BACKGROUND: Benign prostatic hyperplasia is the most common urological disease in older men, leading to the development of bladder outlet obstruction and a decrease in the quality of life of patients. The choice of the method of surgical treatment of benign prostatic hyperplasia with large prostate volumes is the subject of discussion. There is also no unified approach to the management of patients with acute urinary retention due to benign prostatic hyperplasia. AIM: To evaluate the results of thulium laser enucleation of the prostate in patients with large benign prostatic hyperplasia associated with acute urinary retention. MATERIALS AND METHODS: The present study included the results of treatment of 237 patients with benign prostatic hyperplasia with a prostate volume of more than 80 cm3, of which 97 were hospitalized in the urology department for acute urinary retention. The age of the patients ranged from 51 to 89 years (average 70.2 years). The volume of the prostate gland ranged from 80 to 150 cm3 (mean 128.3 cm3). The control examination was performed on the 2nd day, as well as 3, 6 and 12 months after the surgery. RESULTS: Surgical intervention was performed using a thulium fiber laser device FiberLase U1 (IRE-Polyus, Russia) with a power of 120 W. The time of surgery ranged from 63 to 127 minutes (average 74.3 minutes). The irrigation system was turned off on the 1st day of the postoperative period. The duration of urethral catheterization averaged 2.7 days. None of the patients in the study required blood transfusion or repeated surgery to coagulate the vessels of the prostate bed. After removal of the urethral catheter, all patients urinated on the first attempt. In 7 patients (2.95%), after removal of the urethral catheter, urinary incontinence was observed, during the first 6 months after the operation, urinary retention was restored in all of them. We did not note significant differences during the intra-, early and late postoperative period in operated BPH patients with and without acute urinary retention. CONCLUSIONS: ThuLEP is an effective and safe method of surgical treatment of patients with benign prostatic hyperplasia with a prostate volume of more than 80 cm3, complicated by acute urinary retention.
BACKGROUND: The progress made in reconstructive urethral surgery over the past 20 years has shown the effectiveness of one-stage repair of anterior urethral strictures. Nevertheless, multi-stage urethroplasty retains its primary role in the treatment of patients with the most complex urethral narrowing and obliterations. AIM: To evaluate the immediate and long-term surgical results of multi-stage urethroplasty for penile and bulbar urethral strictures. MATERIALS AND METHODS: The study included 110 men aged 1884 years who underwent multi-stage urethroplasty for the anterior urethral structures in 20102019. The techniques of buccal and skin augmentation or urethral replacement plastics were applied. Before surgery, all patients underwent a standard urological examination. Early surgical complications were evaluated from medical records. Late surgical complications were determined according to examinations that included symptomatic assessment with specialized questionnaires, laboratory tests of serum and urine, physical examination, uroflowmetry, and retrograde urethrography and ureteroscopy (if urinary disorders were detected). The median follow-up was 5 years and 2 months. RESULTS: Early surgical complications were detected in 27 (24.5%) patients. Surgical interventions to resolve them were required in 7 (31.8%) cases: urethrocutaneous fistulas (5), acute urinary retention (1), scrotal hematoma (1). Late surgical complications were detected in 33 (30.0%) patients, including 29 (26.7%) cases of recurrent urethral strictures. All late complications cases were classified as Clavien-Dindo IIIb, and a total of 49 additional operations were performed to eliminate them. The primary success rate for multi-stage urethroplasty was 67.3 % with a median follow-up of 62 months. Only 73 (66.4%) completed all stages of the planned surgery. Urethral integrity throughout its entire length was restored in 67 (60.9%) cases, spontaneous urination in 106 (96.4%) cases. CONCLUSIONS: Multi-stage surgery for anterior urethral strictures is associated with relatively high risks of surgical complications at each stage of treatment. The probability of surgical revision of complications can reach 31.8%. Patients should be informed about the risks of developing surgical complications and the potential for more than two surgeries to achieve treatment goals when planning multi-stage urethroplasty.
