Background. Patient S., 55 years old, complained of unbearable pain during when discontinuing hormonal ointments (she repeatedly tried to cancel steroid external remedies both with doctors and on her own, the attempts were unsuccessful. The patient could not endure and overcome the withdrawal syndrome on a physical and emotional level), burning sensation in the face, hot flashes, a constant feeling of "a burn" in the face (as if “a hot frying pan was applied to the face”), the release of clear fluid in the neck, behind the ears, sleep disturbance, unbearable itching not only during the day but also at night, excoriation (the patient unconsciously scratched her face at night due to unbearable itching), severe facial swelling, lack of appetite, redness in the area of eyes, cheeks, neck, décolleté, body, crusts in the lower third of the face and neck, large-scale peeling of the skin in the crusts, and difficulties in hygienic treatment of the affected skin. Other people thought, that the patient was abusing alcohol or eating highly salty food at night, although patient S. had nothing to do with either of these things. The patient was experiencing hypersensitivity of the skin in the eyelid area, swelling, redness, itching, pain in the eye area, rash, white discharge from the eyes, a feeling of a foreign body, impaired focus, a white veil in the eye area, and decreased vision. On examination: signs of a large-scale deep inflammatory process of the skin of the face, neck, décolleté, and eyes (signs of blepharoconjunctivitis) of a symmetrical nature, pronounced total generalized erythema of the entire face, neck, décolleté, and pasty soft tissues of the face (feeling that the skin will crack upon palpation), serous exudate in the neck area, behind the ears, crusts on the affected area, traces of excoriations, and pronounced parchment-like skin atrophy, multiple drainage telangiectasia, the skin is hot to the touch, painful on palpation (the patient closed her eyes in pain during the palpation test), the extreme degree of xerosis is determined, hyperkeratosis is pronounced in the neck and décolleté area, lichenification of the skin (visualized on the elbow, knee bends, back of the neck, back of the hands, forearms), a sharply positive leaf symptom (rustling, crunching of the skin is heard when holding a cotton pad on the surface of the skin), a negative white spot symptom, the inflammatory process has completely shifted from the surface of the cheeks to the skin of the eyelids. The therapy was carried out in accordance with Patents for Invention No. 2810400, No. 2810361, and No. 2811254. 1% hyaluronic acid was injected into the active projections, followed by the application of 20% lactic acid, a combination of 20% lactic acid and arginine, and 15% azelaic acid to the activation points. It is important to note that the different acids were applied depending on the location of the 1% hyaluronic acid injection and their sequence. During the 18 months of follow-up, the patient did not complain of itching, skin redness, swelling, or visual impairment. For the first time in 52 years, patient S. stopped using topical corticosteroids and became free from hormonal dependence. The presented clinical case of severe skin damage on the face, neck, and décolleté as a result of prolonged use of hormonal ointments is illustrative, demonstrating the consequences and outcome of patients with atopic dermatitis after prolonged use of hormonal ointments, the severity of the combined pathology (atopic dermatitis in combination with rosacea), and the complexity of treating the patient with a widespread inflammatory process and a critical state of psychoemotional health, which was accompanied by sleep disturbances, anorexia, and cachexia.

Purpose. Тo analyze, determine the cause-and-effect relationship and pattern of events that led to the development of a severe skin inflammatory process, to develop a strategy and tactics for managing patients with rosacea in atopic dermatitis, to determine an effective method for treating a patient with perioral dermatitis and ophthalmorrosation, and to minimize complications after prolonged use of topical corticosteroids.

Materials and methods. To analyze the current situation with the patient and identify the cause-and-effect relationship, we examined a 55-year-old patient named S., who had a critical skin condition as a result of 52 years of topical corticosteroid use. The patient provided information about her medical history, the nature of her condition, the medications she was taking, her systemic therapy, and her home care. A combined injection therapy was performed in accordance with Patents for Inventions No. 2810400, No. 2810361, and No. 2811254. 1% hyaluronic acid was injected into the active projections, followed by the application of 20% lactic acid, a combination of 20% lactic acid and arginine, and 15% azelaic acid to the activation zones.

Results. The result was observed after each procedure, at 2, 4, 6, 10, 14, and 18 months. The inflammatory process was stopped after the 8th procedure (the course interval was 2 weeks, followed by a transition to maintenance therapy with a gradual increase in the interval to 4 months). After 6 months of the follow-up, the patient's eyes, eyelids, and skin were clean, and there were no complaints.

Conclusion. After injection therapy with 1% hyaluronic acid in accordance with Patents for Invention No. 2810400, No. 2810361, and No. 2811254, and the use of 20% lactic acid, a combination of 20% lactic acid and arginine, and 15% azelaic acid in the activation zones, the inflammatory process of the skin and eyes was resolved.

Background. In experimental rodent models and in human epidemiological cohorts, environmental toxins have been shown to lead to either epigenetic adaptation or adverse effects on the host.

