У мужчин одним из чаще всего встречающихся онкологических заболеваний является рак предстательной железы. Страдают данной патологией в основном пациенты старшей возрастной группы. На сегодняшний день современная медицина располагает большим количеством методов радикального лечения рака предстательной железы с хорошими показателями выживаемости. Однако пациенты пожилого и старческого возраста довольно сложны в лечении хирургическим путем ввиду наличия коморбидности. Любая сопутствующая патология должна быть вовремя компенсирована в предоперационном периоде для достижения максимально возможных положительных клинических результатов после операции. Among the male population, one of the most common cancers is prostate cancer. The predominant number of patients suffering from this pathology are patients of the older age group. Today, modern medicine has a large number of methods of radical treatment of prostate cancer with good survival rates. However, elderly and senile patients are quite difficult to treat surgically due to the presence of comorbidity. Any concomitant pathology should be compensated in time in the preoperative period in order to achieve the maximum possible positive clinical results after surgery.

Актуальность. Доброкачественная гиперплазия предстательной железы — распространенное заболевание у мужчин старше 60 лет. В качестве золотого стандарта лечения доброкачественной гиперплазии предстательной железы объемом до 80 см3 применяют трансуретральную резекцию предстательной железы. В то же время при объеме простаты более 80 см3 выбор оптимального метода хирургического лечения является предметом дискуссий. Цель — оценка эффективности и безопасности тулиевой лазерной энуклеации предстательной железы (ThuLEP) у больных доброкачественной гиперплазией предстательной железы с объемом предстательной железы более 80 см3. Материалы и методы. В исследовании приняли участие 75 пациентов в возрасте от 64 до 83 лет (средний возраст 70,4 года) с объемом предстательной железы от 80 до 215 см3 (в среднем 123,9 см3). Всем больным выполняли ThuLEP с помощью тулий-волоконного лазера FiberLase U1 мощностью 120 Вт. Контрольные обследования проводили через 3 и 6 мес. после операции. Результаты. Продолжительность оперативного вмешательства составила в среднем 84,7 мин (57–135 мин). Длительность нахождения уретрального катетера после операции в среднем составила 2,8 сут. Частота интраи послеоперационных осложнений была низкой, ни одному пациенту не потребовалось проведения гемотрансфузии, а также повторного оперативного вмешательства с целью коагуляции сосудов ложа предстательной железы. У 3 (4 %) пациентов во время марцелляции возникло поверхностное повреждение стенки мочевого пузыря, которое потребовало коагуляции места травматизации. Все зафиксированные осложнения относились к I и II группам по шкале Clavien – Dindo. Проведенные чрез 3 и 6 мес. обследования показали достоверное снижение выраженности расстройств мочеиспускания, повышение качества жизни и улучшение оттока мочи из мочевого пузыря по сравнению с исходным уровнем. Выводы. Результаты проведенного исследования показали высокую клиническую эффективность и безопасность применения тулиевой лазерной энуклеации доброкачественной гиперплазии у пациентов с размерами предстательной железы более 80 см3.

Prostate cancer is an actual problem among males of older age groups, while the concomi-tant premorbid background of this category of patients often leads to the development of postopera-tive complications using the standard surgical method. The article presents the results of using low-pressure pneumoperitoneum with anterior abdominal wall lifting for laparoscopic radical prostatec-tomy in elderly patients with a localized form of prostate cancer. Convincingly shown that the use of low-pressure techniques pneumoperitoneum with lifting anterior abdominal wall ensures satis-factory operating field, obtains stable indicators of operational monitoring and allow to reduce the duration of the operation, as well as reduce the duration of hospitalization and incidence of postoperative complications.

AIM:To compare the results of the MRI-ultrasound fusion targeted biopsy (MRF-TB) and systematic 12-core biopsy (SB) of the prostate and analyze the relationship between biopsy results and the prebiopsy multiparametric MRI.MATERIAL AND METHODS:The study included 380 men aged from 45 to 80 years with a total PSA level of 4 to 10 ng/ml (according to Hybritech calibration) and a negative result of digital rectal examination. All men underwent the multiparametric MRI of the prostate before biopsy. MRI results were assessed according to the PI-RADS Version 2 criterion. In all men (n=247) with PI-RADS category 2 or higher lesion were performed MRF-TB (4 targeted columns) and SB (12 standard points) of the prostate.RESULTS:There were no significant differences in the detection of all types of prostate cancer (PCa) in all patients between MRF-TB and SB (p=0.731). At the same time, significantly less low-risk PCa (Gleason 6) (p<0.001) and significantly more aggressive PCa (Gleason more or equal 7) (p<0.001) were detected in MRF-TB group in comparison with SB group. In addition, MRF-TB allowed to detect significantly more aggressive type of PCa (Gleason more or equal 4 + 3) compared to SB (p=0.025).CONCLUSION:MRF-TB allows to detect more significant PCa (Gleason more or equal 7) in comparison with SB, while limiting the detection of low-risk PCa (Gleason 6) in general population of men.

