Introduction. It has been established that prolonged androgen-deprivation therapy (ADT) of prostate cancer leads to a decrease in bone mineral density (BMD) and increases the risk of fractures, which is an important medical and social problem. Zoledronic acid (ZA) is most often used for the prevention of osteoporosis against the background of ADT. The purpose of the study is to determine the efficacy and safety of ZA for the treatment and prevention of osteopo-rosis in non-metastatic prostate cancer against the background of ADT therapy with GnRH agonists. Materials and methods. The study included 45 men aged 54-81 years with morphologically verified prostate cancer (stages T2-4 N0-1 M0) who underwent surgical castration at least 6 months before inclusion or continuously received therapy with GnRH agonists. The blood level of CTX-1 was used as the main marker of bone resorption. To assess the BMD, the screening method of dual-band X-ray densitometry of the calcaneus with laser determination of the examination area – DXL using the CALSCAN apparatus and the DXL Calscan Workstation software was used. Patients were randomized into groups of 15 people each: Group 1 – received intravenous infusion of ZA at a dose of 4 mg at the beginning of the study and after 3 months of treatment; Group 2 received ZA at 2 mg in the same mode; Group 3 – control. For antire-sorptive therapy (ART), the drug Resorba (JSC «Pharm-Synthesis», Russia) was used. The duration of follow-up was 6 months. Results. In 13 out of 15 patients of Group 1, 3 months after the first administration of ZA, a decrease in the level of CTX-1 by 50% or more was observed, and after 6 months all 15 patients (100%) reached the age norm («complete answer»). Group 2 patients also responded to ART and by the 6th month 13 out of 15 (87%) had achieved a «complete response». In the control group by the 6th month the decrease in CTX-1 was not observed in any of the patients. Initially, the values of BMD in the studied groups did not differ. By the 3rd month of the study, the BMD index significantly increased only in Group 1. In Group 2 this indicator significantly increased by the 6th month of treatment. At the same time, in Group 1 after 6 months the BMD index reached higher values than in Group 2: an increase of 27% and 13%, respectively. In the control group, by the 6th month of observation, a significant decrease in BMD by 12% was noted. In Group 1, the number of patients with osteoporosis decreased to 6% and with a normal level of BMD – reached to 40%. Conclusion. High efficacy and sufficient safety of ZA in doses of 4 mg and 2 mg i/v one time in 3 months for anti-resorptive therapy in patients receiving long-term hormonal therapy with GnRH agonists has been demonstrated.

Первая отечественная монография, посвященная влиянию различной длительности приема альфа1-адреноблокаторов на диафрагмальную функцию радужной оболочки у пациентов с возрастной катарактой и аденомой простаты. Представлены прогностические критерии развития синдрома атоничной радужки в ходе факоэмульсификации катаракты, которые обеспечивают выявление пациентов с клинически значимым флоппи-ирис синдромом, способствуя надлежащей его профилактике. Предложен алгоритм хирургии катаракты у данной категории пациентов. Руководство предназначено врачам-офтальмологам и урологам.

Introduction. The urethroplasty of the urethral stricture disease is still a severe problem for surgeons. The aim of this study is to evaluate own results of buccal mucosa graft urethroplasty (BMGU) for the treatment of urethral stricture. Aim. Evaluation of own results of urethroplasty with a graft of the oral mucosa in the treatment of urethral strictures. Materials and methods. Between 01.08.2014 and 01.06.2020 we treated 136 patients with urethral stricture at our Medical Centers, where we provided buccal mucosa graft urethroplasty for bulbar and penile urethra. Results. The bulbar stricture was found among 105 patients of 136 (77,1 % cases), in which 64 had stricture in proximal part and 41 – in distal part of the urethra, 19 patients – in penile urethra and the other part had panurethral lesion. The median length of the stricture was measured as 3,8 ± 0,6 sm in the first three groups, and in the last group it was 10,4 ± 1,5 sm. At a median follow-up of 16,3 months 87,5% of patients in the first group, 90,2 % in the second, 84,2 % in the third and 83,3 % in the fourth group had no stricture recurrence and were satisfied with BMGU. Conclusion. For patients with urethral stricture disease, BMGU offers excellent success, morbidity with different techniques and methods, which statistically are equal to each other.

