Abstract. Zinc is a critical trace element involved in the maintenance of structural and functional integrity of the prostate gland. It participates in the regulation of DNA synthesis, oxidative homeostasis, and programmed cell death.Disturbances in zinc metabolism are increasingly recognized as contributing factors in the pathogenesis of chronic prostatitis, benign prostatic hyperplasia, and prostate cancer. This review summarizes current data on the molecular mechanisms of zinc’s antiproliferative, anti-inflammatory, and proapoptotic activity, drawing from both experimental models and clinical studies. Special attention is given to pharmacological approaches aimed at restoring zinc homeostasis, including the use of Afalaza—a bioregulatory drug containing technologically processed affinity purified antibodiesto prostate-specific antigen (PSA) and endothelial NO synthase. Preclinical findings suggest that Afalaza contributes to influence of zinc levels and improvement of prostate function. The available evidence highlights the therapeutic potential of zinc in the prevention and treatment of prostate disorders. Keywords: zinc; prostate gland; chronic prostatitis; benign prostatic hyperplasia; prostate cancer; apoptosis; inflammation; antioxidant defense; Afalaza.

Objectivе. To evaluate changes in the lipid spectrum in patients with urinary disorders and dyslipidemia during therapy with alpha1-blockers in combination with vitamin-like drugs in patients with urinary disorders and dyslipidemia in order to normalize the lipid spectrum and correct urinary disorders. Materials and Methods. The study included 130 patients aged from 18 to 81 years, of whom 56 were men and 74 women. The observation group was divided into male and female subgroups, as well as by age criterion - up to 65 years and after 65 years. Long-term (continuously from 11 to 18 months) combination therapy was carried out using α1-blockers (Terazosin, Doxazosin) and vitamin-like drugs (Levocarnitine, Alpha-lipoic acid) in standard dosages. When examining patients, methods were used to assess the clinical symptoms of urinary disorders, instrumental, laboratory and statistical methods (Mann–Whitney test, Spearman’s rank correlation coefficient). Results. In the general observation group, HDL levels changed significantly from 1.3 to 1.38 mmol/l, as well as VLDL from 0.88 to 0.72 mmol/l. However, total cholesterol, LDL and triglycerides appear virtually unchanged. In the male observation subgroup, HDL and VLDL levels also changed significantly from 1.2 to 1.29 mmol/l and from 0.79 to 0.65 mmol/l, respectively. In patients under 65 years of age, there was a significant decrease in VLDL levels from 0.88 to 0.76 mmol/l and Triglycerides from 1.9 to 1.65 mmol/l, however, in the subgroup over 65 years of age there was a constant increase in HDL from 1.29. up to 1.46 mmol/l. Conclusion. Alpha1-blockers in combination with vitamin-like drugs have an effect on the lipid spectrum during long-term therapy of 11 months or more. The most significant results of pharmacotherapy are observed in the male subgroup and in the subgroup over 65 years of age. Keywords: alpha1-blockers, lipid metabolism.

Background: The results of conservative methods of treating Peyronie’s disease (PD) do not exceed the placebo effect, and surgical treatment does not always lead to satisfactory outcomes. Aim: to evaluate the safety and effectiveness of using platelet rich plasma (PRP) and extracorporeal shock wave therapy (ESWT) in patients with PD. Materials and Methods: The study included 40 patients with PD, randomly assigned into two equal groups. Group 1 received ESWT (Dornier Medtech GmbH, Germany, D82234 Wessling, 62 Argelsrieder Feld, 7, Germany (FSZ 2011/09554) on the penis, targeting the fibrotic areas and calcifications twice weekly for 6 weeks. Group 2 underwent 2 visits per week for 6 weeks. Visit 1 involved PRP injections and ESWT on the penis, fibrotic areas, and calcifications. Visit 2 included only ESWT on the same areas. Outcomes were assessed on days 0 and 60 (median (IQR%)) using the Peyronie’s Disease Questionnaire (PDQ), Visual Analog Scale (VAS) during sexual intercourse and erection, penile curvature angle, plaque size, and calcifications based on penile ultrasound. Results: the treatment was well tolerated by all patients. No side effects were recorded. In group 2, one patient experienced disease progression, developing a «hourglass» deformity of the penis. Both groups showed significant reductions in pain and PD symptoms, as measured by VAS during erection (p = 0.001028, p < 0.001) and VAS during sexual intercourse (p = 0.01604, p < 0.001), as well as improvement in PDQ scores (p < 0.001, p < 0.001). The penile curvature angle also significantly decreased in both groups (p = 0.02364, p = 0.007346). While the size and number of calcifications decreased slightly (p > 0.05), the fibrotic plaque area showed significant regression in both groups (p = 0.001929, p = 0.003188). Post-treatment analysis showed a significant difference in plaque size reduction, VAS during erection, and during sexual intercourse in favor of patients who received APGF in combination with ESWT (p < 0.05). Conclusion: PRP and ESWT may represent a promising conservative strategy for treating PD. Combined therapy of APGF and ESWT is more effective in reducing pain and fibrotic plaque size in the penis compared to ESWT alone. Keywords: Peyronie’s disease, platelet rich plasma, extracorporeal shock wave therapy, growth factors, regenerative medicine, erectile dysfunction.

