F. A. Akilov’s research while affiliated with Tashkent Medical Academy and other places

Introduction. Varicocele is one of the main causes of subfertility in men with primary and secondary infertility. Objective. In this study, we compared the initial semen parameters and the effectiveness of varicocelectomy in men with primary and secondary infertility. Materials & methods. 100 men suffering from primary infertility (PI) and secondary infertility (SI) and having varicocelectomy were recruited. Patients were divided into 2 groups. Group 1 included 58 men with PI and the group 2 42 men with SI. Preoperative clinical characteristics and semen parameters before and after varicocelectomy were analyzed and compared between groups. Results. Analysis revealed that the mean age of patients of the group 1 was significantly lower (p < 0,001) and duration of infertility was accurately shorter (p < 0,01) than those of group 2. Main semen parameters increased significantly in group I (e. g., sperm concentration increased by 50 %, from 62,2 ± 8,7 to 93,5 ± 10,0 M/ml and total motile sperm count increased by 113 %, from 76,7 ± 17,1 to 163,4 ± 27,8 M p < 0,05), while in group 2 only % of progressive motile sperm increased significantly (by 107 %, from 13,5 ± 2,6 to 28,0 ± 5,2 % p < 0,05). We identified significant difference in varicocelectomy efficacy between group 1 and group 2 in change of total motile sperm count (by 113 % vs. 74 % respectively, p < 0,01). We also revealed discrepancy between groups in correlation ratio (r) between initial and post-surgical percentage of progressive motile sperm. Conclusions. Patients with SI were older and had longer infertility period. Varicocelectomy resulted in significant semen parameters improvement in patients with PI. In patients with SI only a percent of progressively motile sperm improved significantly. It shows that male age and infertility duration may negatively affect varicocelectomy outcomes in male subfertility treatment.

Varicocele, closely linked to male fertility, requires urgent and focused research due to many unresolved questions. The absence of clear reference values distinguishing “normal” from “abnormal” semen parameters in the 6th World Health Organization (WHO) laboratory manual significantly complicates diagnosis and treatment. Additionally, the clinical relevance of total progressively motile sperm count (TMSC) remains unclear, leaving practitioners without critical guidance. The decision to perform varicocelectomy, particularly in cases of isolated teratozoospermia, is fraught with uncertainty. Furthermore, the best treatment strategy for those experiencing subfertility after varicocele surgery is still undetermined, adding another layer of complexity. These pressing issues, along with contentious debates surrounding isolated teratozoospermia treatment, highlight the need for large-scale multicenter randomized clinical trials. Such studies are essential to fully understand varicocele’s impact on male fertility and to develop evidence-based management protocols.

Introduction & Objectives: It is not clear till now whether additional antioxidant therapy after treatment of varicocele helps subfertile men to restore reproductive function. In this study we aimed to determine the efficacy of vitamin E supplementation in real fertility recovery after varicocele repair in men from infertile couples. Materials & Methods: Prospective uncontrolled study was conducted with 108 men from infertile couples, who had palpable varicocele, pathozoospermia and underwent microsurgical inguinal or subinguinal varicocelectomy. Patients with azoospermia, severe oligozoospermia (concentration less than 1 mln/ml), and other causes of infertility (including a female factor of infertility) were excluded from the study. The participants were evaluated for changes in the spermogram parameters in line with WHO 2010 guidelines and followed for spontaneous pregnancy (SP). According to the postoperative management, patients were divided into 2 groups: control (group C, n=62) and supplementation (group S, n=46) groups (where patients immediately after the surgery received 400 mg of vitamin E once a day for at least 3 months). Information on SP after varicocele repair was obtained from 89 patients. Results: The mean semen parameters improved significantly after varicocele repair (in 3 months): median of total progressively motile sperm count (TPMSC) increased from 19.5 million to 43.5 million (p=0.00000012). 72 patients (67%) experienced improvement in semen parameters. TPMSC remained unchanged in 11 (10%) patients and it decreased in 25 (23%) patients. 26 out of 89 patients (29%) reported SP within a year after surgery. A comparative analysis of the initial clinical (male age, infertility duration, varicocele grade, testicular volume, BMI etc.) and laboratory data (semen parameters) of groups did not reveal any significant differences between groups. 17 patients (out of 55, 30.1%) from group C reported SP, whereas only 9 patients (out of 34, 26.5%) from group S reported SP, difference was not statistically different (p=0.78). Comparison of postoperative semen parameters also did not reveal any statistically significant differences: 1). The median of sperm concentration in group C increased from 55 million to 72 million (p=0.000297), whereas in group S it increased from 70 million to 86 million (p=0.012); 2). The median of TPMSC in group C increased from 23 million to 41.5 million (p=0.000084), whereas in group S it increased from 11 million to 49.5 million (p=0.000285). Conclusions: Our findings indicate that varicocelectomy, in common, leads to semen improvement. Simultaneously, vitamin E supplementation after varicocele repair can not assist real fertility recovery after varicocele repair.