Background. The highest rate of incontinence after radical prostatectomy (RP) is observed in the first 2–6 months after surgery. In order to decrease the period of incontinence, virous surgical methods aimed at preservation and reconstruction of structures participating in the mechanism of urine retention has been developed and improved.The study objective is to evaluate effectiveness of an original method of formation of an urethral anastomosis in the early continence recovery.Materials and methods. Data on 126 patients who underwent retropubic RP were analyzed. Depending on the method of urethral anastomosis formation, patients were divided into 2 groups: in the 1st group (n = 52) the patients underwent PR with urethra suspension m. levator ani, in the 2nd (n = 74) – standard RP. In the 1st group, 6 ligatures were applied to the anterior and posterior urethra walls: at the 12 and 6 hour projections through the mucosa, submucosa, and smooth muscle; at the 10, 2, 4, and 8 hour projections – more laterally with capture of the m. levator ani medial margins. Continence recovery was evaluated on days 1, 7, and 14 after urinary catheter removal and then at days 30, 90, 180, and 365 after RP. The criteria of continence were absence of urine leakage at rest and during physical activity and a necessity of using a safety liner.Results. There weren’t any significant differences at day 1 after urinary catheter removal between the two groups (р > 0.05). In the 1st group, continence values at days 30, 90, and 180 after RP were significantly higher (57.7, 69.2, and 71.1 %, respectively) compared to the 2nd group (35.1, 41.9, and 51.3 %, respectively) (р <0.05).Conclusion. Results of this work show significant benefits of RP with urethra suspension m. levator ani compared to standard RP per continence recovery criteria at days 7, 14, 30, 90, and 180 after the surgery. The technique of urethra suspension m. levator ani is easy to perform and ensures early continence recovery after RP.

This review analyses of the results of using buccal mucosa graft for the management of ureteral strictures. The authors identified sixteen original studies presenting the results of ureteral reconstruction using buccal grafts. Of them, twelve, three and one studies used the open, robotic and laparoscopic technique, respectively. Open surgery was performed 44 times in 42 patients (2 patients underwent bilateral ureteroplasty) with an average ureteral stricture length of 6.0 (2.5-11) cm. Ureteral patency was restored in 93.2% (41/44) of patients with an average follow-up of 26 (3-85) months. The robotic technique was used in 18 patients with an average ureteral stricture length of 3.25 (1.5-6) cm. Positive results after similar operations were achieved in 88.9% (16/18) of patients with an average follow-up of 15 (4-30) months. The laparoscopic technique was used only once for a ureteral stricture measuring 3 cm in length and was characterized as successful at a follow-up of 9 months. All surgical modalities were associated with minimal risk of early and late postoperative complications. The review results suggest that buccal substitution ureteroplasty can be regarded as an advantageous alternative to more complicated surgical procedures associated with greater complication rates (ileal ureteral substitution and kidney autotransplantation) used for long ureteral strictures.

Determination of indications for performing reconstructive and plastic surgical interventions in stricture of UPS is a difficult task. When making an incorrect decision, the treatment can be ineffective. Functional and anatomical preservation of the kidney can significantly affect the outcome of the operation.Purpose. Evaluation of the effectiveness of laparoscopic plastic surgery of stricture of UPS, depending on the anatomical and functional state of the ipsilateral kidney.Material and method. The results of treatment of 134 patients, who underwent for the period from 2012 to 2015 the different types of reconstructive surgical interventions for stricture of the pelvic-ureteral segment (Calp de Virde scrappy plastic surgery, Andersen-Heinz ureteropyelanastomosis, and antineoplastic ureteropyeloanastomosis), were analyzed. To analyze the effectiveness of the treatment, in the preand postoperative period, the following parameters were evaluated: the presence of pain syndrome, the presence of pyeloectasia, the functional state of the renal parenchyma (according to radioisotope renography), and the absence of recurrence of the UPS stricture.Result. The overall efficacy of laparoscopic UPS reconstruction was 94.7%. The results of treatment did not depend on the chosen technique of operative intervention. In this case, the effectiveness of the treatment was dependent on the initial deficiency of kidney function: the best results were seen in patients with kidney function deficiency of less than 25%, and the proportion of ineffective interventions was highest among patients with a deficit of more than 75%. The degree of dilatation of the pelvis in the postoperative period was also associated with preoperative indicators of kidney function deficiency, this may be due to the presence of cup-pelvis-plating system atony.Conclusion. Thus, the results of our work demonstrated the high efficiency of laparoscopic plastics of UPS. The effective- ness of treatment is determined by the timeliness of the intervention. As a basic prognostic criterion for the effective- ness of the forthcoming intervention, the degree of deficiency of the kidney function should be considered.

