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Aim: To estimate frequency and type of renal injury in patients with metastatic renal cell carcinoma (RCC) receiving ipilimumab and nivolumab after nephrectomy.

Materials and methods: The retrospective study involved 50 patients, including 38 (76%) men and 12 (24%) women with a single kidney and progressive metastatic RCC. After nephrectomy before the start of immunotherapy for the progression of RCC, chronic kidney disease (CKD) stage 3 and higher was diagnosed in 39 (78%) cases.

Results: During immunotherapy, acute kidney injury (AKI) developed in 9 (11%) patients after 14 weeks of treatment. The maximum incidence of AKI (n=7; 25%) was documented after the 10th administration of the drugs. When assessing the dynamics of creatinine levels over 28 weeks, a significant increase was noted after the 2nd, 3rd, 4th and 10th administrations. After the 2nd administration of the drugs, the creatinine level in the total sample of patients increased on average to 159.7 mol/l with a baseline level of 127.8 mol/l (p<0.001), while after the 3rd, 4th and 10th administration to 160.3, 151.6 and 147.9 mol/l, respectively (p<0.039, p=0.003 and p=0.029, respectively). Similar dynamics were also seen for urea with a significant increase after the 2nd, 3rd, 4th, 5th and 7th administrations. For example, the maximum urea level was recorded after the 3rd and 5th administrations of the drugs and was 10.2 mmol/l, while before the start of therapy it was 8.1 mmol/l (p=0.001 and p=0.003, respectively).

Conclusion: A significant renal injury was seen during 28 weeks of follow-up in patients with metastatic RCC after nephrectomy receiving ipilimumab and nivolumab.

The prevalence of symptomatic post-pubertal hypogonadism in men 40-79 is 2,1-5,7% and increases with age. The aim of testosterone replacement therapy is to restore testosterone levels in blood plasma to normal physiological averages and provide numerous positive clinical effects: improved sexual function, reduced symptoms of depression, improved mood, normalization of the muscle-fat ratio of body composition and bone mineral density, and many others. The recommendations of various testosterone therapy manuals did not allow us to form an unambiguous opinion on the safety of long-term testosterone replacement therapy. The main purpose of the present work is to analyze the effectiveness of testosterone replacement therapy in the treatment of the main symptoms of post-pubertal hypogonadism, its effect on concomitant somatic pathology, safety and a reasonable choice of the dosage form of the testosterone preparation.

Obstruction of the upper urinary tract (UUT) is a heterogeneous clinical case, which, if necessary or in case of complications, is relieved by percutaneous nephrostomy or ureteral JJ-stent placement, which have its "pros and cons" in relation to complications, costs, difficulties in performing various pathological conditions, quality of life of patients and further treatment. The European Association of Urology Guidelines on Urolithiasis 2024 are based on the 2010s data review., fourteen years later, the optimal method of UUT decompression in various pathological conditions remains under debate. In this lecture we present methods, indications, contraindications, complications, quality of life of patients under various methods of UUT draining, as well as the benefits of ureteral stenting and percutaneous nephrostomy.

Minimally invasive drainage of the upper urinary tract by putting ureteral stents is an accepted and widespread procedure in case of obstructive pyelonephritis and renal colic, including symptomatic upper urinary tract dilation in pregnant women. In addition, ureteral stenting has a wide range of indications in reconstructive interventions, in which it is necessary to "strengthen" the ureter for various periods of time, and is also used as a palliative measure to ensure the outflow of urine in incurable patients. At the same time, in order to avoid stent-associated complications, it is necessary to regular carefully evaluate patients, remembering the "palliative nature" of such procedures, and to correctly choose the indications for the stent placement. Our article describes combinations of problems in treatment tactics by putting ureteral stents, which led to a life-threatening purulent destructive complication and the need for nephroureterectomy.

Complex forms of urolithiasis, such as staghorn and multiple stones, are one of the most severe diseases of the urinary tract. The treatment is associated with high intra- and postoperative risks. These forms of nephrolithiasis are characterized by the frequent presence of residual fragments and disease recurrence, which determines the subsequent need for repeated interventions. Thus far, the choice of treatment strategy presents significant difficulties even for experienced urologists. The maximum efficiency of the treatment of complex forms of kidney stones and minimizing the incidence of complications and re-interventions determine the high scientific interest in this problem. Data reflecting the efficiency and complications of different surgical procedures in patients with complex forms of kidney stones are presented in the article.

Aim: This study aims to find out the correlation of catheter use duration with the incidence of OABS post TURP in patients with urinary retention due to BPH.

Materials and methods: An observational analytical research correlation with a cohort approach was carried out on 29 patients with urinary retention due to BPH post TURP in five hospitals in Padang from January to August 2019. Data collected included the characteristics and duration of catheter use, obtained through interviews using questionnaires, OABS were obtained based on the total score of the overactive bladder symptoms score (OABSS) standard questionnaire. The numerical variable measurement scale is between the duration of catheter use and OABSS post TURP with the Pearson test using IBM SPSS software v23.

Results: The average of catheter used duration was 14,9+/-8,0 days, and the total OABSS score was 4,7+/-2,5. Bivariate analysis showed a positive correlation with a weak strength between the duration of catheter used and the total OABSS score (Pearsons correlation, r=0,396, p=0,033). The longer the catheter is used, the higher the total OABSS.