Purpose. To evaluate the skin pathology, taking into account the adaptive capabilities of laboratory mice and patients with epidermolysis bullosa to the effects of anthropogenic factors.

Materials and methods. Two series of comparisons of white mice, the outbred SHK lines, were studied. In the second part, a clinical and anamnestic study was conducted for 7 patients with recessive dystrophic epidermolysis bullosa (RDBE).

Results. Severe destructive processes and widespread skin diseases were recorded in a group of mice that had been exposed to anthropogenic chemical agents from puberty. Animals that had been exposed to a toxic stimulus throughout their life cycle were able to adapt and normalize or significantly neutralize negative processes in the skin and its appendages.

Conclusions. The results allow to conclude that patients with RDBE respond to the new environment of ecological comfort by stabilizing the skin process. However, positive dynamics can sometimes last only for a short period of time. During dispensary management, it is necessary to take into account their individual reactions to sanatorium-resort factors.

Background. This literature review analyzes current data on the prevalence, clinical manifestations, diagnosis, and treatment of extragenital forms of sexually transmitted viral infections (STIs).

Main Contents. The focus is on the human papillomavirus (HPV), herpes simplex virus (HSV), and human immunodeficiency virus (HIV). It has been shown that changes in sexual behavior in the population, particularly the growing popularity of orogenital and anogenital contact, have led to a significant increase in the frequency of extragenital localizations of these infections. The most vulnerable areas are the oropharynx, anorectal region, and conjunctiva. The review demonstrates that extragenital forms of HPV infection are associated with the incidence of oropharyngeal cancer, in particular, cancer of the tonsils and tongue root, in the development of which HPV plays a predominant etiologic role. Extragenital herpes, especially orofacial and anal, is characterized by frequent relapses and severe pain, significantly reducing patients’ quality of life.

Conclusions. Particular attention is given to the extragenital transmission of HSV, HIV, and HPV infections, as some of the most common viral STIs. The need for increased attention by physicians of various specialties (dentists, otolaryngologists, proctologists, ophthalmologists, and infectious disease specialists) regarding extragenital manifestations of STIs is emphasized, and the importance of comprehensive patient examination and the development of standardized diagnostic and treatment protocols for these STI sites is noted.

Background. Plastic and aesthetic surgery is gaining increasing relevance every year. Among patients aged 40 and older, the infraorbital area deserves the most attention, as it requires rejuvenation through surgical intervention-either as a standalone procedure or in combination with upper eyelid peri-orbitoplasty. To achieve radical surgical correction and rejuvenation of age-related changes in the infraorbital area, such as excess skin under the lower eyelids, wrinkling, loss of skin elasticity, and protrusion of fat compartments under the lower eyelids, lower eyelid peri-orbitoplasty is employed. This procedure includes the redistribution of fat pads beneath the lower portion of the orbicularis oculi muscle in the inferomedial, inferolateral, and inferior central directions, followed by their fixation with separate interrupted sutures to the periosteum of the zygomatic bone and the maxilla. Postoperative outcomes have been analyzed in the long-term follow-up period, demonstrating positive clinical results.

Purpose. To analyze the effectiveness of aesthetic and cosmetic outcomes, their stability, and the frequency of postoperative complications in both early and late postoperative periods following lower eyelid peri-orbitoplasty with fat compartment redistribution beneath the lower portion of the orbicularis oculi muscle in inferomedial, inferolateral, and inferior central directions, with fixation of fat pads using separate interrupted sutures to the periosteum of the zygomatic bone and the maxilla. An expert assessment of the aesthetic result was also conducted.

Materials and methods. The study included 45 female patients who underwent lower eyelid peri-orbitoplasty under general anesthesia between 2024 and 2025. The procedure involved incision and excision of a fragment of the lower eyelid portion of the orbicularis oculi muscle, disruption of the ORL (orbicularis retaining ligament), and redistribution of fat pads in the inferomedial, inferolateral, and inferocentral directions. The fat compartments were fixed with separate interrupted sutures to the periosteum of the zygomatic bone and the maxilla. All patients were between 40 and 48 years old. The main motivation for seeking aesthetic surgery in all cases was age-related changes in the soft tissues under the lower eyelids (laxity of the skin, presence of herniated fat pads, and loss of skin turgor).

Results. By the 10th postoperative day, 94% of the patients reported satisfactory cosmetic results. At the two-month follow-up, 98% of all patients expressed satisfaction with the aesthetic and cosmetic outcomes of the procedure.

Conclusion. The results of lower eyelid peri-orbitoplasty with fat compartments redistribution were assessed. The majority of patients noted a positive effect and were satisfied with the cosmetic and aesthetic outcomes of the surgery. Lower eyelid peri-orbitoplasty with fat pad redistribution can be recommended as a priority procedure of choice for correcting age-related changes in the soft tissues of the lower peri-orbital area (xcess skin and presence of fat pads under the lower eyelids).