Aim. To investigate the renal transplantation results for patients with end-stage renal disease (ESRD) due to autosomal dominant polycystic kidney disease (PKD). Materials and methods . The study included a prospective and retrospective analysis of the kidney transplantation results in 46 patients with ESRD caused by PKD, performed in the period from 2003 to 2018. Two groups of patients were formed. The comparison group consisted of 23 (50%) cases of kidney transplantation in patients whose polycystic-changed kidneys were preserved at the time of transplantation. The study group included 23 (50%) patients who underwent pretransplantation nephrectomy of native kidneys for clinical indications or to prepare for the waiting list. During the study, an algorithm of examination and surgical preparation for inclusion patients with PKD in the waiting list for kidney transplantation was developed and actively used. Results. The mean follow up period of patients who underwent pretransplantation nephrectomy was 3.6 ± 2.5 years, patients with preserved native kidneys - 5.3 ± 3.08 years (p > 0.05). Periodic pain in the lumbar region disturbed 12 (52.2%) patients with preserved polycystic-changed kidneys. The frequency of episodes of leukocyturia, bacteriuria and(or) hematuria significantly differed and amounted to 0.27 ± 0.35 cases per year in the study group, 1.49 ± 0.54 (p < 0.05) in the comparison group. Posttransplant nephrectomy of polycystic-changed kidneys at different times after transplantation was required in 5 (21.7%) patients. Five-year graft survival in the study group was 87.5%, in the comparison group - 76.1%. Among the patients of the comparison group, 76.4% of transplants lost their function after 10 years. The 5 and 10-year survival rates of patients with preserved native kidneys were 90.5% and 80%, respectively. In particular, there was one fatal outcome due to sepsis on the background of infection with cysts of preserved polycystic kidney. There were no deaths in the study group. Conclusion. Among patients whom polycystic-changed kidneys removed, there is a more favorable course of the post-transplant period due to the low frequency of infectious complications. More than 60% of patients with PKD need to perform nephrectomy of native kidneys during life for various reasons, including more than 21,7% need it after kidney transplantation due to complications during immunosuppressive therapy. Reasonable assessment of the polycystic kidneys and timely pretransplantation nephrectomy are an integral part of the preparation and management of the waiting list for transplantation of a patient with PKD.

Aim. To investigate the structure and frequency of occurrence of the infection in the cysts of the kidneys in patients with end-stage renal disease (ESRD) due to autosomal dominant polycystic kidney disease (PKD).Materials and methods.For the first time the microbiological study of the biological materials obtained from the patients with PKD were performed. That were the polycystic-altered kidneys removed in preparation of potential recipients for kidney transplantation, which were made as a routine step. All patients underwent surgical treatment in order to prepare for kidney transplantation or according to clinical indications. Two groups of patients have been distinguished: the 1st group – 7 (33.3%) patients with asymptomatic course of disease, the 2nd group – 14 (76.7%) patients who had symptoms of infection of kidneys and urinary tract.Results. As a result of this work, the presence of latent and active infection in 18 (85.7%) patients, including 6 (85.7%) patients with asymptomatic polycystic course, was proved. At microbiological research the causative agent of infection was not revealed only at the 1st patient in the first group and in 2 patients in the second group. Infection of cysts of kidneys of 6 patients with asymptomatic course of PKD was proved only after research of their contents taken intraoperatively. There is no correlation between the presence of infection, symptoms and the size of polycystic kidneys. Multidrug resistant infection only sensitive to modern antibiotics ultrawide spectrum of action was detected in 6 patients, including 2 patients with asymptomatic.Conclusion.Critically high actual infection of more than 80% of polycystic-altered kidneys has been established, which allows to consider them as a source of chronic infection in the context of future transplantation. The presence of latent, including multiresistant infection in cysts, worsens the prognosis of kidney transplantation in this category of patients without nephrectomy.

The objective of this study was to compare the results of the MRI-ultrasound fusion-targeted biopsy (MRF-TB) and the systematic 12-core biopsy (SB) of the prostate and investigate the relationship between the results of the biopsy and the multiparametric MRI of the prostate before the biopsy.Material and methods. The study included 380 men with a total PSA level from 4 to 10 ng/ml (according to Hybritech calibration) and with negative result of finger rectal examination at the age from 45 to 80 years. All men underwent a multiparametric MRI of the prostate before biopsy. The changes detected on the MRI were assessed taking into account the PI-RADS Version 2-criterion. All men (247 men) with PI-RADS 2 or more underwent MRF-TB (4 aiming columns) and SB (12 standard points) of the prostate.Results. There were no significant differences in the detection of all types of prostate cancer (PC) in all patients between MRF-TB and SB (p=0.731). At the same time, significantly less PC (Gleason 6) (p<0.001) and significantly more PC (Gleason ≥7) (p<0.001) were detected with MRF-TB compared with SB. Also, MRF-TB allows significantly more often to detect the most malignant form of PC (Gleason ≥4+3) compared with SB (p=0.025).Conclusion. MRF-TB detects more cases (Gleason ≥7), compared with SB, while limiting the detection of PC (Gleason 6) in all men presented for biopsy of the prostate.

