Robotic-assisted laparoscopic radical prostatectomy (RALP) is a well-accepted surgical treatment modality for localized prostate adenocarcinoma. Over the past decade, it has become the primary surgical treatment for prostate cancer in the United States and abroad. While more expensive than traditional open prostatectomy, it does confer less operative blood loss and shorter hospital stay at many institutions. Comparative prospective randomized data are lacking, but many studies have demonstrated that RALP confers at least equivalent oncological and functional outcomes compared to open. The surgical steps include peritoneal access, release of the bladder from anterior abdominal wall, ligation of the dorsal venous complex, dissection of the bladder neck and seminal vesicles, ligation of the vascular pedicles, transection of the urethra, and creation of a vesicourethral anastomosis. For patients with intermediate or high-risk prostate cancer, a pelvic lymph node dissection is also performed.

We made an assessment of the situation of Hemodialysis (HD) patients in the period of economic crisis compared to international data through the recording of demographic characteristics. Our sample consists of 2,586 subjects undergoing HD (27% of patients in HD), with the most common cause of end-stage renal disease for patients undergoing HD is the "unknown cause" with 33.02%. Similar is the situation in Spain (30.3%), Italy (30.3%), Hungary (41.7%), Poland (25.8%) and Portugal (28.1%). The mean age was determined at 68.7± 14.1 years (63.7% men) and 66.3± 13.2 years (49.4% men) for the Czech Republic up to 68.9± 15 years (58 , 8% men) for France. We noticed that patients with "unknown cause" are following an ESRD patient in HD. In their dossier, drugs such as,epoetin alfa, IV iron therary, levocarnitine, vitamins, clopidogrel and hydrochloride. At the same time, there is no mention of another co-existing disease, such as fabry disease, which could have led the patient either to hemodialysis or to cause a worsening of the dementia of patients on hemodialysis.

Massively parallel sequencing technologies such as exome sequencing are increasingly applied across medicine. Connaughton report a high diagnostic yield of exome sequencing among adults with hereditary nephropathy or nephropathy of unknown cause. Their findings support broader use of genomic sequencing in nephrology and highlight key associated questions, including how to identify those patients for whom testing is indicated, pinpoint pathogenic variants, and balance the resultant health care benefits and clinical follow-up burden.

In children and adolescents underweight is a significant risk factor for infection especially in developing countries, probably reflecting malnutrition and poor hygienic standards. Data from industrialized countries suggest that infection rate is also increased in obese children and adolescents. Similarly, several studies suggest a U-shaped increased infection rate in both underweight and obese adults. In the latter, infections of the skin and respiratory tract as well as surgical-site infections have consistently been reported to be more common than in normal-weight participants. Paradoxically, mortality of critically ill patients was reduced in obesity in some studies.

A retrospective review of patients undergoing flexible URS for renal stones only with subsequent CT scan within 3 months. Meticulous basketing of all stone fragments was performed whenever possible. A "true" zero-fragment stone-free rate was determined by reviewing the CT scan and radiologist's report. Patients with nephrocalcinosis (as determined by visual inspection of papilla at the time of URS) were assigned the "stone-free" category.

This book describes my journey through my working life as a Doctor. It also describes my experiences as 8 patients, and the wonderful life saving care I received from the NHS.

There are also a few lines on my earlier life, as a Medical Student and how that impacted on my  life as a Hospital Consultant Physician and Nephrologist (kidney specialist). The book consists of a series of vignettes describing episodes that have lingered in my memory.
This is well illustrated by the vignette “A Legacy of 5pina bifida”. In this, I describe a courageous lady with spina bifida. Illustrations come mainly from Bing Pictures, although some are of my own creation.
There is a detailed Glossary at the start of the book explaining abbreviations commonly used in Medicine, for example LP is the abbreviation for Lumbar Puncture, used in the vignette describing my own lumbar puncture.
Towards the end of the book I describe my interaction with the Driving and Vehicle Licensing Authority (Aittocracy), and the General Medical Council (Gang of Mealymouthed Charlatans).
Hopefully the book will entertain and educate. The intended reader is an average member of the public and no prior medical knowledge is required. Some over inflated egos may be punctured.

So Reader, enjoy 'Tales of a Meandering Medic”
Any profits will be donated to Oxfam. 1 have been a donor to Oxfam since my undergraduate days at Oxford.

COVID-19 is the most common pandemic in human history. COVID-19 affects ACE receptors, causing autoimmune processes that damage testicular tissue, disrupting the processes of spermatogenesis and testosterone production. Recently, we have seen an increasing number of patients with erectile dysfunction ED appearing 3-6 months after COVID-19.

The aim of our study was to determine effectiveness of hormone stimulating and replacement therapy, possibility of restorative therapy with autologous stem cells (ASC) and Plasma rich Platelets (PRP) - therapy in patients with primary and secondary hypogonadism.

117 patients with ED, which appeared 3-6 months after COVID-19. All patients except ED had clinical signs of decreased testosterone: decreased libido, mental and cognitive functions, decreased performance, fatigue. Testosterone fractions (total and free), LH, Estradiol, FSH before, during and after rehabilitation therapy were studied. Patients were divided into 2 groups: 1^st- 68 patients with primary hypogonadism (Tm = 7.43 + 2.1 below 12 nmol / l), and 2nd - 49 patients with secondary hypogonadism (Tm = 14.1 + 1.8 above 12 nmol / l). l), they were studied the sensitivity of tissue receptors to testosterone.

In the first group, patients were prescribed Tribulus terrestris extract 45% - 750 mg, Fenugreek extract 50% - 25 mg twice a day for 2 months. 37 patients (54.4%), group 1a (mean age 41.6 + 4.3) responded to therapy by normalizing the level of T (more than 12 nmol / l) and improving erectile function, 31 patients (45.6%), group 1b (average age 47.3 + 5.2) without the effect of herbal medicine prescribed testosterone drug Omnadren 250 1 time in 3 weeks. After 2 months of hormone replacement therapy, 28 patients were diagnosed with normal T levels, but only 19 patients (61.2%) in group 1b improved their erectile function.

In the second group, 49 patients were also prescribed Tribulus terrestris extract 45% - 750 mg, Fenugreek extract 50% - 25 mg twice a day for 2 months and PRP therapy (intracavernous injections of 2 ml of autoplasma with a platelet concentration greater than 1 million / ml) 1 time in 10 days 8 times. 23 patients - group 2a responded to therapy with the disappearance of symptoms of hypogonadism and improvement of ED. 26 patients - group 2b - did not have significant improvements, so they received 2 courses of 5 intravenous injections of 5 million autologous stem cells (50 million in total).  17 patients (65.4% of group 2b) improved their mental health, reduction of symptoms of hypogonadism, improvement of erectile function to normal values​​(IIEF -5 increased to 19.4 + 2.2).

Conclusions:

1. Multicenter studies of the effect of COVID-19 on fertile and androgenic function in men and the possibility of their recovery in postpartum pathology are needed.

2. A significant proportion of men with postcovid hypogonadism and ED are men with normal levels of T, but reduced sensitivity of tissue receptors to T (secondary hypogonadism).

3. In the treatment of secondary postcocious hypogonadism, intracavernous PRP therapy and intravenous stem cell therapy have a clinical effect and can be considered as promising treatments for this pathology.