Introduction. The case of a robot-assisted laparoscopic radical prostatectomy in a patient with an 81-gram prostate with a large medial lobe (39-gram) is presented. We describe the technique of operation, show the main perioperative indications and summarize the rehabilitation period. The aim of the study is to detect possible technical difficulties of this operation, to attract the interest of urologist to this topic and to share our experience. Materials and methods. А 73-year-old male presented to the urology clinic because of elevated PSA level (18 ng/ml); transrectal ultrasound-guided biopsy of the prostate revealed a Gleason score 6 (3 + 3) acinar adenocarcinoma involving left lateral and medial zone; according to the magnetic resonance scan prostate size is 81 g, asymmetric with a prevalence of the left lobe, median lobe size is about 39 g, median lobe prolapses into the bladder for 4,6 cm, the prostatic part of the urethra is shifted to the left, there is no data for extracapsular extension, the lymph nodes haven’t got any changes, there are no signs of specific bone damage according to the bone scan. The patient underwent robot-assisted laparoscopic radical prostatectomy with bilateral nerve sparing. Results. The procedure length was about 200 min; console time — 155 min. Blood loss was 120 ml. The hemoglobin level decreased by 7.6 % of the initial value. Pelvic drain removed on 2rd day. The urethral catheter was removed on 7th day. On the 8th day patient was discharged from hospital. Conclusions. A robot-assisted laparoscopic radical prostatectomy in a patient with a large medial lobe give to the operative surgeon several problems: the large size of the prostate, the difficulty of bladder neck reconstruction, special attention on the stage of mobilization of the ureteral opening.

THE AIM: to analyze the results and estimation of efficacy of robot-assisted radical prostatectomy (RARP) in patients with prostate cancer (PCa). PATIENTS AND METHODS. Between 2010 and 2016 we performed 257 RARP in patients with PCa stage T1-T3aN0M0, Gleason 4-9, 48-78 years old with 11,5-155 ml prostate volume and 3,1-120 ng/ml general PSA level. We performed standard and modified RARP technique which included the preserving and reconstruction of periprostatic anatomical structures of pelvic. RESULTS. The operative time was 170±50 min, blood loss - 130±35 ml. There were no conversions, the intraoperative complications rate was 2,1%. Postoperative Clavien I-II rate - 21%, Clavien III - 3,5%, Clavien IV-V - 0%. Hospital stay was 12,0±4,2 days, urethral catheter removed on day 7-8. The continence rate was 91% and 98,6% after 1 and 12 months respectively, the potency recovery rate was 72% and 92% in 1 and 12 months respectively. The positive surgical margin rate was 14%. The “trifecta” and “pentafecta” were achieved in 87% and 52% respectively after 12 months. Five-years cancer-free survival rate, cancer-specific and overall survival rate were 94%, 100% and 97,5% respectively. CONCLUSION. Due to construction benefits of da Vinci robotic system we may now achieve preserving, reconstruction and enhancing of periprostatiс anatomical structures which are participated in continence mechanism. The improving of RARP technique should contribute to early continence recovery in patients with PCa.

INTRODUCTION. Nephrectomy can be performed by open (ON), laparoscopic (LN) or robot-assisted (RN) method. All methods provide identically certain cancer treatment, however, in recent years the tendency for wider application of minimally invasive methods was noticed. AIM OF RESEARH: to compare three methods of nephrectomy in patients with localized kidney cancer. PATIENTS AND METHODS. We performed 73 open, 10 laparoscopic and 23 robot-assisted nephrectomies to patients with kidney cancer stage T1-2N0M0. We evaluated main factors such as serum creatinine concentration and glomerular filtration rate, surgery duration, extent of blood loss, post operation bed day period. RESULTS. Average duration of ON was lower than LN and RN (139,5; 184,5 and 152,5 min respectively). Average extent of blood loss at ON (447 ml) was significantly higher than at LN and RN (302 and 213 ml respectively). Increase of serum creatinine was 44,7%, 52,2% and 52,9% for ON, LN and RN respectively. Post operation bed day was longer after ON (12 days) than after LN and RN (8 and 7 days respectively). CONCLUSION. After ON, LN and RN appears early acute kidney injury. In blood loss questions and patients post operation recovery ON conceded LN and RN in spite of less operation duration. Preference should be given minimally invasive methods which provide high and comparable to each other results.

The aim of our study is to introduce a safe and easy way to perform partial nephrectomy via different approaches with a set of our specially engineered instruments for parenchyma clamping. Between January 2011 and October 2013 we performed a total number of 110 open, laparoscopic and robotic partial nephrectomies (PN) in patients with RCC stage T1-2N0M0. Eighty-six and 24 patients underwent PN with traditional vascular clamping (VC group) and selective parenchyma clamping (PC group), respectively. We worked out 3 types renal parenchyma clamps (patented inventions): one for laparoscopic/robotic PN and two kinds for open procedures (upper/lower pole and middle segment of kidney). We measured glomerular filtration rate (GFR) before the procedure and 24 hours and 1 year after. We also measured operative time, blood loss, warm ischemia time and parenchyma clamping time. In VC group depression of GFR 24 hours and 1 year after the operation was 22% and 33%, respectively. Deterioration of GFR 24 hours and 1 year after surgery in PC group was 5% and 12%, respectively. In both groups patients didn’t face any perioperative complications or reinterventions. Cancer-specific survival rate was 100% in both groups during 1 year follow-up. NSS can be performed in a safe manner under regional ischemia with selective parenchyma clamping. Regional ischemia shows better functional results immediately and 1 year after the surgery and can be achieved by using specially designed parenchyma clamps during open, laparoscopic and robotic partial nephrectomy.