Múltiples abordajes han sido descritos para la reparación quirúrgica de las fístulas ureterovaginales, incluyendo psoas Hitch y Boari flap. Con el continuo refinamiento de las técnicas laparoscópicas, los abordajes reconstructivos han pasado de un terreno prácticamente experimental, incluso anecdótico a la práctica habitual.Presentamos nuestra experiencia inicial con ureteroneocistostomía con psoas Hitch laparoscópico, en pacientes que han sido referidos con fístula ureterovaginal.Retrospectivamente, identificamos 5 casos de fístula ureterovaginal tratada mediante reimplante ureteral tipo Lich Gregoir y psoas Hitch en nuestra Institución, de septiembre de 2010 a julio de 2012. La indicación de la cirugía fue: presencia de fístula ureterovaginal con o sin estenosis de uréter de tercio distal.Las 5 pacientes tuvieron fístula secundaria a histerectomía por enfermedad benigna. La edad promedio fue de 37.2 (rango 34–43) años. A 2 pacientes se les colocó nefrostomía percutánea, previo a la cirugía. A 3 pacientes se les logró colocar catéter doble J. Involucro de la fístula: uréter derecho 2 y uréter izquierdo 3. La media de la longitud de las estenosis fue de: 1.9 (rango 1.4–2.2) cm. Tiempo quirúrgico promedio fue de 174 (rango 160–180) minutos. Sangrado transoperatorio promedio 130 (rango 50–200) mL.El primer reimplante ureteral laparoscópico fue realizado en 1994 por Erlich et al., en un paciente pediátrico. Reddy y Evans publicaron la primera ureteroneocistostomía en 1994, en la población adulta.La ureteroneocistostomía laparoscópica es un procedimiento seguro, reproducible, que muestra las ventajas de la cirugía de mínima invasión: rápida recuperación, poca convalecencia, corta estancia hospitalaria, con resultados equiparables a la cirugía abierta.Numerous approaches have been described for the surgical repair of ureterovaginal fistulas, including the psoas hitch and Boari flap. With the continual refinement of laparoscopic techniques, reconstructive approaches have gone from being practically experimental, to becoming common practice.We present herein our preliminary experience in ureteroneocystostomy with laparoscopic psoas hitch in referred patients presenting with ureterovaginal fistula.Five cases of ureterovaginal fistula were retrospectively identified that were treated with LichGregoir ureteral reimplantation and psoas hitch within the time frame of September 2010 to July 2012 at our institution. Indication for surgery was: ureterovaginal fistula with or without stricture in the distal third of the ureter.The 5 patients presented with fistula secondary to hysterectomy for benign disease. Mean age was 37.2 (range: 34–43) years. Percutaneous nephrostomy was placed in 2 patients prior to surgery and double-J catheter placement was achieved in 3 patients. The fistula invol-ved the right ureter in 2 patients and the left ureter in 3. Mean stricture length was 1.9 (range: 1.4–2.2) cm, mean surgery duration was 174 (range: 160–180) min, and estimated blood loss was 130 (range: 50–200) mL.The first laparoscopic ureteral reimplantation was performed in 1994 by Erlich et al. in a pediatric patient. Also in 1994, Reddy and Evans published a report on the first ureteroneocystostomy in the adult population.Laparoscopic ureteroneocystostomy is a safe procedure with the advantages of minimally invasive surgery: rapid recovery and short convalescence, with similar results to those of open surgery.

AIM:To evaluate the effectiveness of laparoscopic repair of primary strictures of ureteropelvic junction (UPJ) depending on baseline renal function of the ipsilateral kidney.MATERIALS AND METHODS:The study analyzed results of 134 patients (78 women and 56 men, age from 18 to 56 years) who underwent various types of laparoscopic repair of the UPJ stricture from 2012 to 2015. Depending on the surgical technique all patients were divided into three groups: group 1 (n=34) underwent spiral flap technique by Culp and DeWeerd, group 2 (n=59) - Anderson-Hynes pyeloplasty and group 3 (n=41) had antevasal dismembered pyeloplasty. All interventions ended with internal ureteral stenting for up to 6-8 weeks. Also, all patients were divided into three subgroups, depending on the degree of renal function deficiency - less than 25%, 25-50%, and 51-75%. Treatment effectiveness criteria included the following parameters: complete relief of the pain syndrome, a decrease in the degree of pyeloectasia, stabilization or improvement of the functional state of the renal parenchyma (according to radioisotope renography), and the absence of recurrence of the UPJ stricture.RESULTS:The overall effectiveness of UPJ laparoscopic reconstruction was 94.7% (127 of 134). The effectiveness of the treatment was independent of the surgical technique, the initial thickness of the renal parenchyma and the degree of PCS dilatation. There was an inverse correlation between the treatment effectiveness the degree of kidney function deficiency.CONCLUSION:In patients with hydronephrosis secondary to UPJ stricture, the effectiveness of surgical treatment is mainly determined by its timeliness. The best treatment results were observed in patients with better renal function. The degree of renal function deficiency should be considered the main prognostic factor for the effectiveness of the forthcoming operation.