BACKGROUND: Radical cystectomy is the standard treatment for patients with muscle-invasive bladder cancer and superficial neoplasms in cases of resistance to intravesical immunochemotherapy. AIM: To establish the frequency of local pelvic recurrence in patients with bladder cancer after radical cystectomy. MATERIALS AND METHODS: From 1997 to 2022 radical cystectomy was performed in 407 patients with bladder cancer: 344 (84.5%) men and 63 (15.5%) women. Orthotopic urinary diversion methods were performed in 302 (74.2%) patients, including gastrocystoplasty 24 (5.9%), ileocystoplasty 253 (63.8%) and sigmocystoplasty 25 (6.1%) patients. Continent skin diversion of urine was performed in 13 (3.2%) patients, ureter transplantation into the sigmoid colon in 42 (10.3%) patients, and ureterocutaneostomy in 50 (12.3%) patients. RESULTS: Local recurrence in the pelvis after radical cystectomy was observed in 33 (8.1%) patients: 27 (81.8%) men and 6 (18.2%) women. The average age of men with relapses was 58.7 11.7 years (from 43 to 73 years), women 50.0 7.8 years (from 24 to 65 years). Simultaneous metastatic lesions of internal organs were detected in 6 (18.2%) patients. Local pelvic recurrence after radical cystectomy occurred more often in lymphopositive patients with extravesical spread of the primary low-grade tumor. The median time from radical cystectomy to detection of pelvic recurrence was 7.0 months, from the moment of detection of pelvic recurrence to the death of the patient 4.5 months. CONCLUSIONS: The frequency of local pelvic recurrence of bladder cancer after radical cystectomy is 8.1%. The survival rate of patients with local pelvic recurrence is extremely low.
BACKGROUND: Penile fracture is a rare injury that most often occurs during intercourse. In 238 % of cases, a penile fracture is accompanied by an injury to the urethra. AIM: To determine rational treatment of patients with urethral injuries of varying severity as a result of a penile fracture. MATERIALS AND METHODS: The retrospective group of the study included 8 patients in whom a penile fracture was accompanied by an injury to the urethra. Among them, in 6 (75%) patients, along with a rupture of the albuginea and urethra, unilateral damage of cavernous body was observed. The severity of trauma to the penis and urethra was assessed according to the classification of the American Association for the Surgery of Trauma (AAST). RESULTS: According to the diagnostic results, the fracture of the penis in all patients corresponded to the grade III according to the AAST classification. Urethral injury in 7 patients was grade III, and one was grade I according to the AAST classification. Patients with grade III urethral injury underwent primary urethral plastic surgery. A patient with grade I was treated conservatively. In all patients the bladder was drained with a urethral catheter. Penile fracture was treated surgically in all cases. CONCLUSIONS: A penile fracture associated with urethral trauma always requires immediate surgical treatment. In case of injuries of the urethra III grade according to AAST, the urethral catheter installation and conservative management are indicated. In case of injury of the urethra III, IV, V grade according to AAST, urgent primary urethroplasty is necessary. Damage to the corpora cavernosa and albuginea require surgical treatment after restoration of the integrity of the urethra.
BACKGROUND: Alpha-blockers are the first-line treatment for the elimination of symptoms of impaired urination due to benign prostatic hyperplasia. At the same time, the focus is not only on efficiency, but also on the safety of their appointment. AIM: Comparison of the efficacy and tolerability of the alpha1-blocker tamsulosin at a dosage of 0.2 mg twice a day and 0.4 mg once a day in patients with benign prostatic hyperplasia presenting with mild to moderate LUTS. MATERIALS AND METHODS: The study is based on the results of examination and treatment of 90 patients with symptoms of impaired urination in benign prostatic hyperplasia, aged 50 to 80 years. In the 1st group (n = 45) patients received tamsulosin 0.2 mg twice a day, in the 2nd group (n = 45) 0.4 mg once a day. The duration of treatment was 4 weeks. RESULTS: In patients of both groups, according to the IPSS questionnaire, a statistically significant decrease in the severity of obstructive and irritative symptoms, an improvement in the quality of life, an increase in the maximum urine flow rate, and a decrease in the volume of residual urine were revealed. When comparing the dynamics of clinical indicators in patients of the 1st and 2nd groups, no significant differences were found between the groups. At the same time, treatment tolerance was somewhat better in patients of the 1st group, which manifested itself in a smaller number of adverse events from the cardiovascular system and ejaculatory function disorders. CONCLUSIONS: The results of the study demonstrate the same efficacy of tamsulosin 0.2 mg twice a day and 0.4 mg once a day. At the same time, taking tamsulosin at a dose of 0.2 mg twice a day was characterized by better tolerability of therapy.
