Introduction. Male stress urinary incontinence (SUI), which affects 10 % of the population, is most commonly caused by the effects of operations on the prostate gland. Despite the presence of a large number of surgical and conservative methods to treat this disease, the problem of choosing treatment tactics is still relevant. There are limited literature data on the effectiveness of using the stromal-vascular fraction (SVF) of autologous fat in the treatment of stress urinary incontinence. The aim of this study is to analyse the usage of SVF in the treatment of SUI patients.
Materials and methods. A randomised study was carried out on a group of 8 patients with stress urinary incontinence of mild and moderate severity more than one year after radical prostatectomy or transurethral resection of the prostate. The patients received stromal-vascular fractions of autologous fat into the bladder sphincter area during the period November 2017 — June 2018.
Results. After 4 weeks, the Pad Test and ICIQ-SF QoL assessments showed the first positive clinical results and improving quality of life. Checkpoints of 3, 6 and 12 months were selected for measuring results. Cytological analysis of the stromalvascular fraction of autologous fat revealed the expression of mesenchymal stem cell markers CD44, CD73, CD90, which may explain the method’s high efficiency.
Conclusion. This work supports the hypothesis that transplantation of SVF from autologous adipose tissue is an effective and safe method for treating patients with incontinence.

Introduction. Bladder cancer is one of the most common malignancies in humans, causing significant economic and social damage. In the connection, it is proposed to use a highly sensitive bladder cancer detection method, which also detects residual tumours. Additionally, the method can be used to determine the boundaries of the bladder tumour, namely through intraoperative fluorescence molecular imaging. The target agent was synthesised earlier with indocyanine green-arginine-glycine-aspartic acid, which is an integrin avß3-targeted in in vitro and in vivo bladder cancer models.
Materials and methods. The toxicity of indocyanine green-arginine-glycine-aspartic acid (Agac-IG) was measured using the MTT-test. Urothelial carcinoma cell lines were introduced in Female BALB/nu and MB49 mice by means of tumour xenografts via injection in the back of the elbow area. Tumour growth was observed on a daily basis and tested by magnetic resonance imaging until it became suitable for in vivo experiments. Then, all the laboratory animals were divided into 2 groups: ig and AGAk-ig (150 μl, 0.2 mg/ml for all mice). Following this, the tumour was surgically removed. The removed tissue was subjected to a fluorescent microscopy on the basis of infrared-spectrum and histologic studies.
Results. Operations carried out on subcutaneous and orthotopic mouse models under the control of fluorescent imaging using AGAk-IG demonstrate the effectiveness of using a targeted tumour sample to achieve consistent and accurate RMP-resection. Operations under the control of BIC-spectrometry have demonstrated that the proposed substance can effectively help surgeons to locate tumours, determine their edges and constantly check the presence of tumour residues during surgery.
Conclusion. The findings demonstrated the high efficiency of AGAk-IG as a potential molecular fluorescent agent for tumour-specific intraoperative imaging in bladder cancer resection, as well as offering great potential for further clinical studies.

Introduction. A decrease in the number of patients with tuberculosis of the bone system coincides with an increase in the number of indications and methods for operational treatment. The continuing development in skeletal tuberculosis surgery techniques determines the search for a material capable of replacing autologous bone. Therefore, the main purpose of this paper is to enhance the results of treatment of spinal caries to speed up treatment of tuberculous osteomyelitis by applying collagen material and to solve the issues of orthopedic alignment for TB patients.

Materials and methods. Surgical treatment was carried out on 32 patients in 2016–2018. The patients were divided into several groups: 18 underwent transpedicular fixation of the spine, 2 had concomitant HIV-infection, 2 underwent necrectomy of vertebral bodies with anterior spondylodesis lift system, 1 underwent necrectomy of vertebral bodies with bone autoplasty and with plate fixation, 2 had cervical spine fixation, while 2 patients with pulmonary tuberculosis in the humerus traumatic fracture received intramedullary surgery.

Results. 31 patients reported a positive dynamic following surgery, while a fatal outcome not connected with the surgery was experienced in one case. Complications included allergic reaction in one case, while three patients developed postoperative wound seroma (both patients having HIV infection). One patient reported pain in the lower extremities following TPF. 3 patients with osteitis underwent necrectomy and filling of cavities with collagen material. Wounds were healed by secondary healing, while no rejection of collagen material took place.

