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АЛТАЙСКИЙ ГОСУДАРСТВЕННЫЙ МЕДИЦИНСКИЙ УНИВЕРСИТЕТ
Бюллетень медицинской науки

ТЕСТОСТЕРОН И СИМПТОМЫ НИЖНИХ МОЧЕВЫВОДЯЩИХ ПУТЕЙ У МУЖЧИН (ЛИТЕРАТУРНЫЙ ОБЗОР)

ТЕСТОСТЕРОН И СИМПТОМЫ НИЖНИХ МОЧЕВЫВОДЯЩИХ ПУТЕЙ У МУЖЧИН (ЛИТЕРАТУРНЫЙ ОБЗОР)

УДК 612.616.31:611.6
DOI: 10.31684/25418475-2026-3-149

Чирков Сергей Викторович
Белгородский государственный национальный исследовательский университет,
г. Белгород

Шкодкин Сергей Валентинович
Белгородский государственный национальный исследовательский университет,
г. Белгород
Белгородская областная клиническая больница Святителя Иоасафа, г. Белгород

Нечипоренко Владислав Юрьевич
Белгородский государственный национальный исследовательский университет,
г. Белгород

Шкодкин Кирилл Сергеевич
Белгородский государственный национальный исследовательский университет,
г. Белгород

Пономарев Евгений Геннадьевич
Белгородский государственный национальный исследовательский университет,
г. Белгород

Иванисов Владислав Иванович
Белгородский государственный национальный исследовательский университет,
г. Белгород

Левкина Элина Юрьевна
Российский национальный исследовательский медицинский университет
имени Н.И. Пирогова, г. Москва
*** Авторские права принадлежат Сергею В. Чиркову и соавт. Данная статья находится в открытом доступе и распространяется в соответствии с условиями лицензии Creative Commons Attribution (CC BY 4.0), которая разрешает неограниченное использование, распространение и воспроизведение в любом формате при условии указания автора и источника. https://newbmn.asmu.ru
Ключевые слова: тестостерон, заместительная гормональная терапия, симптомы нижних мочевыводящих путей, доброкачественная гиперплазия предстательной железы, ноктурия, андрогены
Аннотация:

Симптомы нижних мочевыводящих путей (СНМП) – частое проявление возрастных изменений у мужчин, традиционно связываемое с доброкачественной гиперплазией предстательной железы (ДГПЖ). Однако мультифакторная природа СНМП, включающая нейрогенные и метаболические нарушения, заставляет пересмотреть роль андрогенов в их патогенезе.

Цель. Анализ взаимосвязи уровня тестостерона с СНМП и оценка эффективности/безопасности заместительной гормональной терапии (ЗГТ).

Материал и методы. Проведен систематический анализ 125 публикаций (2000–2025 гг.) с общим охватом 149 862 пациента. Отбор проводился по критериям доказательной медицины (Cochrane/Newcastle-Ottawa) с акцентом на влияние эндогенного тестостерона и ЗГТ на показатели IPSS, объем простаты и уродинамику.

Результаты. Современные данные опровергают постулат о прямой зависимости роста предстательной железы от системного уровня тестостерона. Концентрация андрогенов в ткани простаты регулируется локальными факторами и достигает насыщения при уровне тестостерона в сыворотке крови около 150 нг/дл. Установлено, что тестостерон модулирует функцию нижних мочевыводящих путей через рецепторы в уротелии, регуляцию оксида азота и кровоснабжение тазовой области, что благоприятно сказывается на симптомах накопления и опорожнения. Обзоры рандомизированных исследований не выявили статистически значимого ухудшения СНМП или неконтролируемого роста простаты при проведении ЗГТ у гипогонадных мужчин. Напротив, терапия способствует улучшению емкости мочевого пузыря, снижению выраженности ноктурии и нормализации метаболических показателей (ожирение, инсулинорезистентность), ассоциированных с СНМП.

Заключение. Тестостерон играет протективную роль в поддержании функции мочевых путей. Заместительная терапия у мужчин с возрастным андрогенодефицитом является клинически оправданной и безопасной стратегией, не повышающей риск прогрессирования ДГПЖ. Необходимы дальнейшие исследования для оптимизации протоколов терапии у пациентов с тяжелой коморбидностью.


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Информация об авторах

Чирков Сергей Викторович
аспирант кафедры госпитальной хирургии Медицинского института, Белгородский государственный национальный исследовательский университет, г. Белгород.
E-mail: stiletsv@list.ru.
https://orcid.org/0000-0002-5828-1664.

Шкодкин Сергей Валентинович
д. м. н., доцент, профессор кафедры госпитальной хирургии Медицинского института, Белгородский государственный национальный исследовательский университет; врач-уролог урологического отделения, Белгородская областная клиническая больница Святителя Иоасафа, г. Белгород.
E-mail: shkodkin-s@mail.ru.
https://orcid.org/0000-0003-2495-5760.

Нечипоренко Владислав Юрьевич
аспирант кафедры госпитальной хирургии Медицинского института, Белгородский государственный национальный исследовательский университет, г. Белгород.
E-mail: nechiporenko@bsu.edu.ru.
https://orcid.org/0000-0002-5726-5945.

Шкодкин Кирилл Сергеевич
аспирант кафедры госпитальной хирургии Медицинского института, Белгородский государственный национальный исследовательский университет, г. Белгород.
E-mail: kirill_shkodkin@mail.ru.
https://orcid.org/0000-0003-4270-165X.

Пономарев Евгений Геннадьевич
аспирант кафедры госпитальной хирургии Медицинского института, Белгородский государственный национальный исследовательский университет, г. Белгород.
E-mail: dr.ponomarev95@mail.ru.
https://orcid.org/0000-0003-0811-681X.

Иванисов Владислав Иванович
студент 6 курса лечебного факультета Медицинского института, Белгородский государственный национальный исследовательский университет, г. Белгород.
E-mail: dr.ponomarev95@mail.ru.
https://orcid.org/0009-0001-7155-3695.

Левкина Элина Юрьевна
студентка 6 курса лечебного факультета, Российский национальный исследовательский медицинский университет имени Н.И. Пирогова, г. Москва.
E-mail: elina.levkina333@gmail.com.
https://orcid.org/0009-0001-5135-9553.

Поступила в редакцию:
06.05.2026

Принята к публикации:
29.06.2026

Опубликована:
30.09.2026

№ 3(2026) Бюллетень медицинской науки