Background. Cicatrical ectropion of the lower eyelid is a common complication in patients with blast and shrapnel injuries of the face. Eyelid deformation leads to functional disorders (exposition keratitis, lacrimation, lagophthalmos) and requires surgical correction. In cases with pronounced scarring, the use of standard skin grafts or cantopexy may be ineffective.

Purpose. To evaluate the effectiveness of using the upper eyelid skin-muscle flap in the surgical treatment of cicatricial ectropion of the lower eyelid using the clinical case of the participant of the Special Military Operation (SVO) with the consequences of a shrapnel wound.

Materials and methods. The article describes a case of a patient with post-traumatic cicatricial ectropion that developed after being wounded in a combat zone. The lower eyelid was reconstructed by transposition of a vascularized skin-muscle flap from the upper eyelid. The surgical technique, features of the preoperative tissue condition, anatomical and functional parameters, and postoperative observations were analyzed.

Results. Ectropion was eliminated, eyelid position stability was achieved with restoration of contact with the eyeball. Superficial healing was completed without signs of necrosis. Symptoms of irritation and lagophthalmos were eliminated.

Conclusion. Transposition of the upper eyelid skin-muscle flap is a reliable and physiologically sound method for correcting ectropion in cases of severe cicatricial changes, especially when it is impossible to use free skin grafts or flaps with axial blood supply.

Background. Acute myocardial infarction (AMI) caused by a penetrating chest wound, is an extremely rare and dangerous condition.

Purpose. To demonstrate the possibility of using high-tech medical care in acute myocardial infarction resulting from a penetrating chest injury.

Materials and methods. Based on the presented clinical case of a 42-year-old patient with a mine-explosive chest wound, a step-by-step examination (laboratory tests, ECG, EchoCG, CT angiography, coronary angiography, myocardial scintigraphy) and comprehensive treatment are described in detail. The tactics included emergency percutaneous coronary intervention with stenting of the damaged artery with drug- coated stents and subsequent implantation of a cardioverter defibrillator to relieve severe rhythm disturbances.

Results. The use of a multidisciplinary approach and modern endovascular technologies has made it possible to restore the patency of the coronary artery, eliminate the threat of the pseudoaneurysm rupture, stop conduction disturbances and prevent fatal complications.

Conclusion. This clinical case confirms that timely diagnosis (including mandatory troponin and ECG testing) and comprehensive treatment using high-tech interventions are key to successful treatment of traumatic AMI. This experience motivates the need for further development of standardized clinical algorithms for managing such patients and poses new challenges for assessing long-term outcomes and improving diagnostic and treatment methods.

Background. Gunshot spine injuries represent one of the most severe forms of combat-related trauma, associated with an unfavorable prognosis and a high risk of mortality. The clinical severity is determined not only by the primary spinal injury but also by concomitant trauma, extensive wound contamination, and the subsequent development of infectious and inflammatory complications. A retrospective analysis of clinical cases was performed to assess injury patterns, the impact of associated abdominal organ damage, the nature of antibiotic therapy and surgical management, as well as the dynamics and structure of early and late infectious complications.

Purpose. To evaluate the incidence and structure of infectious and inflammatory complications in patients with shrapnel penetrating injuries of the spine and spinal cord in isolated and combined abdominal injuries.

Materials and methods. A retrospective study was conducted on 138 patients with shrapnel penetrating injuries of the thoracic and lumbosacral spine. The patients were divided into two groups: isolated spinal injuries (n=107) and combined injuries involving the abdominal organs (n=31). All the patients underwent surgical intervention, antibiotic therapy, and computed tomography. The incidence, structure, timing of onset, and clinical outcomes of infectious complications were assessed.

Results. The overall incidence of infectious complications was 10.1%. In the group with combined injuries, complications developed in 29.0% of the patients, which was significantly higher than in the isolated injury group (4.7%, p<0.01). The most common complications were paravertebral abscesses (5.1%), osteomyelitis (2.2%), and meningitis (1.4%). All cases of meningitis and sepsis were observed in the patients with combined abdominal injuries, predominantly involving the colon.

Conclusion. Combined injuries of the spine and abdominal organs are associated with a significantly higher incidence of infectious and inflammatory complications, more severe clinical course, and prolonged hospitalization. Patients with gastrointestinal injuries, particularly those involving the colon, should be considered a high-risk group requiring intensive infection control measures and a multidisciplinary treatment approach.