Zinners syndrome refers to rare malformations and is characterized by a triad of signs - unilateral renal agenesis, obstruction of the vas deferens, and cystic transformation of the seminal vesicle. A description of a clinical case of Zinners syndrome with an atypical clinical picture is presented. This observation indicates the need for an in-depth examination of the genital organs in men with renal agenesis.
Diverticula of the bladder in adults in most cases are secondary and develop against the background of bladder outlet obstruction. Their true prevalence is unknown. More often, they are small in size and clinically asymptomatic. In cases where the diverticulum of the bladder is complicated by a chronic recurrent infection, stones, tumor or hydronephrosis on the side of the lesion, diverticulectomy is indicated. Approaches to diagnosis and treatment options for this pathology are considered on several clinical examples.
BACKGROUND: In a significant number of patients with benign prostatic hyperplasia who underwent transurethral resection (TURP), micturition disorders are detected in the late postoperative period. The issues of drug treatment of overactive bladder are widely covered in the literature and clinical guidelines. However, the number of studies on the treatment of patients with detrusor overactivity after TURP is relatively small. AIM: The aim of the study is to increase the effectiveness of treatment of patients with detrusor overactivity after TURP in the late postoperative period. MATERIALS AND METHODS: We treated 51 patients with urodynamically confirmed detrusor overactivity after TURP aged 56 to 87 years (mean 71.5 8.4 years). Taking into account the comorbid background, concomitant therapy, age characteristics and the presence of contraindications, 8 patients were prescribed solifenacin, 9 trospium chloride, 34 mirabegron. Appointment of anticholinergic therapy for 1 month in 7 patients was ineffective, they were prescribed mirabegron. Drug treatment lasted 3 months. With insufficient effectiveness of drug therapy, combined treatment with mirabegron was performed in combination with extracorporeal magnetic stimulation (ECMS) for 1 month (12 sessions of ECMS in total). When the combination of ECMS and mirabegron was ineffective, intravesical botulinum therapy was performed. The effectiveness of treatment was assessed by subjective assessment by patients, the results of patients filling out IPSS questionnaires, urination diaries, ultrasound results and uroflowmetry. RESULTS: After the end of drug therapy 17 (33.3%) patients subjectively rated the result of treatment as excellent, 15 (29.4%) patients as good. In 19 (37.3%) patients the effectiveness of drug therapy was regarded as insufficient and they underwent combined therapy with mirabegron and ECMS. As a successful combination therapy was recognized in 10 (52.6%) patients. Botulinum therapy was performed in 6 patients with ineffectiveness of the previous stages of treatment with a positive effect in 5 (83.3%) of them. Tolerability of treatment was satisfactory. Based on the results of the study, an algorithm for the treatment of detrusor overactivity in patients with urination disorders in the late postoperative period after TURP was proposed. CONCLUSIONS: The applied treatment regimen for patients with detrusor overactivity after TURP is effective and can be recommended for use in clinical practice.
BACKGROUND: Currently there are practically no works in the literature to assess the outcomes of systemic therapy in patients with solitary, single and multiple metastases of renal cell carcinoma. AIM: The aim of the study was to analyze the outcomes of systemic drug therapy of the first line in patients with solitary, single and multiple metastases of renal cell carcinoma. MATERIALS AND METHODS: The data of 981 patients with metastatic renal cell carcinoma who underwent systemic therapy of the first line at the City Oncological Hospital No. 62 in Moscow and the City Oncological Dispensary in St. Petersburg from 2006 to 2022 were retrospectively analyzed. All patients underwent clinical, laboratory and pathomorphological examination. 90 (9.2%) patients had solitary metastases, 252 (25.7%) single metastases and 639 (65.1%) multiple metastases. An analysis was made of the outcomes of 1st line therapy, which were conditionally divided into favorable, including all cases of complete response, partial response and stabilization, and unfavorable progression during treatment, death or deregistration. Subsequently patients who had previously received chemotherapy or cytokine treatment were excluded from the analysis. RESULTS: Complete response (3.3%) and deregistration (5.56%) were more often observed in patients with solitary metastases, stabilization more often occurred in patients with single metastases (51.1%), partial response (9.4%) and death (6.2%) in patients with multiple metastases. In patients with multiple metastases treated with immune checkpoint inhibitors a partial response was observed in almost half of the cases. Stabilization and progression were observed in almost the same percentage of cases (about a quarter of cases), and only two patients had a fatal outcome, which is slightly lower than in patients receiving tyrosine kinase inhibitors. Frequent outcomes when using tyrosine kinase inhibitors were stabilization of the process (40.72% of cases) or progression (38.72%), a complete and partial response was rarely recorded. Significant differences in the occurrence of favorable and unfavorable outcomes were revealed in patients with multiple metastases, depending on the number of affected organs and the prescribed drug. When comparing the results of systemic therapy of the first line, a higher efficiency of tyrosine kinase inhibitors was observed in solitary metastases of tumors with a high and moderate degree of differentiation. Systemic therapy of G3 tumors with solitary metastases had low efficacy in the appointment of tyrosine kinase inhibitors in 27.27% of patients. Higher efficiency was noted in single and multiple metastases. The effectiveness of immune checkpoint inhibitors was revealed in 70.6% of patients with single and multiple metastases. CONCLUSIONS: When choosing systemic therapy for metastatic renal cell carcinoma in clinical practice, it is necessary to take into account such prognostic factors as histological variants, the degree of differentiation of the tumor and the number of affected organs.
