BACKGROUND: Despite the development of nerve-sparing techniques, erectile dysfunction remains a common complication after radical prostatectomy. The method of hemostasis is one of the important factors determining the risk of cavernous nerve injury during surgery. A review of the published data demonstrates the evolution of hemostatic approaches: from traumatic monopolar coagulation with deep thermal damage to modern methods with minimal impact. Research data are conflicting: although “cold” methods (clipping, ligation) have traditionally been considered the “gold standard,” some studies indicate a risk of ischemia and fibrosis from clips, whereas modern precision bipolar coagulation and lasers with shallow penetration depth show comparable erectile outcomes. AIM: To compare clipping and precision bipolar coagulation as intraoperative hemostasis methods in terms of optimizing erectile function preservation during nerve-sparing robot-assisted radical prostatectomy. METHODS: A retrospective analysis of data from 157 patients operated by a single expert surgeon between 2011 and 2024 was performed. Inclusion criteria: localized prostate cancer (cT1-2N0M0), preserved preoperative erectile function (22–25 points on the IIEF-5). Patients were divided into two groups: the clipping group (n = 74) and the precision bipolar coagulation group (n = 83). Erectile function was assessed using the IIEF-5 questionnaire 12 months after surgery. Statistical analysis included Student t-test, χ² test, and calculation of odds ratios. RESULTS: The groups were comparable in age and baseline IIEF-5 score. The proportion of patients with recovered erectile function (IIEF-5 ≥ 17) was 71.1% in the precision coagulation group vs. 54.1% in the clipping group (p = 0.027). In the clipping group, the odds of erectile function recovery were 2.1 times lower (odds ratio 0.47; 95% CI: 0.24–0.91). The rate of biochemical recurrence at 12 months did not differ statistically significantly (17.6% vs. 8.4%; p = 0.089), although a trend favoring the coagulation group was observed. CONCLUSION: Precision bipolar coagulation during nerve-sparing robot-assisted radical prostatectomy is associated with significantly higher rates of erectile function recovery at 12 months postoperatively compared to clipping, without compromising oncological safety. These findings indicate the multifactorial nature of cavernous nerve injury and suggest that precision bipolar coagulation can be considered an effective alternative to clipping. Prospective randomized studies are needed to definitively confirm these results.
One of the serious and rare complications of Intrauterine Contraceptive Device (IUCD) migration is intravesical stone formation. This report presents a case of a large bladder calculus secondary to a migrated IUCD, highlighting the clinical presentation, diagnostic challenges, and subsequent surgical management. We report the case of a 41-year-old multiparous woman with a history of long-term IUCD use, presenting with a four-month history of chronic lower abdominal pain, dysuria, urinary frequency, urgency, incomplete bladder emptying, and straining to void. Abdominal radiography revealed a large bladder calculus with a central nidus suggestive of a forgotten and migrated IUCD. The patient's contraceptive history included multiple IUCD insertions between 2009 and 2022. The patient underwent open vesicolithotomy under regional anesthesia. Intraoperatively, a bladder stone measuring 4.7 × 4.0 cm encasing an IUCD was successfully removed. Three months postoperatively, the patient's lower urinary tract symptoms had resolved, demonstrating significant clinical improvement. Clinical awareness of this rare complication enhance early detection and facilitate appropriate management to prevent long-term complications.