Background. Tubular breasts is primarily a congenital anomaly (deformation) of one or both breasts, caused by pronounced fibrotic changes in the parenchyma and thickening of the superficial fascia. Tubular breasts is a completely healthy and functional organ, but with an external deformity. According to modern research, the prevalence of tubular breast deformity among women ranges from approximately 8% to 71%. It is crucial to identify tubular breast deformity at the diagnostic stage, before surgery, in order to determine and select the optimal surgical approach. This enables a significant improvement in aesthetic outcomes, allows for the prediction of potential complications, and helps prevent their occurrence. Tubular breast deformity has a psychological impact on patients, contributing to complexes and a decrease in quality of life. The external features of tubular breasts (deformation, asymmetry, small volume, and unaesthetic shape) motivate patients to seek augmentation, achieve symmetry, and improve breast aesthetics. For most patients, especially young women, tubular deformity and asymmetry represent aesthetic concerns that negatively affect their psychological well-being. Over the past five years, there has been an active search for optimal adaptive methods and a logical sequence of surgical approaches to address tubular breast deformity and asymmetry. At present, various surgical techniques are used depending on the type of tubular deformity. Unfortunately, there is no unified opinion among surgeons regarding the choice and sequence of combined surgical methods for solving this problem in a single operative stage.

Purpose. To analyze modern approaches used by surgeons in the surgical correction of tubular breast deformity, evaluate the effectiveness and stability of aesthetic results, assess the incidence of early and late postoperative complications, and provide an expert assessment of aesthetic outcomes of all types of tubular breast deformity correction using combined methods, including breast implants, in a single surgical procedure.

Materials and methods. The clinical study included 27 female patients who underwent corrective surgery for bilateral tubular breast deformity between 2024 and 2025. The operations were performed using the method of symmetrical mastopexy with implants of different volumes. Postoperative morphometric analysis was carried out for all patients to evaluate the effectiveness of surgical results. The study included female patients aged 18 to 23. The main motivational reason for seeking aesthetic surgery among all participants was psychological and physical discomfort associated with tubular deformity, asymmetry, and unsatisfactory breast shape.

Results. By the third postoperative day, 95.7% of patients reported satisfaction with the aesthetic and cosmetic outcome. At the three-month follow-up, 98.3% of patients noted complete satisfaction with both the functional and aesthetic results of the corrective surgery aimed at eliminating tubular deformity and breast asymmetry.

Conclusion. An evaluation of the aesthetic effectiveness of corrective surgery aimed at eliminating tubular breast deformity and asymmetry in young patients was performed. More than 97% of the operated patients reported a significantly positive functional and aesthetic outcome following surgical correction of tubular breast deformity.

Background. The microbiology of modern military wounds is unique for each military conflict and for each stage of medical care.

Purpose. To study the microbial landscape in patients with peritonitis caused by gunshot wounds to the abdomen.

Materials and methods. At the stage of specialized care (level 4), a study was conducted on 34 male patients who gave their consent to participate in the study. The study included patients with confirmed gunshot wounds to the abdomen, operated on at the stage of qualified medical care, with laparostoma. During sanitation relaparotomies, bacteriological studies of abdominal exudate were performed.

Results. The majority of the victims (58.8%) were transported to the qualified assistance and operated on within a few hours after the injury. At the stage of specialized care, 61.8% of patients were admitted within 24 hours. Due to the rapid evacuation, sanitation relaparotomies were performed within 24-48 hours of the first surgery in 76.5% of patients. With gunshot wounds, isolated wounds occur in 17.6% of the cases. Most often, abdominal injuries are combined with injuries to the limbs (50.0%), chest (26.6%), pelvis (17.6%). Damage to only one abdominal organ is 55.9%, two organs — 35.3%, three or more — 8.8%.

Conclusion. Bacteriological cultures in 20.0% of the cases of bacterial flora growth were not detected. Among the detected strains, gramnegative bacteria accounted for 23.0%, gram-positive bacteria — 53.5%, fungi — 8.6%. Monoculture was mainly distinguished (91.7%) and only 8.3% identified microbial associations. Escherichia coli is most commonly detected in patients with gunshot wounds to the abdomen (19.44%). Only 11.76% of the identified strains showed complete antibiotic resistance.

Background. Predicting the outcomes of tibial artery revascularization o in severe atherosclerotic lesions is an urgent challange of angiosurgery.

Purpose. To determine the possibility of predicting the results of arterial recon-struction in severe atherosclerotic lesions of the tibial arteries with trophic defects using luminescent spectroscopy.

Materials and methods. A 14-day prospective study was conducted on 30 pa-tients who were treated in the Department of Vascular Surgery of the Republican Clinical Medical and Surgical Center in Nalchik. In the preoperative period, the in-tensity of luminescence of inflamed tissues was measured in all patients at the level of existing trophic ulcers using laser-induced ultraviolet violet photoluminescence spectroscopy. According to the luminescent signal level, the patients were divided into 2 groups: gGroup 1 — with a signal level in the projection of a ulcerative defect 0.3-0.5 x 105 photons; Group 2 — with a signal level of 0.5-0.7 x105 photons. In addition, subgroup A underwent conservative therapy with alprostadil 40 mcg twice a day intravenously during the entire follow–up period, while subgroup B underwent hybrid surgery with angioplasty of the key artery of the tibia. The size of trophic defects on the lower leg was measured using the “AnalyRan” software.