BACKGROUND: Renal cell cancer is accompanied by the development of a disorder of renal function. The parameters of homeostasis after nephrectomy in renal cell cancer are not well understood. AIM: The aim of the study is to compare the kidney functional status and parameters of homeostasis in patients with RCC after nephrectomy performed by open and laparoscopic surgery. MATERIALS AND METHODS: Eighty patients with renal cell cancer Т3N0M0 were randomized according to the surgery into the comparison group with open nephrectomy (n = 40; 50,1 3,4 years old; 18 males, 22 females) and the main group with laparoscopic nephrectomy (n = 40; 52,4 5,1 years old; 16 males, 24 females). The control group was comprises from twenty subjects without urological pathology, 2258 years old, 10 males, 10 females. Laboratory parameters of endotoxicosis, lipid peroxidation, kidney functional status, partial kidney functions, and urinary syndrome were assessed on the 1st, 3rd, 6th and 10th days after the surgery. RESULTS: The early postoperative period of nephrectomy in renal cell cancer is accompanied by the development of endotoxicosis, activation of lipid peroxidation, deterioration of the functional state of the remaining kidney, and the formation of chronic kidney disease. At the same time, both systemic indicators (toxicity index, as well as concentrations of medium-weight molecules, diene conjugates, malondialdehyde), and renal parameters (glomerular filtration rate, albumin-creatinine ratio) are associated with the method of surgery: with a laparoscopic approach, changes in these indicators are reversible and less pronounced than with open nephrectomy. CONCLUSIONS: The present study demonstrates the advantage of laparoscopic nephrectomy compared to open nephrectomy in patients with renal cell cancer.
The article presents information about the clinical manifestations, diagnosis and treatment of bladder endometriosis. The issues of etiology and pathogenesis of endometriosis are considered in detail. The classification of extragenital endometriosis is given. Information about the prevalence of endometriosis of the urinary system is given. A clinical observation of a patient with endometriosis of the bladder that developed after surgery on the pelvic organs is presented.
BACKGROUND: Renal cell cancer is complicated with bone metastases quite often, which are determined in a third of patients at the time of diagnosis of the primary tumor. The development of skeletal complications causes the complexity of managing such patients, which requires optimizing treatment tactics using combined methods and improving the quality of life after treatment. AIM: The aim of this study is to assess the quality of life of renal cell cancer patients with single metastases in the bones before and after surgical treatment in combination with targeted therapy and without it. MATERIALS AND METHODS: The study included 62 patients with single bone metastases of renal cell cancer with the presence of skeletal related events. 20 patients (group 1) underwent surgical treatment of metastases after surgery on the primary focus in combination with targeted therapy, 42 patients (group 2) underwent only surgical treatment of metastases. The quality of life was assessed using the EORTC QLQ-C30 questionnaire before and after surgery within and between groups. RESULTS: Comparison of the survey influence on life quality in group 1 before and after treatment revealed that 8 out of 30 indicators of the EORTC QLQ-C30 questionnaire did not show a statistically significant change. These include: any restrictions in daily activities, as well as doing what you like, decreased appetite, nausea, shortness of breath, diarrhea, fatigue, financial difficulties. The remaining 22 indicators of the scale showed a statistically significant improvement. Comparison of quality of life indicators in group 2 before and after treatment showed that for 3 out of 30 indicators of the EORTC QLQ-C30 questionnaire, no statistically significant changes were registered, among them: the severity of pain syndrome, the presence of financial difficulties and health status over the past week. Statistically significant improvement was revealed for the remaining 27 indicators of the scale. Prior to treatment, difficulties in taking a short walk, doing daily chores, doing favorite things are more pronounced in group 1, and the need for rest in group 2 patients. After surgery, the indicators associated with daily activity were worse in group 1 patients, while the severity of the pain syndrome, its effect on daily activity, the need for rest, a sense of tension, and the effect on the emotional background were more noticeable in group 2 patients. Both before and after surgery, group 1 patients had a better assessment of both their health and quality of life over the past week. CONCLUSIONS: The comparative analysis of the treatment confirmed our hypothesis that the most rational and effective combination is an active surgical tactic in combination with targeted therapy for bone oligometastases of renal cell cancer.
