Introduction. Bladder neck sclerosis (BNS) is a widespread complication of the surgical treatment of prostate diseases. Nevertheless, the etiology and pathogenesis of BNC development are not well understood, the frequency and degree of iatrogenic BNS varies depending on what treatment took place before its appearance. Treatment options for BNS can vary from simple dilatation to complex surgical interventions. Clinical variants of BNS, as well as their treatment options, vary in complexity, from simple short annular contractures to obliterating stenosis, which requires a significant expansion of surgical treatment volume. The purpose of this study – is to assess the effectiveness of modern and alternative methods of prevention and treatment of BNS based on the analysis of published studies. Materials and methods. The search and analysis of publications in the databases PubMed, Scopus, Cochrane Library, elibrary, according to the keywords, «bladder neck sclerosis», «benign prostatic hyperplasia», «bladder neck contracture», «bladder neck stenosis», «balloon dilatation», «treatment». As a result, 46 publications were selected and included in this review. Results and discussion. In this review, we highlighted the routine and alternative methods of BNS treatment. Currently, there are quite modern methods for treating prostate diseases (using robotic techniques, electrosurgical resections, and enucleations, laser enucleations, etc.), which are often complicated by secondary BNS. Nowadays, there are a lot of routine and alternative methods of treatment of secondary BNS in the urologist’s armamentarium. Routine methods include TUR and incision of the bladder neck using electric and laser energy, alternative methods include balloon dilatation, installation of a urethral stent, instillation (or intraoperative injection) of the bladder with cytostatics, hormonal drugs, derivatives of hyaluronic acid, and biomedical cell products. Conclusions. According to the literature from the listed alternative treatment methods for BNS, balloon dilatation is the most promising one. Based on the results of the literature analysis, we concluded that the use of balloon dilatation as a method of primary (least invasive) treatment and prevention of the occurrence of BNS is advisable.

Introduction. Varicocele is one of the frequently identified and corrected causes of male subfertility. However, varicocele correction results in improved sperm quality only in 60 – 70% of subfertile men. At the same time, it is not completely clear which semen parameters improve to a greater extent, and what is the proportion ofpatients with an improvement in parameters to normozoospermia.Objectives. To assess qualitative changes in semen after microsurgical varicocelectomy according to WHO 2021 Laboratory manual of semen analysis.Materials & methods. This study analysed qualitative changes in sperm in infertile men after varicocelectomy. All patients had a clinical varicocele, for which microsurgical varicocelectomy was performed. The study included 100 subfertile men with varicocele and abnormal sperm parameters.Results. In the postoperative period (after 6 months), the main semen parameters increased significantly. Also, the proportion of patients with isolated asthenozoospermia decreased by 22% (p < 0.05), the proportion of patients with oligoasthenozoospermia decreased by 14% (p < 0.05). The proportion of patients with normospermia was 35% (p < 0.0001). In patients with oligoasthenozoospermia significant improvement in sperm to normospermia was observed in 19% of cases.Conclusions. Varicocele repair leads to an improvement in the quality of the ejaculate in subfertile men with palpable varicocele and pathozoospermia, with the most significant improvement in sperm motility. However, only in a third of patients semen quality improved to normal levels. Additionally, varicocelectomy demonstrated high efficacy in patients with oligoasthenozoospermia.

Оценка эффективности баллонной дилатации рубцового сужения шейки мочевого пузыря после трансуретральных вмешательств на предстательной железе (предварительные результаты)