THE AIM OF STUDY was to find out the beginning of the acute kidney injury (AKI) after partial or radical nephrectomy. PATIENTS AND METHODS. 17 patients with renal cell carcinoma were treated either via radical (5 cases) or partial (12 cases) nephrectomy. The procedures were performed through open, laparoscopic or robotic approaches. Partial nephrectomies were made under regional (local) ischemia by putting special clamps on renal parenchyma. The serum creatinine was measured before procedure and 24 h later. Plasma NGAL levels was measured before surgery and 2 hours later. Urine NGAL was measured before surgery after 2, 4 and 8 hours. RESULTS. The histological diagnosis was RCC in all cases. In groups of radical and partial nephrectomy initial level of blood serum creatinine, blood serum NGAL and urine level didn’t exceed normal values. In radical nephrectomy group urine NGAL level increased 2 hours after surgery. Maximal values were detected at 8 hours after surgery (increase of factor to 123,4±29,1 ng/ml). In group of partial nephrectomy urine NGAL begin to increase at 2 hours after surgery too. Maximal values were detected after 8 hours after surgery 25,4±14,6 ng/ml. CONCLUSIONS. Concentration of urine NGAL over time provide to reveal acute kidney injury 2 hours after surgery.

Introduction. The aim of the study is to share the experience in performing robotic and laparoscopic partial nephrectomy in the conditions of regional ischemia by placing a special surgical clamp on renal parenchyma or by selective clamping of segmental renal artery. We describe the main pros for performing regional ischemia, i. e. lower risk of acute kidney injury in the postoperative period. Matherials and methods. Laparoscopic and robot-assisted partial nephrectomy under regional ischemia was performed in 7 cases aged 35–72. The tumor size varied from 2 to 4 cm. Special surgical clamp was used in 6 cases and segmental renal artery clamping was performed in 1 case. Results. The operative time varied from 120 to 190 minutes, regional ischemia time was 13–30 minutes and blood loss — 30–270 ml. The were neither conversions nor complications. The serum creatinine level did not vary significantly before and after the procedure. Conclusion. Partial nephrectomy under regional ischemia prevents the onset of acute kidney injury. The special surgical clamp makes the surgery easier and reduce the operative time and blood loss.

Introduction. The aim of the study is to share the experience in performing robotic and laparoscopic partial nephrectomy in the conditions of regional ischemia by placing a special surgical clamp on renal parenchyma or by selective clamping of segmental renal artery. We describe the main pros for performing regional ischemia, i. e. lower risk of acute kidney injury in the postoperative period. Matherials and methods. Laparoscopic and robot-assisted partial nephrectomy under regional ischemia was performed in 7 cases aged 35–72. The tumor size varied from 2 to 4 cm. Special surgical clamp was used in 6 cases and segmental renal artery clamping was performed in 1 case. Results. The operative time varied from 120 to 190 minutes, regional ischemia time was 13–30 minutes and blood loss — 30–270 ml. The were neither conversions nor complications. The serum creatinine level did not vary significantly before and after the procedure. Conclusion. Partial nephrectomy under regional ischemia prevents the onset of acute kidney injury. The special surgical clamp makes the surgery easier and reduce the operative time and blood loss.

AIM OF RESEARCH: to evaluate glomerular filtration rate dynamics before and after the various options and volume of surgery in patients with kidney malignant neoplasms. PATIENTS AND METHODS: We examined 62 patients (men – 41, women - 21) surgically operated with malignant renal tumors (open, laparoscopic, or robot–assisted total nephrectomy or partial nephrectomy). The group 1 (n = 28) – tumor resection, group 2 (n = 34) – nephrectomy. Estimated glomerular filtration rate (eGFR) was calculated by several methods: a brief MDRD formula [7], D.W. Cocroft and M.H. Gault formula (CCG) [8], the equations of CKD-EPI [9] and MCQ. RESULTS: showed that surgical operation led to authentic increase of SCr and Sur and significant decrease of eGFR regardless of the extent of surgical intervention. Intergroup differences in all researched parameters after surgery has not been established, although there was a trend downwards concerning all used eGFR methods in patients with nephrectomy (not statistically significant due to the considerable scatter of data). CONCLUSION: Surgical interventions in patients with renal cancer in the great majority of cases induce the development of chronic kidney disease 2–3 and, even 4 stages – an independent predictor of cardiovascular morbidity and mortality.

Pharmacotherapy of prostatic adenoma is based in present-day practice primarily on two basic groups of medicines--inhibitors of 5alpha-reductase and blockers of alphal-adrenoreceptors. Our trial included 98 patients with prostatic adenoma aged 59-79 years given combined treatment with finasteride (inhibitor of 5alpha-reductase) made in Hungary (prosteride, Gedeon Richter) and an uroselective blocker of alpha1-adrenoreceptors sonisin (Gedeon Richter, Hungary). Prosteride was given for 12 months, sonisine--for the first 6 months of combined treatment. Positive results were achieved in 97 (99%) of 98 patients. After 12-month combined treatment symptoms of the disease reduced by IPSS from 17.9 +/- 1.8 to 3.9 +/- 0.9 points, Qmax rose from 8.8 +/- 0.3 to 14.6 +/- 0.3, residual urine volume diminished from 91.7 +/- 8.5 to 31.7 +/- 4.4, the size of the prostate reduced from 72.4 +/- 2.9 to 50.6 +/- 3.7, quality of life improved 2-fold. Combined administration of finasteride (prosteride) and alpha1-adrenoblocker tamsulosine (sonisine) meet three principles of pharmacotherapy of prostatic adenoma: prevents progression of the disease and surgical treatment, relieves symptoms and improves quality of life.