Patients with urological pathology often develop supravesical obstruction (SVO), which affects the renal parenchyma and causes disruption of the normal renal function and various complications, such as chronic renal disease and urosepsis, which can lead to death. Prediction accuracy assessment for this group of patients is challenging, making it difficult to draw firm conclusions Objective: To develop predictive models for choosing rational treatment tactics in SVO. Methods: Data from 655 patients aged 4 to 86 (average age 39.56±17.23 years) admitted to the Republican Specialized Scientific and Practical Medical Center of Urology in 2021-2023 with SVO were analyzed. There were 350 men (53.4%) and 305 women (46.6%) enrolled in the study. Patients were divided into groups according to the primary diagnoses: urolithiasis (UL) – 231 (35.3%), anomalies of the upper urinary tract (UUT) – 332 (50.7%), acquired diseases of the ureter – 92 (14.0%). Results: Critical Z-values (cut-off points) were calculated for each group, determining the complicated course of SVO. In the UL group, the Z-value was 1.910; in the group of patients with anomalies of the UUT, ureteropelvic stricture (UPS) – 1.998, ureteral stricture – 1.239, ureterocele – 1.894; in the group of patients with acquired diseases of the ureter, secondary ureteral strictures – 1.209, ureteral obliteration – 1.713. Conclusion: Discriminant prediction models showed high sensitivity and specificity for choosing the optimal tactical approach in patients with complicated SVO. Keywords: Supravesical obstruction, hydronephrosis, prediction model, management tactics.

Introduction & Objectives: This study aims to assess the results of balloon dilation procedures with special catheter in patients with recurrent BNC after transurethral interventions for benign prostatic hyperplasia (BPH). Materials & Methods: The study involved 100 patients with recurrent BNC after transurethral interventions for BPH (TURP, ThuLEP, TUBiEP). All patients underwent transurethral resection (TUR) of the bladder neck and were divided into two groups: Group A (n=35) included men who additionally underwent repeated TRUS guided balloon dilation procedures (5 min exposure with special catheter with increased balloon capacity – 3 channels Dufour RUSCH Softsimplastic®, Ireland), while the control group B (n=65) included men treated with alpha‑blockers alone. Patients of group A underwent 4 procedures of bladder neck balloon dilation in 1, 2, 3, and 6 months after TUR of the bladder neck. Control examinations (IPSS, IPSS-Qol, uroflowmetry, postvoid residual urine – PVR) were provided in 2, 3, 4 and 12 months after TUR of the bladder neck. Results: The mean IPSS decreased from 20.3±9.4 to 15.2±8.4, and the IPSS‑QoL from 4.2±1.2 to 3.1±1.1 (p<0.05) in 12 months after TUR and 6 months after the 4th balloon dilation procedure in Group A. In Group B, they were 20.7±7.8 and 4.3±1.1 (p>0.05), respectively. In addition, the mean flow rate in Group A was 13.8±6.4 ml/s, whereas in Group B, it was 9.7±4.7 ml/s (p<0.05). There was a significant decrease in the postvoid residual urine volume from 74.3±98.2 ml to 39.6±65.2 ml in Group A, whereas, in Group B, it increased from 68.1±33.5 ml to 78.4±68.7 ml (p>0.05). Furthermore, 32% of Group B patients and 14% of Group A patients underwent repeated TUR of the bladder neck for BNC recurrence (p<0.05, between groups) during 12 month follow-up period. Procedures were accompanied by a less amount of complications. Acute urinary retention developed only in 1 (3%) case, which was resolved with indwelling catheterization for 48 h. In 2 (6%) patients, acute orchiepididymitis was observed and treated successfully with antibacterial drugs. In 10 (29%) men haematuria was determined, which did not require any treatment. In 3 (9%) patients' short-term urethrorrhagia occurred which resolved without additional therapy. Dysuria was observed in 6 (17%) patients, which resolved without treatment. There were no severe surgical complications according to the Clavien–Dindo scoring system that required repeated intervention. Conclusions: TRUS-guided transurethral balloon dilation with special catheter of BNC using local anesthesia is a relatively safe and less invasive method that assists to avoid gross trauma to the urethra and bladder neck with a cystoscope. This method can be used as an alternative less invasive method for treatment and prophylaxis of recurrent BNC.