Postradiation obstructive changes of distal parts of the ureter most commonly occur after radiation therapy for cervical cancer, endometrial cancer, bladder cancer. Pathogenesis of postradiation lesions of the ureteral wall are explained by destructive effects of radiation on the basal membranes of the capillary cell, causing an occlusion, thrombosis, and neovascularization, which in turn leads to proliferation of fibroblasts and stromal fibrosis. Possible complications include hematuria, urinary tract infections, vesicoureteral reflux, stent migration, stent encrustation. By the way, presence of the stent is often associated with pain and discomfort in patients. Aim of this work is to improve the results of treatment of strictures of the lower ureter following radiotherapy, by evaluating effectiveness of extravesical uretherocystoanastomosis and Boari procedure.

Osteoporosis could be present in the different conditions: oncologic, endocrinologic and rheumatologic diseases, diseases of the gastrointestinal system, kidneys, lungs and also as the complication of the intake of somemedications (corticosteroids, gonadotropin-releasing-hormone analogues (GnRH-A), etc.). According to the literature data, osteoporosis develops in 40-50% of patients with prostate cancer aer 2 years on GnRG-A. Osteodensitometry is a gold standard for diagnostics of the osteoporosis, but it allows not always to reveal the disturbances of the bone metabolism in oncologic diseases, especially at the earlier stage. In this review we show the contemporary evidence with biochemical markers of bone resorption (calcium, hydroxiprolin, NTX, CTX, PYD, DPD, TRAP-5b, bone sialoprotein BSP) and markers of the bone synthesis (osteocalcin, AAF, AKF, KKF), their advantages and disadvantages. e level of these markers is increases in the most of the patients with osteoporosis and bone metastasis. e changes in the markers of the bone metabolism in the serum shown to be the relevant method of the efficacy estimation of the antiresorptive therapy in patients with secondary osteoporosis, including that, induced by the androgen deprivation therapy for prostate cancer. e main markers recommended are CTX and PINP. Hormonal therapy is a first line standard in patients with locally-advanced and metastatic prostate cancer. Bisphosphonates are the main medication for osteoporosis, induced by GnRG-A. We discuss the different regimens for the dosage and duration of the antiresorptive therapy using bisphosphonates. стеопороз (греч. оsteon – кость + poros – пора) – системное заболевание скелета, характеризующееся уменьшением костной массы и нарушением микроархитектоники костной ткани, ведущими к повышению хрупкости кости и появлению переломов [1]. Остеопороз может развиваться при различных состояниях: онкологических, эндокринологических и ревматологических заболеваниях, при болезнях органов пищеварения, почек, легких, как осложнение при приеме некоторых медикаментозных средств (глюкокортикостероиды, аналоги ЛГРГ, тиреоидные гормоны, иммунодепрессанты и др.). Дефицит эстрогенов и тестостерона является одной из основных причин возрастного остеопороза и приводит к увеличению частоты переломов [1, 2]. По данным литературы, через 2 года лечения аналогами гонадотропин-релизинг-гормона (ГнРГ) остеопороз развивается у 40-50% больных раком предстательной железы (РПЖ). У мужчин с РПЖ, получающих андрогендепривационную терапию (АДТ), происходит нарушение костного обмена с уменьшением минеральной плотности костной ткани. При этом риск перелома костей увеличивается на 40% 50% [2, 3]. В исследовании, проведенном в США, риск переломов костей у мужчин, получивших агонисты гонадолиберина, составил 7,91 на 100 человеко-лет, по сравнению с 6,55 на 100 человеко-лет для пациентов, которые не получили агонисты ГнРГ (относительный риск 1,21; 95% ДИ, 1,09-1,34) [4].