Results. The healing rate of trophic ulcers healing differed significantly in Group 1 starting from Day 11, with a higher rate in surgically treated patients (p<0.05). In Group 2, the situation was opposite, the statistically significant healing rate of trophic defects in the subgroup with conservative alprostadil therapy exceeded that in subgroup B, from the 9th day of the study (p<0.05). As the wound healing rate increased, the rate of granulation tissue formation also increased, which was in-versely related to the amplitude of the measured tissue luminescence.

Conclusion. In patients with stenoclusive lesion of the lower leg arteries and trophic defects, with an autoluminescence amplitude of 0.3-0.5x105 photons, indi-rect revascularization and conservative treatment is preferable, and with an ampli-tude of 0.5-0.7x105 photons, direct revascularization of the angiosomal artery is preferable.

Background. Endourological interventions are one of the main methods of treating prostatic hyperplasia, allowing to quickly eliminate obstructive symptoms. However, in some patients, surgery not only fails to improve their condition, but there may also be an increase in the symptoms of the disease or even the appearance of new clinical manifestations, which requires an analysis of the features of the postoperative period in this category of patients.

Materials and methods. The analysis of the course of the postoperative period for 90 days was carried out in 130 patients who underwent various endourological interventions. Anthropometric data, concomitant pathology of patients, prostate volume and amount of residual urine, uroflowmetric parameters, severity of symptoms assessed using the IPSS, QoL, and OAB questionnaires, as well as the type of patient's attitude to the disease (using the TOBOL technique) were analyzed. The initial data were evaluated and the results of the examination immediately after discharge, 2 weeks, 1, 2 and 3 months after surgery.

Results. Within 90 days, there was a steady tendency to improve the symptoms of the disease, reflected in reduced mean scores on the IPSS, QoL, and OAB scales, increased average and maximum flow rate of urine, and normalization of the amount of residual urine. Nevertheless, 26.2% of patients were not satisfied with the results of treatment. Predictors of such outcomes could not be identified. Discussion. By the end of 3 months of the postoperative period, patients who underwent endourological interventions for prostatic hyperplasia retained moderate symptoms, which may be due to ongoing reparative processes in surgery.

Conclusion. Endourological interventions can quickly and effectively eliminate the symptoms of the lower urinary tract in patients with prostatic hyperplasia, however, 3 months after surgery, patients may experience moderate symptoms, and a quarter of them are not satisfied with the results of treatment. Further studies are needed to evaluate the results of treatment in the long-term postoperative period.

Background. Due to the global spread of antibiotic resistance, the problem of selecting an appropriate antibacterial agent for empirical therapy of healthcare-associated infections in hospital conditions has become particularly urgent.. Effective prevention and treatment of postoperative infectious and inflammatory complications rely on continuous local microbiological monitoring within each medical institution.

Purpose To examine the microbiological profile of the urological department of a multidisciplinary hospital and to analyze the resistance patterns of the identified isolates to antibacterial drugs.

Materials and methods. The analysis was conducted of urine cultures results from patients who received both conservative and surgical treatment for various urological condition. A total of 1230 urine samples from 856 patients were studied. The spectrum of pathogens responsible for nosocomial urological infection was determined, and their susceptibility to antimicrobial drugs was assessed. The presence of genes of the most common carbapenemases and beta-lactamases was identified using the real-time polymerase chain reaction method.

Results. A total of 652 microbial strains were isolated from 502 positive samples. Monoculture was detected in 384 cases (76.5%) in the urine culture results. The analytical stage revealed the prevalence of gram-negative flora (69%) in the urology unit. The majority (54.1%) of the detected microorganisms belonged to the order Enterobacterales. The most common microorganism detected in hospital conditions was E. coli, found in 27.4% of the total number of strains. The second most common pathogen was gram-positive Enterococcus faecalis (23.9%).96 strains of K. pneumoniae(14.7%) were identified, and the detection of Pseudomonas aeruginosa reached 10.6%. Of the 652 isolated microorganisms, 479 (73.5%) were characterized by polyresistance.

Conclusion. The high level of antibiotic resistance in a urological hospital requires a n individualized approach to the treatment of infectious and inflammatory processes. Incorporating local microbiological monitoring data helps to optimize the initial antibiotic therapy, the success of which determines the timing and results of inpatient treatment.

Background. Chronic postoperative pelvic pain (CPP) is a pain syndrome that persists for more than three months following surgical interventions and significantly impairs patients' quality of life. The prevalence of CPP ranges from 2% to 30%, and the lack of standardized treatment protocols underscores the relevance of implementing a multimodal and individualized approach to managing this condition.