The interaction of tumor cells, especially if they are stem or resting, with myeloid and lymphoid components, as well as extracellular matrix producers, leads to the formation of a pathological microenvironment that causes resistance to many systemic treatment options. The aim of the work is to present modern literature and own data concerning the features of the composition and structure of the microenvironment in tumors of the kidney, prostate and bladder. The article presents data on the composition and interaction of various subpopulations of cells in the tumor microenvironment, as well as on the role of stem tumor cells in its formation. Defects of signaling pathways of stem tumor cells are described, as well as the mechanism of interaction between the tumor and the immune system in the process of carcinogenesis. Approaches to the assessment of the type of microenvironment for the purpose of individualization of treatment are analyzed in detail. The authors present their own data on the nature of the distribution of subpopulations of lymphocytes and suppressor cells of myeloid origin in patients with metastatic forms of tumors of the genitourinary tract. The variants of using data on the structure of the microenvironment in order to optimize treatment tactics in cancer patients are indicated.
Arteriovenous conflicts of the ileocecal segment are a frequent cause of recurrent and bilateral varicocele. Insufficient and untimely diagnosis of varicocele causes in this group of patients leads to multiple repeated surgical interventions due to recurrence. This paper presents a clinical case of successful fertility of a 30-year-old patient with bilateral varicocele and testicular hypotrophy on the background of Mey–Thurner syndrome by two-stage surgical treatment including transsclerotal ligation of testicular veins, angioplasty and stenting of the left common iliac vein.
Renal cysts can be both an independent nosological entity, and a clinical manifestation, or a complication of a severe diseases. Understanding the epidemiology, pathogenesis and diversity of causes of cystic kidney disease contributes to the timely diagnosis and selection of reasonable treatment and prevention tactics. The presented literature review describes the most common processes that contribute to the development of this pathology, as well as genetic diseases and rare causes, the clinical manifestation of which is the formation of cystic cavities. The article presents the main diagnostic algorithms and modern classifications of the disease for practical assistance to the doctor. The review contains up-to-date information on the modern staging of cystic kidney disease according to the Bosniak classification, and also presents the risk of malignancy, according to the statistical data presented in the literature.
