Urogenital transplantation has emerged as a ground-breaking field with the potential to revolutionize the treatment of end-stage organ failure and congenital or acquired defects of the kidney and urinary bladder. This review provides a comprehensive analysis of the current state, clinical experiences, and experimental progress in kidney and bladder transplantation, with a particular focus on immunological, surgical, and ethical challenges. While kidney transplantation is now a well-established procedure offering improved survival and quality of life for patients with chronic renal failure, bladder transplantation remains in the experimental phase, facing hurdles in vascularization, tissue integration, and functional restoration. Recent advancements in tissue engineering, regenerative medicine, and immunosuppressive strategies are critically discussed, highlighting their role in shaping the future of urogenital grafts. This review also explores xenotransplantation and bio-artificial organ development as promising frontiers. Continued interdisciplinary research is essential to overcome the current limitations and enable routine clinical application of bladder transplantation while optimizing outcomes in kidney grafts.

Background: The coexistence of type two diabetes (T2D) and cardiovascular diseases (CVD) in patients with overweight increases the risk of macro-vascular complications. Some studies are controversial of the results of Ramadan fasting (RF) in patients T2D+CVD. Objective: To compare different RF (antique and modern) on anthropometric, glycemic, blood pressure (BP), lipids, heel bone mineral density (HBMD), and ejection fraction (EF) in patients with T2D+CVD. Methods: An open, 60-day, controlled, single-center, randomized clinical trial included 51 patients (29 women) with T2D+CVD: 26 in Main (antique RF); 25 in Controls (modern RF). Primary endpoints: weight loss, fasting blood glucose and, blood insulin, BP. Secondary endpoints: blood lipids, HBMD, and EF. Results: Patients in Main lost weight –8.02 kg ( P <0.0001), in Controls lost weight –2.67 kg ( P <0.025); BMI in Main significantly decreased ( P <0.0001), but in Controls did not significantly decrease ( P> 0.025). During a 30-day follow-up, Main did not regain weight and WC; but Controls regained weight and WC. In Main BP, all glycemic parameters (fasting glucose, immunoassay insulin, HOMA-IR), lipids (cholesterol, triglyceride, HDL), HBMD, and EF in patients with and without heart failure (HF) were significantly normalized at 30-day RF ( P 0.025). In Controls HBMD and EF in patients with HF did not change ( P >0.025). At 30-day follow-up, glycemic, BP, lipids, HBMD, and EF parameters did not significantly change in Main; but in Controls they worsened as weight regained. Conclusion: Both the RF methods allowed weight loss, but antique RF led to markedly weight loss and significant positive change in glycemic, BP, lipids, bone mineralization, and EF in patients with T2D+CVD; the antique RF allowed patients to stop taking medications. The duration of the positive results depended on the maintenance of the achieved weight loss on RF. Trial Registration: ClinicalTrials.gov NCT06410352 (05/08/2024): https://register.clinicaltrials.gov/prs/app/action/SelectProtocol?sid=S000EG8K&selectaction=Edit&uid=U0006MBT&ts=139&cx=bhsvd1

Background: The impact of overweight and adipocyte size on the development of type 2 diabetes mellitus (T2DM) even remains unclear. Aim: To study: 1) the relationship between the state of adipocytes and/or overweight/obesity, the development of T2DM and its clinical and laboratory signs; 2) the effect of weight loss on glycemic level, hyperinsulinemia (HI), insulin resistance (IR), and T2DM status. Methods. Design: a systematic review. Settings: Web of Science, EBSCO, Scopus/ Science-Direct, Google Scholar, PubMed, Cochrane, и Wolter Kluwer were searched for articles published for 26 years (2000-2026). The study bases on a systematic review of 3853 articles published worldwide. Results. In total, 142 full-text articles were assessed for eligibility. With an increase in overweight, the size of adipose tissue increases, adipocytes increase, the cell radius increase. All it leads to an overload of intracellular transport and internal organs. Increase in cell size triggers intracellular mechanisms to limit further nutrient supply. When cell size increases excessively, conformational changes in cellular receptors are activated, resulting in the development of IR. The increase in cell size and the maximum accumulation of overweight, as parallel processes, lead to hyperglycemia and HI with gradual development of IR and T2DM. Any type of i ntentional weight loss leads to a decrease in IR, HI and the disappearance of T2DM. Targeted weight loss in patients with T2DM improves metabolic and cardiovascular health, reduces blood pressure and blood sugar, reduces doctor visits, normalization of HbA1c, HI, IR. Conclusions. IR is a protective reaction of the cells, preventing its oversaturation and overflow. Overweight is an independent risk factor for the development of T2DM and its clinical and laboratory manifestations. Targeted weight loss leads to disappearance of symptoms of HI, IR and T2DM.

Background: The comparative effects of pharmacological treatment, bariatric surgery, and diet on insulin resistance (IR) remain unclear. Aim: To study the comparative effects of the methods on IR: pharmacologic, bariatric surgery, and very-low-calorie diet (VLCD) in patients with type 2 diabetes mellitus (T2DM) and hypertension. Methods. Design: a 90-day prospective, multicenter, comparative clinical trial including 130 adult patients divided in three groups: Drug, Surgical, and VLCD groups. Endpoints: HOMA-IR; weight loss; HbA1c, systolic/diastolic blood pressure (SBP/DBP). Results. At 90 days, weight lost in Surgery (-19.8%) and VLCD groups (-17.4%) (P< 0.0001), while in Drug group the loss was unsignificant (-6.5%; P=0.06). SBP/DBP in Drug group decreased by -9.5% (P=0.0002) and -4.1% (P=0.09), respectively. SBP/DBP in: Surgical group decreased by -13.6% and -10.6%, respectively (P< 0.001); VLCD group -23.3% and 21.3%, respectively (P< 0.0001). HOMA-IR in Drug, Surgery and VLCD groups decreased by -42.2% (P=0.004), -87.6% (P< 0.0001), and -88.7% (P< 0.0001), respectively. In Drug group HOMA-IR did not reach normal level. Correlation-regression-analysis revealed a direct correlation between weight-loss and a decrease in HOMA-IR (r=0.526; F=33.2, P< 0.0001). HOMA-IR decreases by 65% if weight decreases by 10%; if weight decreases by 25%, then HOMA-IR decreases by 83%. Conclusions. HOMA-IR was associated with weight loss: the greater the weight loss, the lower HOMA-IR. Weight loss leads to reduce the need for antidiabetic/antihypertensive drugs in the patients.