Conclusions. Introduction of collagen material in osteitis treatment can speed up fistula healing. The research work demonstrated the possibility of providing trauma care to patients under the conditions of an antitubercular centre.

Introduction. Despite the large number of scientific studies on metastasis problems, the state of liquid media (lymph and blood) in oncological diseases remained without sufficient attention.

Materials and methods. A study of the lymph fluid properties, including viscosity, of 100 female patients with malignant breast tumours was carried out. The age of the patients ranged from 50 to 80 years. All patients were in menopause. The material for determination of viscosity was taken 5–7 days following mastectomy with extended dissection of axillary lymph nodes. On the first and second days, the contents of the wound were represented by blood clots and serous fluid. Between three- and five-days following surgery, the discharge from the wound consisted of serous discharge, prelims and lymph. On the fifth day and the following days, the wound discharge consisted primarily of lymph fluid caused by the completed haemostasis and continuation of discharge from the small lymphatic vessels.

Results. The metastatic process is more active during the initial stages of cancer, since the metastatic medium is represented by less viscous lymph fluid while the vessels for the most part retain their permeability. With advanced stages of cancer, when the viscosity of the lymph rises, metastasis slows down.

Conclusions: (1) In breast cancer, the viscosity depends on the stage of the cancer, while the lymph in the tumour pool behaves like a non-Newtonian fluid. (2) In stages I-II of cancer, metastasis occurs more actively than in cancer at more advanced stages. This phenomenon is determined by the rheological properties of the lymph and the functional viability of the regional vascular system.

Introduction. Pulmonary Arterial Thromboembolism (PATE), which is characterised by low prognosis probability and potentially high danger, ranks third in the mortality structure of cardiovascular diseases. The primary method for treating PATE is recanalisation of the pulmonary arteries affected by embolism. Although the destruction of thromboemboli with thrombolytic drugs has proven effective, the right ventricular failure progresses faster in a majority of patients with massive pulmonary embolism. The aim of the present study is to evaluate the long-term results of surgical treatment of PATE by balloon angioplasty in combination with thrombolytic therapy in comparison with isolated systemic thrombolysis.
Materials and methods. The treatment of 80 patients with pulmonary embolism was analysed. Depending on the selected treatment approaches, the patients were divided into 2 groups as follows: group 1 — 39 patients, conducted by the BAP LA, in combination with thrombolysis; group 2 — 41 patients who underwent conservative treatment (thrombolysis and subsequent anticoagulation therapy).
Results. Despite the small sample and short period of observation, we may note the significantly better results of treatment in group 1 of the study. Positive dynamics of ECG indicators — in particular, pulmonary hypertension, RV KDR, functional class of heart failure NYHA as well as the reduction of right ventricular overload according to the ECG — indicates that the BAP LA method for the surgical treatment of pulmonary embolism, in combination with thrombolytic therapy, is effective and safe.
Conclusions. Balloon angioplasty of pulmonary arteries in combination with thrombolytic therapy can significantly reduce the degree of pulmonary hypertension (рχ2 = 0.034), as well as helping to normalise the size of the right ventricle (рχ2 < 0.001) and improvement in functional class of heart failure NYHA (рχ2 = 0.026) in patients with pulmonary embolism compared with patients with isolated thrombolytic therapy.

Introduction. The available literature on the surgery of echinococcosis is mainly presented by retrospective studies, and the results of these studies are often contradictory, especially when it comes to options for the elimination of the residual cavity after removal of the parasitic liver cyst. In this regard, the main purpose of this work is to evaluate the effectiveness of various ways to eliminate the residual liver cavity after echinococcectomy.
Materials and methods. The Republican clinical hospital was the host (city of Ufa, Russia) to conduct a prospective analysis of 234 cases of laparotomic surgical removal of echinococcal cysts in the period from 2000 to 2017. The patients were divided into three groups depending on the surgical tactics to solve the problem of residual liver cavity: the first group (n = 84) patients underwent capitonnage and intussusception of the fibrous capsule of the residual cavity; in the second (n = 79) group the greater omental pedicle flap was tamponaded; in the third (n = 71) group underwent the maximum possible excision of the fibrous capsule and the remaining empty space in the liver was opened into the abdominal cavity.
Results and discussion: The suppuration of the residual cavity, being the most frequent complication encountered in our study, with almost the same frequency was noted in both groups of patients, where the elimination of the residual cavity was carried out by capitonnage or greater omentum tamponading. According to multifactorial analysis, infectious complications and recurrence of echinococcus were statistically lower in group III than in other groups (p = 0.002 and 0.001; p = 0.004 and p = 0.002).
Conclusion. The findings showed that the safest option for “frugal” echinococcectomy was the maximum possible excision of the fibrous cap with subsequent aplatisation. This approach was characterised by the least number of infectious complications and did not require repeated interventions.