THE AIM: to evaluate the clinical significance of the use of prostate-specific antigen (PSA) and its fractions and indexes for early detection of prostate cancer (PCA) in men with total PSA (tPSA) 2-10 ng/ml with a negative digital rectal examination (DRE). MATERIALS AND METHODS . It were examined 904 men aged 45-80 years with tPSA 2-10 ng/ml (Hybritech calibration) and a negative result DRE. Morphologic study of 628 people were identified benign prostatic hyperplasia (BPH) and 276 – PCA. All patients underwent ultrasound examination of the prostate, with determined total PSA (tPSA) concentration, its fractions and indexes. RESULTS . In PCA, the relative concentrations in the serum free PSA was 19% lower and the absolute content [-2]proPSA at 42% higher, and the prostate health idex (PHI) – at 49% higher. At low values of tPSA for prostate cancer would not be diagnosed in 9%, and at normal values of – 28% of patients. The sensitivity of the method at tPSA of 4.0 to 10.0 ng/ml is 0,630 and specificity of 0,519. tPSA, %fPSA were negative, but [-2]proPSA, %[-2] proPSA and PHI is positively correlated with the Gleason sum. All indicators in stage 2 for PCA are significantly different from the values characteristic of stage 1 of the disease. Though, for commonly used metrics – tPSA, fPSA and %fPSA – differences did not exceed 22-27%. However, [-2] proPSA, %[-2]proPSA and PHY at stage 2a increased by 20-53%, and at stage 2b – by 55-77%. CONCLUSION . The most in-formative indicators for early diagnosis of PCA was PHY, [-2]propsa. Determinatioms of PHY in the dynamics within the screening can substantially improve early diagnosis of PCA.

AIM: to determine the significance of [-2]proPSA and prostate health index for the diagnostics of prostate diseases in patients with PSA level in blood plasma less than 4 ng/ml. PATIENTS AND METHODS: 148 men were examined in the urology clinic of Pavlov First Saint Petersburg State Medical University for the exclusion of prostate cancer (PCa). The inclusion criteria were: the level of total PSA in blood plasma less than 4 ng/ml, the presence of changes in the prostate during digital rectal examination, the detection of hypoechoic sites according to transabdominal ultrasound examination of the prostate or a decrease in the ratio of free and total PSA in blood plasma less than 15%. For all the patients the level of [-2]proPSA was assessed, its percentage to total PSA and the prostate health index were calculated. Based on the results of the biopsy, all patients were divided into 3 groups. Patients with histopathomorphologically verified benign prostatic hyperplasia (BPH) were included in the first group (83 patients), in the second group (14 patients) - with prostatic intraepithelial neoplasia (PIN), in the third (51 patients) - patients who had focal atypia and/or adenocarcinoma of the prostate. Clinical and laboratory parameters were compared between the abovementioned groups. RESULTS: Prostate health index was found to be the most significant factor of difference comparing patients with BPH and PCa, as well as in the presence of PIN and PCa (p<0.001 for both), while a statistically significant difference in this indicator was not obtained comparing BPH and PIN patients. CONCLUSION: Prostate health index showed the greatest prognostic value in the diagnostics of prostate diseases in patients with PSA level in blood plasma less than 4 ng/ml.

Aim. To assess the possibilities of the use of laparoscopic transabdominal nephrectomy (LNE) for surgical treatment and preparation of the patients with autosomal dominant polycystic kidney disease (ADPKD) for kidney transplantation. Materials and тethods. In the course of the study 28 patients who underwent nephrectomy of a polycystic-modifi ed kidney were analyzed and divided into two groups. The fi rst group (15 patients) underwent open surgical intervention with the use of midline laparotomy and lumbotomy (16 operations), of which: bilateral nephrectomy – 11 (68.7%), monolateral nephrectomy – 5 (31.3%). In the second group (13 patients), laparoscopic transabdominal monolateral nephrectomy (17 operations) was done. Surgical interventions were performed for emergency indications and to prepare for kidney transplantation. Results. The average duration of laparoscopic and open surgical interventions was not signifi cantly different and amounted in the fi rst and second group to 146 ± 14 and 124 ± 11 minutes (p > 0.05), respectively. The frequency of postoperative complications after open surgical interventions made up 43.75%, the mortality rate was 6.25% (1 case). In patients operated on laparoscopically postoperative complications occurred in 11.8% of cases. Patients after laparoscopic procedures were activated in 2–3 days (2.63 ± 0.23), after open operations on 4–5 (4.13 ± 0.39, p < 0.05). The average length of postoperative hospital stay was in the fi rst group – 13–14 (13.7 ± 1.3), in the second group – 7–8 (7.7 ± 0.5, p < 0.05). Conclusion. Atraumatic laparoscopic technology leads to a more favorable course of the postoperative period after nephrectomy. It can reduce the duration of inpatient treatment and help activate patients at an earlier date. The method of LNE can signifi cantly reduce the frequency of postoperative complications and expand the possibilities of using nephrectomy in the treatment and management of patients with autosomal dominant polycystic kidney disease waiting for renal transplantation.