BACKGROUND: Infertility is detected in 15% of sexually active couples who engage in unprotected sexual intercourse. At the same time, the male factor of infertility accounts from 30 to 50%. It is known that in 15–25% the cause of frozen pregnancy and miscarriage is the male factor of infertility associated with violations of the integrity of sexual chromatin – pathological fragmentation of sperm DNA (FDNAS). One of the main pathophysiological mechanisms of the occurrence of pathozoospermia and FDNAS in secretory male infertility is oxidative stress, which occurs in patients with varicocele. It has been proven that varicocelectomy increases the frequency of spontaneous pregnancy and improves the results of IVF-procedures. However, there are currently insufficient studies devoted to the comparative evaluation of the effectiveness of various methods of varicocelectomy in patients with pathological FDNAS. AIM: To conduct a comparative assessment of the dynamics of sperm DNA fragmentation after subinguinal and laparoscopic varicocelectomy in male infertility. MATERIALS AND METHODS: The study included the results of examination and treatment of 87 men who complained of infertility in marriage for 1–9 years (on average, 3.8 ± 2.7 years). The age of the patients was 24–42 years (the average, 28.6 ± 11.3 years). All patients were diagnosed with grade II left-sided varicocele. Other pathological conditions potentially affecting ejaculate parameters were excluded. All patients underwent ejaculate analysis — sperm analysis, determined the degree of FDNAS by TUNEL method and the level of IgG class antisperm antibodies in the ejaculate by direct Mar-test. The patients were divided into 2 groups by randomization. The group 1 included 41 patients who underwent subinguinal varicocelectomy (Marmar operation), the group 2 included 46 patients who underwent laparoscopic varicocelectomy. Studies of the ejaculate — a sperm-analysis (according to WHO criteria, 2010), a MAR test and FDNAS — were carried out before, 3 and 6 months after surgery. RESULTS: In all patients of both groups in six months after surgical correction of varicocele the concentration of spermatozoa, the number of progressively mobile and normal forms of spermatozoa (according to the strict Kruger criteria) were significantly increased. The MAR test value in all patients of both groups before surgery did not exceed 10%. There were no statistically significant changes in this indicator in the postoperative period. FDNAS values in patients of group 1 before and 3 months after surgical treatment no statistically significant differences were found (27.6 ± 6.7% and 22.4 ± 8.3%, respectively, p > 0.1). In patients in group 2, 3 months after surgical treatment a statistically significant decrease in the FDNAS value was noted compared with that before treatment (from 26.1 ± 8.9% to 13.3 ± 7.7%, p < 0.001). 6 months after surgery, patients in both groups showed a significant (p < 0.001) decrease in FDNAS values compared to the value before treatment: up to 14.6 ± 7.8% in patients of group 1 and up to 12.1 ± 8.0% — in patients of group 2. CONCLUSIONS: 1. Performing subinguinal and laparoscopic varicocelectomy contributes to the significant improvement of the main parameters of sperm in six months after the surgical operation. 2. The DNA fragmentation level significantly decrease already in 3 months after laparoscopic varicocelectomy, and just in 6 months after Marmar operation.
BACKGROUND: The ureteral plastic surgery with their extended constrictions and obliterations remains one of the most difficult problems of reconstructive urology. This is especially true in cases where it is impossible to repair the patency of the ureter due to unchanged urinary tract sections. In such cases, various segments of the gastrointestinal tract and, above all, the ileum proved to be the best plastic material. However, the number of such operations in the world is not enough, which requires further accumulation of experience and study of long-term results of ileoureteroplasty. AIM: The aim of the research is to present the technical features and results of intestinal plastic surgery of ureters. MATERIALS AND METHODS: From 2001 to 2023 ileoureteroplasty was performed in 193 patients of the Clinic of the North-Western State Medical University named after I.I. Mechnikov on the basis of the urological department of City Multidisciplinary Hospital No. 2. The panel consisted of 71 men (36.8%), 122 women (63.2%). The average age was 51 ± 3.2 years. Indications for these operations were extensive defects of the ureters as a result of complications of surgical intervention on the upper urinary tract in 69 (35.8%) of patients, radiation therapy — in 54 (28.0%) and the consequences of iatrogenic damage to the ureters — in 40 (20.7%). Megaureter (6.2%), Ormond’s disease (7.3%) and neoplasms of the ureters (2.0%) were observed less frequently. RESULTS: Unilateral ileoureteroplasty was performed 153 (79.3%), bilateral — 40 (20.7%). The total number of ureteralsurgeries is 235. Since 2013 ileureteroplasty has also been performed with laparoscopic method, and the share of such operations for this period was 35.9%. The early postoperative complications occurred in 18 (9.3%) patients. There were no fatal outcomes. Late complications developed in 16 (11.2%) of 143 examined patients. CONCLUSIONS: This surgical tactics may be recommended in the clinical practice of large urological hospital due to our 22-year experience in using small intestine segments to replace extended ureteral constrictions with a minimum number of postoperative complications, no deaths and good long-term results allows us to recommend.
Congenital diverticulum of the distal urethra is extremely rare in urological practice, there are isolated descriptions of it in the literature, as a result every clinical observation is of interest. The aim of this study is demonstration of a rare clinical observation congenital diverticula of the distal urethra without infravesical obstruction (meatostenosis) in a teenager. The article describes a clinical case of treatment of congenital diverticula of the anterior urethra without signs of infravesical obstruction in a 13-year-old teenager. A case of surgical treatment of congenital urethral diverticulum without infravesical obstruction in a 13-year-old teenager is presented. Diverticulectomy with suture of the urethra was performed with good anatomical and functional results. A distal urethral diverticulum of a congenital nature is extremely rarely noted as an isolated condition without an anterior urethral valve or another variant of infravesical obstruction. The method of choice is to perform diverticulectomy with suturing of the urethra.