Introduction. The widespread adoption of Artificial Intelligence (AI) technologies forms the core of the so-called Industrial Revolution 4.0.
The aim of this study is to examine qualitative changes occurring over the last two years in the development of AI through an examination of trends in PubMed publications.
Materials. All abstracts with keyword “artificial intelligence” were downloaded from PubMed database https://www.ncbi.nlm.nih.gov/pubmed/ in the form of .txt files. In order to produce a generalisation of topics, we classified present applications of AI in medicine. To this end, 78,420 abstracts, 5558 reviews, 304 randomised controlled trials, 247 multicentre studies and 4137 other publication types were extracted. (Figure 1). Next, the typical applications were classified.
Results. Interest in the topic of AI in publications indexed in the PubMed library is increasing according to general innovation development principles. Along with English publications, the number of non-English publications continued to increase until 2018, represented especially by Chinese, German and French languages. By 2018, the number of non-English publications had started to decrease in favour of English publications. Implementations of AI are already being adopted in contemporary practice. Thus, AI tools have moved out of the theoretical realm to find mainstream application.
Conclusions. Tools for machine learning have become widely available to working scientists over the last two years. Since this includes FDA-approved tools for general clinical practice, the change not only affects to researchers but also clinical practitioners. Medical imaging and analysis applications already approved for the most part demonstrate comparable accuracy with the human specialist. A classification of developed AI applications is presented in the article.

Introduction. The present article, in which a contemporary analysis of the literature on the pathophysiology of ischemic and reperfusion injury (IRI) of the myocardium is presented, focuses on the possible role played by of the calpain system and oxidative stress. Several process development options were proposed, including cytosolic and mitochondrial Ca2+ overload, reactive oxygen stress release, acute inflammatory response and metabolic degradation. The combined effect of all of the above factors produces irreversible ischemic and reperfused damage of cardiomyocytes.
Materials and methods. The role of the calpain system in the creation of myocardial IRI was experimentally investigated. It was found that active calpain substrates play a significant role in the processes of cell cycle, apoptosis and differentiation, adversely affecting cardiomyocyte functionality. The calpain system is part of an integrated proteolytic system that is critical to the relationship between the structure and function of the cardiac sarcomere. Uncontrolled activation of calpain is indicated in the pathophysiology of many cardiovascular disorders. As shown by research, inhibitor calpain reduces the size of the zone of infarction following ischemia reperfusion and thus lessens the risk of “stunning” the myocardium. As is known, a consequence of IRI is acute myocardial infarction (AMI), which is a central factor in cardiovascular disease (CVD) and is one of the primary causes of mortality. Understanding the exact pathophysiological mechanisms remains an urgent problem for clinical physicians. To date, the mechanisms of IRI are not fully known, which creates certain difficulties in further treatment and prevention tactics. In addition, myocardial IRI is also an important issue for pathoanatomical service, since sudden coronary death can occur despite timely reperfusion therapy following AMI.
Conclusion. The development of strategies for creating conditions that limit the degree of damage to myocardial tissues significantly increases the ability of the heart to withstand ischemic damage.

Introduction. Gastrointestinal bleeding is currently one of the most significant pathologies indicating lethality. Factors in the incidence of gastrointestinal bleeding include the spread of gastrointestinal diseases caused by eating disorders, Helicobacter Pylori infection and routine use of anticoagulants. The various causes leading to the development and level of bleeding in the gastrointestinal tract require a differentiated therapeutic approach. In addition to surgical haemostasis, pharmacological support is also required. In the article, we consider medicamentous therapeutic approaches to bleeding due to phlebeurysm, which is one of the most common causes of gastrointestinal bleeding. This problem is very relevant due to the spread of hepatitis and alimentary toxicity having cirrhosis as the outcome.
Materials and methods. The review considers the priority methods for treatment of patients with gastrointestinal bleeding, depending on the etiopathogenetic factors.
Conclusion. Adequate pharmacotherapy of bleeding from varicose veins of the esophagus is more important than surgical interventions, both for prevention and for haemostasis and subsequent control of the development of re-bleeding. Obviously, the use of vasoactive drugs improves the prognosis and effectiveness of endoscopic ligation of esophageal varicose veins, balloon tamponade, portosystemic shunting, and beta-blockers play a significant role in primary and secondary prevention.