BACKGROUND: Warm renal ischemia (WRI) is an important step in partial nephrectomy for malignant tumors. This procedure reduces blood loss and improves visualization. However, hypoxia damages renal tissue cells, leading to postoperative complications. Pharmacological agents with antihypoxic properties are used to reduce the risk of complications. The development and implementation of new methods for intraoperative monitoring of the renal parenchyma are of interest because they can provide additional quantitative information on blood microcirculation in the kidney and help investigate the nephroprotective efficacy of various drugs. One such method is laser Doppler flowmetry (LDF). AIM: To evaluate the feasibility of using LDF for intraoperative monitoring of renal blood microcirculation during WRI and subsequent reperfusion. METHODS: The study was conducted on 11 Wistar rats, 8 of which underwent prior right nephrectomy. The animals were divided into groups: group 1, WRI for 40 min in rats without nephrectomy; group 2, WRI for 40 min and saline administration in nephrectomized rats; and group 3, WRI for 40 min and administration of 15% sodium fumarate in nephrectomized rats. Sodium fumarate was administered intravenously at 1 mL/kg on the day before and on the day of WRI, 1 hour before surgery. Saline was administered in an equivalent volume on the same schedule. The blood microcirculation index (MI) was measured every 10 minutes before, during, and after ischemia. RESULTS: Averaged MI values showed decreased renal perfusion in the nephrectomized groups. A greater relative increase in MI was also observed during reperfusion in the experimental groups compared with the intact group, with a pronounced hyperemic effect in the first 10 minutes after reperfusion with 15% sodium fumarate. In the saline (0.9% NaCl) control group, higher mean MI values were recorded during ischemia, but the increase during reperfusion was less pronounced. CONCLUSION: These preliminary findings demonstrate the sensitivity of LDF for detecting dynamic changes in renal microvascular blood flow during ischemia and reperfusion in an experimental WRI model. The changes and differences observed at various stages warrant further investigation into the relationship between the effects of the tested substances on cell status and renal microhemodynamics, with expansion of the studied perfusion-metabolic parameters of renal tissue.
BACKGROUND: Urolithiasis is a multifactorial metabolic disorder characterized by kidney stone formation. It is widespread in southern Russia and around the world. Studying trends in urolithiasis prevalence is therefore crucial in clinical practice. A nonfunctioning kidney — a serious complication of advanced urolithiasis — often leads to nephrectomy. However, this outcome can be prevented with timely, appropriate treatment and regular follow-up. AIM: To analyze the causes of complications that lead to nephrectomy in patients with urolithiasis. METHODS: We conducted this retrospective study using a database of nephrectomy outcomes over the past 3 years at Regional Clinical Hospital No. 2 (Krasnodar, Russia). We recorded age, sex, indications for nephrectomy, surgical technique, and whether the patient had a primary or recurrent disease. RESULTS: During the study period, 82 nephrectomies were performed. Female patients predominated. Patients aged 60–74 years were at the highest risk. Patients with urolithiasis and no history of prior surgery were more likely to undergo nephrectomy for a nonfunctioning kidney due to upper urinary tract obstruction. Laparoscopic techniques are gradually replacing conventional open nephrectomy in our clinic. CONCLUSION: In our study, the main cause of nephrectomy was urolithiasis and its complications, which are preventable risk factors. Patient education, prevention, timely monitoring and early treatment, and the introduction of minimally invasive techniques at various levels of healthcare may help address this problem in the future.
Thrombosis is one of the most common complications in cancer patients. It poses a life-threatening risk and may delay treatment. Because thrombosis is relatively rare in prostate cancer, its occurrence is often underestimated. This review systematizes current data (2010–2025) on the epidemiology, pathogenesis, and management of thrombotic complications in prostate cancer patients. A search was conducted in PubMed, Scopus, and Web of Science using the keywords рак предстательной железы (prostate cancer), венозная тромбоэмболия (venous thromboembolism), андроген-депривационная терапия (androgen-deprivation therapy), AДТ (ADT), гиперкоагуляция (hypercoagulation), онкологический тромбоз (cancer-associated thrombosis), and профилактика (prevention) for 2010–2025. Original studies, systematic reviews, and clinical guidelines were selected. The adjusted thrombosis risk in prostate cancer patients is increased 1.5-fold, with the highest risk in the first 6 months after diagnosis, persisting for 5 years. Pathogenesis involves tissue factor, proinflammatory cytokines, endothelial dysfunction, and thrombocytosis. Standard coagulation tests and thromboelastography may be used to diagnose cancer-related hypercoagulation. Radical prostatectomy, androgen deprivation therapy, chemotherapy, and radiotherapy increase thrombosis risk. Thrombosis may have prognostic value, reflecting tumor aggressiveness, and can cause treatment interruptions and death. Prevention strategies should include risk stratification, pharmacological prophylaxis (low-molecular-weight heparins and oral anticoagulants), and non-pharmacological measures (adequate hydration, physical activity). Thromboembolic complications should be treated for at least 6 months. Prostate cancer carries a significant venous thromboembolism risk, requiring clinician awareness and active screening. Future research should focus on developing validated risk stratification tools specifically for prostate cancer and exploring novel biomarkers and hemostatic monitoring methods.