Introduction & Objectives: Bladder neck contracture (BNC) is one of the most severe and prevalent complication of transurethral interventions on the prostate. This study aims to assess the results of repeated balloon dilation procedures in patients with BNC after endoscopic surgery for benign prostatic hyperplasia (BPH). Materials & Methods: The study involved 120 patients with recurrent BNC after transurethral interventions for BPH. All patients underwent transurethral resection (TUR) of the bladder neck and were divided into two groups: Group A (n=45) included men who, after TUR, additionally underwent repeated transrectal ultrasound (TRUS) guided balloon dilation procedures (5 min exposure with special catheter with increased balloon capacity under local anesthesia), while the control group B (n=75) included men treated with alpha-blockers alone. Patients of group A underwent 4 procedures of bladder neck balloon dilation in 1, 2, 3, and 6 months after TUR of the bladder neck. Check-ups (IPSS, IPSS-Qol, uroflowmetry, postvoid residual urine volume – PVR) were provided in 2, 3, 4 and 9 months after TUR of the bladder neck. Results: In 9 months after TUR and 3 months after the 4th balloon dilation procedure in Group A, the mean IPSS decreased from 20.1±8.4 to 17.2±7.4, and the IPSS‑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. In addition, the mean flow rate in Group A was 13.2±5.4 ml/s, whereas in Group B, it was 8.7±4.9 ml/s (p<0.05). There was a significant decrease in the PVR from 76.2±96.1 ml to 37.6±55.1 ml in Group A (p<0.05), whereas, in Group B, it increased from 63.0±36.9 ml to 79.4±71.6 ml (p>0.05). Furthermore, recurrences of BNC were revealed in 28.0% of patients of Group B and 13.3% of patients of Group A in 9 months follow‑up period (p<0.05). Balloon dilation procedures were accompanied by a less amount of complications. Acute urinary retention developed in 1 (2.2%) case, which was resolved with indwelling catheterization for 48 h. In 2 (4.4%) patients, acute orchiepididymitis was observed and treated successfully with antibacterial drugs. In 14 (31.1%) men haematuria was determined, which did not require any treatment and was not accompanied by a decrease in hemoglobin. In 4 (8.8%) patients' short-term urethrorrhagia occurred which resolved without additional therapy. Dysuria was observed in 8 (17.8%) patients, which resolved without treatment. There were no severe surgical complications according to the Clavien–Dindo scoring system that required repeated intervention. Conclusions: TRUS-guided transurethral balloon dilation of BNC is a relatively safe and less invasive method that assists to avoid gross trauma to the urethra and bladder neck with a cystoscope and reduced the likelihood and severity of complications of this treatment method. This method can be used as an alternative tool for treatment and prophylaxis of BNC after TU surgery for BPH.

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.

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.

Экстракорпоральная ударно-волновая литотрипсия в течение четырёх десятилетий зарекомендовала себя как эффективный, безопасный и малоинвазивный метод лечения мочекаменной болезни.Несмотря на бурное совершенствование эндоурологического оборудования, ЭУВЛ является процедурой выбора при камнях размером менее 15 мм. В поисках более углубленной информации об историивозникновения данного метода, клиническом применении, ограничениях и возможных осложнениях,нами проанализированы такие зарубежные источники, как PubMed, Embase, Medline, e-library. Согласно полученным данным, было установлено, что на успех лечения влияют многочисленные факторы,связанные с пациентом и техникой. Расстояние от кожи до камня, плотность камня и состав, размери расположение камня в мочевыводящей системе – все эти факторы влияют на частоту «stone-free».Более медленная скорость с постепенным увеличением напряжения, точное наведение, правильноесоединение способствуют улучшению фрагментации камня и снижению риска осложнений.