Introduction. Urethral valves (UVs) are congenital malformations of the urethra, leading to infravesical obstruction. The most common UV is the posterior urethral valve (PUV). The anterior urethral valve (AUV) is a somewhat rarer, but still well-known congenital anomaly. UVs can provoke significant obstruction of the proximal urinary system, which can later lead to disability of children and more frequent deaths.
Materials and methods. The article presents a clinical example of a 32-year-old man with a congenital double urethral valve occuring in the anterior and posterior urethra, which led to the development of chronic urinary retention, urinary tract infection and chronic renal failure. The patient underwent a successful urethroplasty operation to remove the valve mechanism.
Results. Six months following surgery, the patient noted the complete disappearance of symptoms, with renal function having returned to normal. No signs of recurrence of the disease or the formation of stricture of the urethra were detected by to the survey.
Conclusion. A congenital variant of the double UV is an unusual extremely rare cause of infravesical obstruction. Early diagnosis and treatment of this anomaly is very important for preventing further irreversible damage to the urinary system. The presented clinical observation demonstrates the need to organise and conduct periodic preventive examinations of children of different age groups.

Introduction. Over the past decade, endovascular interventions have become widely used in patients with obliterating atherosclerosis of lower extremity arteries. This is due to the low-trauma nature of the methodology, various technological achievements in the improvement of instruments and the accumulation of operational experience. However, despite all the successes achieved, no intervention is without its complications. In the case of endovascular interventions, complications are most commonly associated with the site of arterial access. One of the most widely-used arterial approaches is retrograde femoral access. However, if an intervention is planned on the femoropopliteal arterial segment, the antegrade femoral approach is generally the method of choice. Among the advantages of antegrade access can be noted the shorter path to the site, better toolkit support and a shorter operation duration. One of the main complications involved in antegrade access is the development of dissection. Although this complication occurs in less than 1% of cases, it carries a threat of critical ischemia of the lower limbs, which may require emergency open surgery up to and including emergency limb amputation.
Materials and methods. The paper presents a clinical case of successful treatment of iatrogenic spiral dissection, which occurred following antegrade vascular access. During surgical treatment of this complication, stents were implanted throughout the dissection to “press” the exfoliated layer of the intima.
Results. The study presents a case of iatrogenic spiral dissection after antegrade femoral puncture followed by successful endovascular treatment of this complication.
Conclusion. Endovascular balloon angioplasty and stenting can be successfully used when iatrogenic dissection develops following antegrade puncture of the right femoral artery, allowing classic “open” surgical intervention to be avoided.

Introduction. The Buschke — Loewenstein tumour was described for the first time in 1925 as a rare giant condyloma. The main cause of this pathology is the human papillomavirus, which is introduced into the body under certain conditions. This pathogen can be transmitted sexually. The neoplasm is usually localised in the anogenital region. Malignant transformation and its spread to the penis are even more rare.

Aims. The Buschke — Loewenstein tumour is a rare pathology, whose course and treatment features are of considerable interest to urologists.

Materials and methods. This article presents a clinical case of the malignant giant Buschke — Loewenstein tumour with primary localisation on the anterior abdominal wall and spreading to the genitals of a 42-year-old man without accompanying immunodeficiency or urogenital infections. The anamnesis of the gradually progressive disease in the absence of any treatment was more than 10 years. When preoperative cytological examination of the biopsy did not reveal signs of malignant transformation, the patient underwent simultaneous removal of all neoplasm foci and reconstructive plastic surgery using skin grafts.

Results and Discussion. The foci of the tumour were removed entirely without disturbing surgical boundaries. A postoperative histological examination revealed small foci of squamous cell carcinoma in remote tissues. A postoperative observation conducted six months following surgery revealed no signs of recurrence of the disease.

Conclusion. Buschke-Loewenstein tumours are rarely accompanied by malignancy. Nevertheless, oncological vigilance forms a necessary element of postoperative procedures. Following removal of a large neoplasm, the choice of reconstructive plastic surgery is of particular significance for postoperative quality of life. For the prevention of relapse, it is advisable to conduct immunotherapy in the postoperative period.