Male infertility is an acute medical and social problem, affecting from 20 to 50% of couples all over the world. According to official statistics, male infertility caused by infectious etiology, specifically bacteria, viruses, fungi and protozoa, accounts for 15% of all cases of male infertility. Today, many authors strongly state that the microbiome is an etiological factor in many diseases, and also contains enormous potential from a diagnostic point of view. The purpose of this review was to summarize data on the microbiome of the urogenital tract correlated with male infertility. Based on the results of the above works, we could conclude that today traditional methods for identifying microorganisms do not meet modern requirements due to their limitations. Microorganisms can have a negative effect on male reproductive cells, and can also be associated with different disorders of male fertility, however, to date, it is impossible to reliably determine the true contribution of the microbiota of the urogenital tract to male infertility. Keywords: maleinfertility, prostatitis, microbiome, NGS, gaschromatography-massspectrometry

Testosterone deficiency in men (male hypogonadism) poses a serious threat to men’s health and life expectancy, therefore, it should be diagnosed and corrected in a timely manner using hormonal treatment methods. However, until now, a certain part of the male population is afraid of hormone therapy or has concomitant diseases that make it unsafe. In this case, hypogonadal men usually turn to alternative (non-hormonal) methods of restoring low testosterone levels based on the use of various non-hormonal drugs or therapeutic procedures. This review analyzes the steroidogenic effectiveness of surgical treatment of varicocele (varicocelectomy) and the use of trace elements, vitamins and insulin sensitizers (metformin) in order to increase testosterone levels in men based on evidence–based studies and meta-analyses over the past 5 years. The review showed significant heterogeneity and inconsistency of the research results: while varicocelectomy shows its effectiveness in terms of improving spermatogenic and steroidogenic testicular functions in infertile hypogonadal men, its effectiveness as a method of increasing testosterone levels in fertile hypogonadal men or in normogonadal infertile men remains unproven. The steroidogenic effectiveness of trace elements, vitamins and metformin is very low and does not lead to reliable significant clinical results in terms of increased testosterone in hypogonadal men. Thus, none of the described non-hormonal approaches to the correction of low testosterone levels in men can be considered as a proven and effective alternative to the classic hormonal methods of male hypogonadism treatment in routine clinical practice.

Introduction: The role of penile rehabilitation after surgical treatment of Peyronie’s disease remains debatable to this day.Objectives: to evaluate the impact of penile rehabilitation on the long-term results of plaque incision and grafting in patients with Peyronie’s Disease.Materials and Methods: a single-center, prospective, observational, uncontrolled study included 44 patients who underwent plaque incision and grafting in the period from 2012 to 2021. During the control examination, the state of erectile function was assessed using the IIEF-5 questionnaire, the presence or absence of postoperative complications (paresthesia of the glans penis, shortening of the penis, recurrence of curvature), and it was also clarified about the methods of penile rehabilitation that the patient used in the postoperative period (inhibitors phosphodiesterase type 5 use, vacuum therapy, traction therapy). Patients before surgery and during control examination underwent penile doppler ultrasound with pharmacological test (Alprostadil 10 mcg). 26 patients came to the follow-up examination. 18 patients were excluded from the study due to refusal to participate further. Patients were divided into two groups depending on the use of penile rehabilitation methods. The first group included 10 (38.5%) patients who did not use any of the recommended methods of penile rehabilitation in the postoperative period. The second group included 16 (61.5%) patients who used at least one of the recommended methods of penile rehabilitation.Results: the groups were comparable in terms of the main characteristics. The median follow-up period was 77 months in the first group and 94.5 months in the second group. The highest compliance was noted with regard to the use of PDE-5 inhibitors (100% of patients in the second group) and vacuum therapy (68.75% of the second group). In the first group, the frequency of venogenic dysfunction according to penile doppler ulrtasound was statistically significantly higher (p = 0.03). In the second group (patients who used penile rehabilitation methods), the IIEF-5 score was statistically significantly higher (p = 0.006), and the incidence of penile shortening and curvature recurrence was statistically significantly lower (p = 0.001 and p = 0.01, respectively).Conclusion: penile rehabilitation significantly improves the long-term functional results of plaque incision and grafting in patients with Peyronie’s disease.