Purpose. To evaluate the effectiveness of comprehensive therapy for chronic postoperative pelvic pain, taking into account the type of prior surgical intervention and the predominant pathophysiological mechanism of the pain syndrome.

Materials and methods. A retrospective analysis was conducted involving 14 patients with a confirmed diagnosis of chronic postoperative pelvic pain. Diagnostic evaluation included assessment of pain intensity using the Visual Analog Scale (VAS), palpation of pelvic muscles, and testing for the presence of a neuropathic pain component. Treatment effectiveness was assessed using the VAS and the Global Response Assessment (GRA) scale. A correlation analysis was performed to identify associations between patients’ medical histories, treatment modalities used, and therapeutic outcomes.

Results. Prior to treatment, the mean VAS score was 4.8±1.31. Clinical improvement was observed in 85.7% of patients, with a mean GRA score of 5.7±1.07. A negative correlation was found between previous mesh hernioplasty and clinical improvement, indicating a higher risk of implant-associated pain syndrome. Similarly, gabapentin monotherapy showed a negative correlation with treatment success, suggesting the involvement of additional pain mechanisms beyond neuropathic origin. Standard analgesics were found to be ineffective. The most favorable therapeutic outcomes were achieved with a combination of peripheral nerve blocks and physiotherapy. Myofascial pain was successfully managed with obturator internus muscle blocks in conjunction with muscle relaxants. In cases of neuropathic pain, combined administration of gabapentin and tricyclic antidepressants demonstrated high efficacy.

Conclusion. The study results confirmed the high efficacy of a combined therapeutic approach in the treatment of chronic postoperative pelvic pain. The greatest clinical improvement was observed with the use of peripheral nerve blocks in combination with physiotherapeutic modalities. The use of synthetic implants was associated with an increased risk of persistent implant-related pain syndrome. The lack of effect from standard analgesics highlights the need for detailed diagnostics to identify neuropathic and myofascial pain components. Therefore, the treatment of CPP requires a personalized and multidisciplinary strategy, with careful consideration of the underlying pathophysiological mechanism and clinic.

Background. Prostate cancer (PCa) is a malignant neoplasm arising from the glandular epithelium of the prostate. It currently ranks among the most frequently diagnosed oncological diseases in men. Robot-assisted radical prostatectomy (RARP) is considered the primary radical treatment for localized forms of PCa. Purpose. To assess the effectiveness of robot-assisted radical prostatectomy using various types of fascial dissection.

Materials and methods. From 2018 to 2024, a total of 200 robot-assisted radical prostatectomies (RARP) with bilateral preservation of the neurovascular bundles were performed at the Urology Department of the N.I. Pirogov National Medical and Surgical Center in patients with localized prostate cancer. All patients were randomized into four groups of 50 individuals: Group 1 — intrafascial RARP; Group 2 — interfascial RARP; Group 3 — extrafascial RARP. All procedures were performed by a single robotic surgeon using a standardized technique.

Conclusion. Intrafascial dissection provides the best chances for rapid recovery of function: continence and erectile function are achieved more frequently and earlier compared with the interfascial technique; when patients are properly selected and surgery is performed by an experienced surgeon, oncological safety is not compromised. The interfascial technique yields intermediate outcomes: functionally inferior to the intrafascial method but potentially more reliable in terms of resection margins in patients with a higher risk of extracapsular extension. Extrafascial dissection maximizes oncological radicality at the expense of functional outcomes, making it appropriate for patients with elevated risk of positive margins or suspected extracapsular tumor growth.

Background. The advancement of molecular genetic technologies opens new opportunities for the diagnosis of male infertility. Particular interest lies in the study of the testicular microbiome, previously considered sterile. Modern research demonstrates that the composition of the testicular microbial community correlates with reproductive status: the predominance of Lactobacillus is associated with normospermatogenesis, while an increase in the proportion of conditionally pathogenic genera (Prevotella, Finegoldia) is linked to impaired spermatogenesis.

Main content. This review is dedicated to analyzing the role of urogenital tract dysbiosis in the pathogenesis of male infertility, particularly azoospermia. Data on taxonomic changes in the microbiome across various pathological forms are presented. It is shown that non-obstructive azoospermia is characterized by an increased abundance of Proteobacteria (up to 45% compared to 18% in controls), Prevotella, and Escherichia/ Shigella, which are associated with pro-inflammatory processes. The mechanisms of the pathogenic impact of symbiosis are discussed, including the induction of oxidative stress, impairment of the blood-testis barrier function, and modulation of hormonal balance. Special attention is paid to functional metagenomic analysis, which revealed alterations in metabolic pathways in azoospermia: upregulation of lipopolysaccharide (LPS) biosynthesis and metabolism of aromatic amino acids alongside a decrease in the synthesis of short-chain fatty acids (SCFAs).