BACKGROUND: The number of older patients with kidney tumors is steadily increasing. Surgical methods are the main ones in the treatment of patients with localized forms of renal cell carcinoma, including the elderly. AIM: to conduct a comparative analysis of perioperative data and functional results of surgical interventions for renal cell carcinoma in patients of different age groups. MATERIALS AND METHODS: The study included 256 patients with kidney tumors (mean age 65.2 8.6 years). 146 (57.0%) patients aged 56 to 64 years made up group I, and 110 (43.0%) patients aged 65 to 75 years group II. In 210 (82.0%) patients, the tumor diameter did not exceed 4 cm (T1a), in 46 (18.0%) patients it ranged from 4 to 6.2 cm (T1b). Radical nephrectomy and partial nephrectomy were performed respectively in 44 (30.1%) and 102 (69.9%) patients of group I and 58 (52.7%) and 52 (47.3%) patients of group II. All operations were performed laparoscopically. RESULTS: In patients of group I, the duration of radical nephrectomy was 115.0 18.0 min, and partial nephrectomy 135.5 25.0 min (p 0.0001), in patients of group II, 120.0 20.5 and 138.0 25.5 min (p 0.0001), respectively. Warm ischemia time during partial nephrectomy was 17.6 1.2 min in patients of group I and 18.2 1.5 min in patients of group II (p = 0.25). The volume of blood loss in patients of both groups I and II was significantly higher during partial nephrectomy. The average volume of blood loss in patients of group I was 130.0 20.0 ml when performing radical nephrectomy and 236.5 20.0 ml when performing partial nephrectomy (p 0.0001), and in group II 125.0 18.5 ml for radical nephrectomy and 246.0 22.0 ml for partial nephrectomy (p 0.0001). The frequency of significant complications did not differ in patients of groups I and II. Grade IIIa complications according to the ClavienDindo classification of surgical complications were observed in 5 (3.4%) patients of group I and 4 (3.9%) patients of group II (p 0.05), and grade IIIb in 3 (2.1%) and 2 (1.8%) patients (p 0.05). Intraoperative bleeding developed in 19 (7.4%) patients: in 13 (8.4%) of 154 patients with partial nephrectomy, and in 6 (5.9%) of 102 patients with radical nephrectomy. In the early postoperative period in patients of group I after radical nephrectomy and partial nephrectomy, normal glomerular filtration rates was observed in 34.0% and 54.0% of patients, respectively, and in group II in 31.0% and 52.0% of patients, respectively. Renal function significantly decreased in patients of both groups after radical nephrectomy compared with partial nephrectomy (p 0.05). The results of GFR 3 months after surgery improved in patients after partial nephrectomy, and did not change significantly in the radical nephrectomy group. CONCLUSIONS: The results of the study showed no differences in perioperative parameters (volume of intraoperative blood loss, warm ischemia time) during radical nephrectomy and partial nephrectomy in patients aged 5664 and 6575 years. The functional results of partial nephrectomy in patients of both groups were better compared to patients after radical nephrectomy. Thus, our data indicate the justification for performing organ-preserving operations, including in elderly patients.
The review article discusses modern methods for diagnosing and treating patients with non-muscle-invasive bladder cancer. The search and analysis of information was carried out in the databases PubMed, Google Scholar, eLibrary. Information about photodynamic diagnostics, narrow-band imaging, mono- and bipolar transurethral resection, transurethral thulium and holmium laser resection, en-bloc resection of neoplasms, Nd:YAG laser ablation of the tumor bed is presented. The features, advantages and disadvantages of each of these methods, as well as their combinations and modifications are described in detail. Particular attention is paid to the use of laser technologies in the surgical treatment of patients with non-muscle-invasive bladder cancer. An analysis of the results of studies of the efficacy and safety of various methods of surgical treatment of non-muscle-invasive bladder cancer was carried out. The significance of the problem of increasing the efficiency of treatment of such patients, which is one of the priority areas of modern oncourology, is indicated.