Conclusion: The longer the catheter used increase the incidence of OABS post TURP, it is necessary to shorten the duration of catheter use to decrease the incidence and severity of OABS in urinary retention due to BPH patients post TURP.

Introduction: The second most common reason for prescribing antibiotics in children is urinary tract infection (UTI). Since antimicrobial stewardship is a priority in the further development of strategies of the treatment of children with UTIs, the need to form an optimal model for its diagnosis and treatment is relevant in pediatric urology.

Aim: To analyze domestic and foreign publications devoted to the study of the urinary tract microbiome in children.

Results: Cultivation or culturing methods continue to be considered the "gold standard" in many countries for the diagnosis of bacterial infections, although more sensitive and specific technologies are available. A urine sample was previously considered sterile if uropathogens did not grow using standard techniques. It remains unclear whether standard microbial culturing methods are adequate to determine species diversity and identify all microorganisms capable of causing UTIs. A study of the bladder microbiome and maintenance of its homeostasis to prevent inflammatory lower urinary tract diseases is an emerging area of research. It is known that the bladder of a healthy person contains non-uropathogenic bacteria, such as Lactobacillus, which are believed to function as an immune system and protect against the effects of uropathogens.

Introduction: Treatment of urolithiasis remains an urgent problem related to medical, social and work rehabilitation.

Aim: To evaluate the efficiency of the biologically active additive "Oxaphorin" in the treatment of urolithiasis after extracorporeal shock-wave lithotripsy (ESWL).

Material and methods: The study included 60 male and female patients from 18 to 75 years old (average age of 45.56+/-12.49 years) with renal stones of up to 10 mm in size, which were disintegrated by the ESWL. All patients were randomized into 3 groups (20 people each). In the first group, patients received standard treatment in the postoperative period (antispasmodics, NSAIDs, uroseptics). In the second group, along with standard therapy, Oxaphorin (1 capsule 2 times a day) was administered, while in the third group Oxaphorin as monotherapy (1 capsule 2 times a day) was given. Treatment and follow-up were carried out in accordance with the study protocol for 30 days. The efficiency of treatment was assessed by the stone-free rate and time to complete evacuation of fragments. Study design included history taking, physical examination, assessment of the tolerability of therapy and adverse events, complete blood count, urinalysis, biochemical panel, ultrasound of the genitourinary system and kidney X-ray.

Results: As the study showed, the rate of stone expulsion was higher in groups of patients receiving Oxaforin. Stone-free rate after 10 days was confirmed using imaging studies and laboratory analyses in 8 (40%) patients of the first group, in 11 (55%) in the second group and in 6 (30%) in the third group. After 1 month of follow-up, stone-free status was confirmed in 16 (80%), 18 (90%) and 15 (75%) patients, respectively. In those taking Oxaforin as part of combined therapy, stone-free rate after ESWL was higher (90% vs. 75% in third group, where Oxaforin was used as monotherapy). The frequency of renal colic and its severity based on a visual analogue scale was significantly lower and less pronounced in patients receiving Oxaforin.

Conclusions: Our results showed that the biologically active additive "Oxaphorin" has a pronounced effect as medical expulsive therapy without any adverse events and is effective in patients with urinary stone disease after ESWL for kidney stones.

Transurethral resection of the bladder tumor (TURBT) is not only the main method for staging of bladder cancer, but also the standard of surgical treatment for patients with non-muscle-invasive tumosr. Previously, the generally accepted technique for performing TURBT was electroresection using loop, but the active introduction of laser technologies has made the resection of the entire tumor in a single block (en bloc) widely available. According to some authors, en bloc resection of the bladder tumor allows to overcome some limitations of standard TURBT, including insufficient quality of the specimen containing the muscle layer and implantation of floating tumor cells in the bladder. However, the en bloc resection also has limitations. When using the en bloc resection for tumors larger than 3 cm, successful evacuation of the entire lesion becomes unlikely, therefore, it is usually recommended to use it for smaller tumors. Publications devoted to the successful en bloc resection for large bladder tumors are included in the literature review. According to most authors, all the advantages of en bloc resection are preserved regardless of the tumor size, such as potentially better local control, lower recurrence rates outside the resection area, and higher quality of specimens for pathological study. A significant limitation of the technique is the inability to evacuate the tumor through the endoscope channel, which requires additional interventions (morcellation, dissection, ablation) or equipment (endoscopic baskets, forceps, etc.). Taking into account the conclusions of the Delphi consensus held in 2020, tumor size should not limit the use of the en bloc resection of the bladder tumor in the routine practice. However, an effective method for evacuating large bladder tumors that suits all specialists has not yet been proposed.

Retroperitoneal fibrosis (RPF) is a rare cause of postrenal acute kidney injury (AKI). We present a clinical case of a 65-year-old patient who developed acute right-sided hydronephrosis with postrenal AKI. Contrast-enhanced computed tomography showed dilation of the ureter, pelvis and calyxes on the right, diminished size of the left kidney and signs of RPF, including fat tissue thickening, compaction and stranding along the aorta and its visceral branches, mesenteric sinuses, thickening of the peritoneum at the level of the paracolic gutters, pelvic tissue compaction, descending and infrarenal abdominal aortic aneurisms, subocclusion of the left renal artery, and atherosclerosis of the visceral arteries. The patient received hemodialysis. IgG4-related RPF was diagnosed. A 6Ch/24 cm stent was placed in the right ureter, after that AKI resolved. Patients with RPF require multidisciplinary approach for timely diagnosis and successful treatment.