Conclusion. Urogenital tract dysbiosis is a key factor in the pathogenesis of male infertility, sustaining chronic inflammation and oxidative stress. The identification of specific microbial signatures opens prospects for the development of novel diagnostic and therapeutic strategies, including targeted antimicrobial therapy and probiotic application. The integration of microbiome analysis with machine learning represents a promising direction in precision andrology.

Background.Benign prostatic hyperplasia (BPH) is one of the most common pathologies among men, observed in half of males over 50 years of age. Manifestations of BPH can vary from asymptomatic to disorders that significantly reduce the patient's quality of life. Numerous multicenter studies have convincingly proven the progressive nature of the disease with active monitoring of patients.

Purpose. To determine the impact of multiple transurethral resections of the prostate on the performance of robot-assisted prostatectomy.

Material and methods. From 2018 to 2024, a comparative prospective study was conducted at the Urology Department of National Medical and Surgical Center named after N.I. Pirogov, involving 100 patients with localized prostate cancer (PC) who underwent robot-assisted radical prostatectomy (RARP). All patients were divided into 2 equal groups of 50 patients each. Group 1 (n=50) included patients who had a history of 2 or more transurethral resections (TUR) of the prostate gland due to BPH. The diagnosis of prostate cancer in this group was established either by histological examination of the material obtained during TUR or by transrectal biopsy performed because of rising serum prostate-specific antigen (PSA). Group 2 (n=50) consisted of patients without previous surgical interventions on the prostate gland, except for transrectal biopsy. For the accuracy and reliability of the results of the study, all surgical interventions were performed by one robotic team using the same equipment.

Results. During the study, surgical interventions in patients with a history of TUR were accompanied by significant technical difficulties due to the presence of postoperative tissue sclerosis and neoangionesis. The obtained postoperative functional results indicate that previously undergone TUR complicates the implementation of RARP, and also affects the quality of life after the surgical intervention.

Conclusion. Transurethral resection of the prostate gland has an effect on the restoration of urinary function after surgery, slightly reducing the degree of restoration of urinary continence in the postoperative period. However, prior TUR has no effect on the restoration of erectile function.

Background. Radiation-induced heart disease (RIHD) represents a serious late complication of radiation therapy, characterized by a wide spectrum of pathological manifestations and latent course with gradual progression from subclinical stages to manifest clinical symptoms. This review analyzes contemporary diagnostic approaches for RIHD detection at various stages of the pathological process based on domestic and international literature data.

Main content. It has been established that RIHD diagnosis requires a comprehensive multimodal approach, including imaging techniques, biomarker assessment, and functional testing. The most diagnostically valuable methods for early detection of subclinical changes are cardiac magnetic resonance imaging with late gadolinium enhancement and T1-mapping, echocardiography with assessment of left ventricular global longitudinal strain, and determination of specific biomarkers including high-sensitivity troponin T and NT-proBNP. Traditional parameters such as left ventricular ejection fraction have been shown to lack sufficient sensitivity in early stages of RIHD. Promising diagnostic directions include the use of novel radiotracers for positron emission tomography, evaluation of microRNAs as predictors of pathology development, and development of personalized surveillance algorithms.

Conclusions. Early diagnosis of RIHD is of critical importance for timely initiation of preventive measures and improvement of long-term patient prognosis, which emphasizes the necessity of implementing standardized protocols for dynamic monitoring of individuals who have undergone radiation therapy involving the cardiac region.

Background. This article provides an overview of existing studies on the role of instrumental diagnostic studies in the context of determining the rehabilitation potential of patients with diseases and conditions of the central nervous system (CNS). At the moment, there is no single unified method for determining the rehabilitation potential.

Main content. This review provides a detailed assessment of Russian and foreign publications and studies to determine the possibility of using instrumental and neuroimaging studies in addition to existing clinical tools for determining the rehabilitation potential. The emphasis is on the analysis of data from the most common studies performed in acute CNS diseases, such as stroke and traumatic brain injury, requiring long-term rehabilitation.

Conclusion. By taking into account all the factors that influence the overall rehabilitation potential of the patient during rehabilitation treatment, healthcare professionals can develop more personalized and targeted treatment plans, which will improve the quality of life of patients and their rapid return to normal activities.

Background. The trend of modern medicine towards the search for new non-pharmacological technologies and mechanisms that promote the activation of the body's reserve and adaptive capabilities, as well as their implementation in the medical and psychological rehabilitation of individuals whose professional activities involve exposure to extreme and adverse factors, remains a crucial and urgent task. This article provides a review of the scientific literature on the application of neurobiological control methods in the comprehensive medical and psychological rehabilitation of individuals in hazardous professions.

Purpose. Based on the study of scientific literature, to analyze the results of the use of neurofeedback methods in the medical and psychological rehabilitation of people of dangerous jobs.