Introduction. The problem of endoscopic treatment for urethral strictures and obliterations remains unresolved. It is necessary to note that the effectiveness depends not only on the right indications, but also on the surgical technique and the study of the postoperative period management.Objective. To evaluate the efficacy and safety of endoscopic treatment of patients with bulbar-membranous urethral obliteration.Materials and methods. The study included 103 patients aged 20 to 89 years with bulbar-membrane urethral obliteration, who, for some reason or another, cannot perform urethroplasty. The patients underwent endoscopic recanalization of the urethra under X-ray control with further circular transurethral electroresection (TUR) of the scar tissues in the urethral obliteration zone (after 6 – 7 days).Results. The average age of the patients was 61.1 ± 18.3 years. After the operation, self-urination was restored in all patients. The average maximum urine flow rate (Q max) before discharge from the hospital was 12.6 ± 0.5 ml/s. Throughout the follow-up period, Q max tended to increase and at the end of the study (36 months) reached values of 16.5 ± 0.5 ml/s. During the first year of follow-up, 18 (17.5%) patients developed recurrent urethral stricture. Seventeen (16.5%) patients underwent repeated circular TUR of scar tissue in the zone of recurrent stricture. The effectiveness of the treatment was 90.0%.Conclusion. Endoscopic urethral recanalization followed by TUR of scar tissue in the obliteration zone is an effective and safe method in the treatment of bulbar-membranous urethral obliteration with length less than 1.0 cm.

Introduction. Currently, urologists are divided on which method is most effective for treating bladder neck contracture (BNC) after surgery: transurethral resection (TUR) or incision.Objective. The study aimed to assess the balloon dilation safety and success in patients with recurrent bladder neck contracture (BNC) after endoscopic surgery for benign prostatic hyperplasia (BPH).Materials & Methods. This study involved 110 patients with recurrent BNC after transurethral interventions for BPH. All patients underwent TUR of the bladder neck and were divided into 2 groups: group A (n = 45) included men who, after TUR, additionally underwent repeated balloon dilation, while the control group B (n = 65) included men who were treated with alpha-blockers alone.Results. In 9 months after TUR and 3 months after the fourth balloon dilation procedure in group A, the mean international prostate symptom score (IPSS) decreased from 20.1 ± 8.4 to 17.2 ± 7.4, and the IPSS-quality of life (QoL) was 4.2 ± 1.2 (p > 0.05). In group B, they were 21.7 ± 7.7 and 4.7 ± 1.1 (p > 0.05), respectively. Additionally, the mean flow rate in group A was 13.2 ± 5.4 ml/s, while in group B, it was 8.7 ± 4.9 ml/s (p < 0.05). There was a significant decrease in the post-void residual urine volume (PVR) from 76.2 ± 96.1 ml to 37.6 ± 55.1 ml in group A, whereas, in group B, it increased from 63.0 ± 36.9 ml to 79.4 ± 71.6 ml (p > 0.05). Also, 28.0% of patients of group B, and 13.3% of patients of group A underwent repeated TUR of the bladder neck in 9 months follow-up period (p < 0.05).Conclusion. Balloon dilation procedure is a relatively safe less invasive procedure and can reduce the BNC recurrence rate and consequently the rate of repeated transurethral interventions.

Erectile dysfunction is aprevalent condition affecting millions of men worldwide, with significant implications for physical health, psychological well-being, and quality of life. This systematic literature review aims to provide a comprehensive overview of the current landscape of ED, focusing on its diagnosis, management, and emerging interventions. A structured search of peer-reviewed literature was conducted across multiple databases, including PubMed and Cochrane Library, using predefined inclusion and exclusion criteria. The review highlights the multifactorial nature of erectile dysfunction, emphasizing the importance of accurate diagnosis through tools such as the International Index of Erectile Function, penile Doppler ultrasound, and nocturnal penile tumescence testing. Pharmacological treatments, particularly phosphodiesterase type 5 inhibitors, remain the cornerstone of management, while nonpharmacological options like vacuum erection devices and psychotherapy play complementary roles. Emerging therapies, including stem cell therapy, platelet-rich plasma therapy, and low-intensity extracorporeal shockwave therapy, offer promising avenues for refractory cases. Despite advancements, challenges such as stigma, cost, and limited access to innovative treatments persist. This review underscores the need for a multidisciplinary approach to erectile dysfunction care and calls for further research to refine diagnostic tools, optimize treatment strategies, and enhance accessibility to cutting-edge interventions. By addressing these gaps, we can improve outcomes for men with erectile dysfunction and promote holistic sexual health.