X-ray research methods: by the presence of calculus its average size and the expansion of the pelvicellular system. As part of laboratory diagnostics, a general blood test was performed with an assessment of 3 parameters, such as: hemoglobin level, erythrocytes, leukocytes; general urine analysis with an assessment of 2 parameters (erythrocyturia and leukocyturia). For statistical analysis, Student's t test and Fisher's angular transformation method were used. Results. The efficacy of combination therapy with renotinex after SWL of ureteral stones was 24% higher than that of standard lithokinetic therapy with NSAIDs and alpha-blockers; the significance of differences was obtained only after 4 weeks of therapy. Сconclusions. The effectiveness of lithokinetic combination therapy in combination with renotinex after SWL of ureteral stones is higher than standard therapy, including NSAIDs and alpha-blockers.

Prostate cancer (PCa) is one of the most common cancers in men and the actual problem of modern oncology. Based on the results of worldwide research, the expected number of patients with prostate cancer in the city of Voronezh and the Voronezh region was calculated. This calculation shows, how the volume of patients requiring medical intervention, will have to face health care, not only in the Voronezh region, but in other regions of the Russian Federation. Existing health care system, where the systematic and standardized approaches to medical care didn’t available, calls into question the successful implementation undoubtedly important and necessary screening. The way out of this situation is to create a system based on the existing urological care to the population of the Voronezh region , « three-tier system of health care ,» which implies an increase in the number and volume of services at the outpatient phase , as well as the division of hospital care on the technological principle according to the principles of prevention and standardization, transfer of care from the principle of « negotiability « to the principle of « detection «, the organization of control of quality of care, established urology service of the Voronezh region is ready to run, and the decision of screening programs.