Materials and methods. A method for collecting and analyzing published information on the use of neurofeedback methods in the medical and psychological rehabilitation of persons of dangerous professions was chosen for this article.

Results. A review of the literature on the use of neurofeedback methods in the complex medical and psychological rehabilitation of people of dangerous jobs is presented.

Conclusion. Constantly repeated exposure to psychotraumatic factors in persons of dangerous professions leads to the development of functional and pathological disorders of the central nervous system. The use of neurofeedback methods in medical and psychological rehabilitation contributes to the prevention and early treatment of PTSD symptoms.

Background. Due to the widespread prevalence, high level of disability and mortality, the prevention of cardiovascular diseases (CVD) is of particular relevance. This article discusses the main technologies of primary prevention of CVD.

Purpose. To study the possibility of using the volumetric compression oscillometry (VCO) method in the preventive examination program for young people.

Materials and methods. The study used an analysis of scientific literature from PubMed, Google Scholar, CyberLeninka, the eLIBRARY.RU information and analytical portal in the field of science, a questionnaire for medical faculty students, and the VCO method.

Results. According to the results of the survey, a combination of three and four phases of hypertension prevails among students (aged 18 to 30 years) (65% of the survey participants), which proves the importance of primary prevention of cardiovascular disease at a young age. Our study using the volumetric compression oscillometry method revealed that only a third of the subjects had normal values of the main hemodynamic parameters (heart rate, total peripheral vascular resistance, stroke index). Two thirds of the subjects had deviations in the values of these indicators in the absence of complaints and normal blood pressure. Thus, 68% of young people aged 18 to 30 are at risk of developing hypertension.

Conclusions. The results of the studies of systemic hemodynamics indicators in medical students allow us to conclude that it is advisable to use the VCO method in the primary prevention of cardiovascular diseases among young people and to develop effective preventive measures from the early stages of pathological changes in the cardiovascular system.

Purpose. To evaluate the results of obliteration of paratympanic spaces with bone chips in patients with chronic tympanic otitis media.

Materials and methods. Surgical treatment was performed in 58 patients with chronic tympanic otitis media and cholesteatoma with a sclerotic type of mastoid process structure. Anatomical and functional results were evaluated according to the following criteria: good result — absence of cholesteatoma, complete solvency of the neotympanic membrane, improved hearing, preservation of the volume of bone chips according to MSCT of the temporal bones within 85-100%; satisfactory result — preservation of the volume of bone chips according to MSCT of the temporal bones within 85-100%, absence of cholesteatoma, need for reoperation due to lack of hearing improvement due to the presence of cicatricial changes in the tympanic cavity or neotympanic membrane, dislocation of the prosthesis, presence of retraction pockets; unsatisfactory result — if the above criteria are not met.

Results. Good results were achieved in 65.5% (38 patients) of the cases, satisfactory results were in 19.5% (11 patients), unsatisfactory results were detected in 15% (9 patients).Among patients with satisfactory results, 11 revision interventions were performed due to the development adhesive process in the tympanic cavity in 4 cases, dislocation of the prosthesis in 3 cases, retraction pocket in the neotympanic membrane in 2 cases. The reason for unsatisfactory results was the presence of one or more signs: 3 cases of cholesteatoma recurrence, 2 cases of formation of partial fibrous atresia of the external auditory canal, 3 cases of cicatricial adhesive process in the tympanic cavity. In all 9 cases the amount of bone-plastic material was less than 85% and the formation of retraction pockets was noted. According to audiometry data after 1 year, out of 38 patients with a good result, 20 patients (53%) had an air-bone interval of 0–10 dB, 16 (42%) had it of 10–20 dB, and 2 patients (5%) had it of 20–30 dB. 49 patients with good and satisfactory results according to MSCT of the temporal bones showed complete obliteration of the postoperative cavity.

Conclusion. The technique of using bone chips to obliterate paratympanic spaces in the surgical treatment of chronic otitis media with cholesteatoma has shown high efficiency in the sclerotic type of mastoid process structure, and allows achieving a stable anatomical result in 85% of cases during the primary operation and avoiding the formation of a radical cavity.

The problem of pharmacotherapy safety for pregnant and lactating women is relevant all over the world. Currently, scientific data on the safety, effectiveness and dosing of drugs for this vulnerable population group is insufficient and treating physicians are forced to make their own decisions about the appropriateness of pharmacotherapy. Pregnant and breastfeeding women are rarely included in clinical trials, making it difficult to obtain up-to-date information about the risks of using medications during these periods in the lives of women and their children. Internationally, there are information resources for medical professionals and consumers that help make clinical decisions for prescription and over-the-counter drugs during pregnancy and lactation in order to reduce the potential risks of pharmacotherapy. Modern pharmacoepidemiological and pharmacokinetic studies of the use of drugs during pregnancy and lactation remain in high demand in the medical community.