Introduction. When assessing the urogenital tract microbiome in both men and women, modern clinical guidelines suggest using the real-time polymerase chain reaction method, which allows qualitatively and quantitatively identifying the microbiota of sexual partners. The urogenital tract microbiome of a married couple remains poorly understood. The impact of the urogenital tract microbiota of sexual partners and the possibility of transmitting it to each other also remains open. To date, there are no clear recommendations on which of the biotopes in men to choose primarily for verification of microorganisms, while one of the possible biotopes is most often examined. In our previously published works, we noted that the biotopes of the urethra, prostate secretion and ejaculate in men have a low level of concordance among themselves, and the biotopes of the urogenital tracts of sexual partners in most cases do not coincide, which calls into question the daily practice of prescribing treatment to both spouses at the same time, having data from only one of them. The role of male factors in the development of bacterial vaginosis in the spouse remains debatable to this day. Modern advances in molecular diagnostics have made it possible to consider bacterial vaginosis as a probable sexually transmitted infection, including the spouse.Material and methods: а survey of 127 married couples who sought help for pre-conception preparation, infertility or miscarriage was conducted, and then divided into two groups. The first group, «Normocenosis», consisted of 67 married couples in whom the proportion of Lactobacillus spp. was determined to be 80-100% of the cervical canal microflora. The second group, «Dysbiosis», consisted of 60 couples in whom the proportion of Lactobacillus spp. was determined to be lower than 80% of the total cervical canal microflora, which corresponded to the diagnosis of BV. The biotopes of the cervical canal of women, the urethra and ejaculate of men were analyzed by the PCR real-time method using the «Androflor®» and «Femoflor®» reagent kits («DNATechnology TS», Russia).Results. The biotope of the ejaculate had statistically lower values of the total bacterial mass, compared with the urethra and cervical canal. In the biotope of the cervical canal, Gardnerella vaginalis/Prevotella bivia/ Porphyromonas spp. and Ureaplasma spp. were found significantly more often compared with the biotope of both the urethra and the ejaculate of men. In the urethra of men, Staphylococcus spp., Streptococcus spp., Eubacterium spp. and Peptostreptococcus spp. were identified more often than the cervical canal. Eubacterium spp. were determined significantly more often in the ejaculate, compared with the cervical canal. The occurrence of Enterobacteriaceae/Enterococcus spp. in the urethra and in the sperm was reliably higher compared with the cervical canal. The concordance for all bacteria detected in the compared biotopes of the spouses did not exceed 34%. The concordance for Gardnerella vaginalis and Ureaplasma spp. was significantly higher between the biotopes of the cervical canal and urethra, compared with the concordance between the cervical canal and ejaculate. In the «Normocenosis» group, Ureaplasma spp. and Enterobacteriaceae spp. were encountered significantly less frequently in the cervical canal compared with the «Dysbiosis» group. In men, Staphylococcus spp. and Gardnerella vaginalis were detected significantly more often in the ejaculate of the «Dysbiosis» group compared with the «Normocenosis» group. In the ejaculate of men from the «Dysbiosis» group, an increase in the total bacterial mass was encountered significantly more often compared with the «Normocenosis» group.Conclusion. In our opinion, in men with infertility and/or miscarriage, it is necessary to evaluate the biotope of both the urethra and the ejaculate, because the biotopes of the spouse’s cervical canal, urethra and ejaculate have a low percentage of concordance, which must be taken into account when diagnosing and treating urogenital tract infections of sexual partners.

Objective: to present a modification of the Cantwell epispadias reconstruction technique aimed at lengthening and straightening the penile shaft.Patients and methods: a prospective follow-up of all boys with classic exstrophy who underwent the proposed technique was conducted. Inclusion criteria were patients with exstrophy with a postoperative followup period of more than 12 months, who had a urethral plate longer than 15 mm.Results: between November 2021 and June 2023, penile reconstruction was performed on 36 patients with exstrophy. Of this cohort, 14 boys aged 12 to 47 months met the inclusion criteria and underwent a modified reconstruction. The surgery and the postoperative period were not accompanied by serious complications. In the medium term, penile appearance, erectile shape, and urination were assessed both in an outpatient setting and by photo and video recording.Conclusion: the presented technique, applied in a homogeneous group of patients with classic bladder exstrophy, allowed to achieve penile elongation, improved appearance, erectile function, and elimination of dorsal curvature.

In the structure of malignant neoplasm morbidity in men worldwide in 2020, prostate cancer (PCa) ranked second, second only to neoplasms ofthe trachea, bronchi and lung.Currently, oncourologists have a large arsenal of methods forthe treatment of prostate cancer, however,there are often problems in examining the patient and determining the stage ofthe disease. The choice oftreatmenttactics is based on stratification of patients into low-, intermediate-, and high-risk groups based on the results of prostate palpation, prostate-specific antigen level, Gleason sum, scintigraphy results, and prostate MRI. This review presents modern methods of diagnostics of prostate cancer and recommendations on stratification of patients in risk groups of progression..