Introduction. Warm renal ischemia (WRI) is used during the organ-preserving surgery of localized renal cell carcinoma to reduce blood loss, improve the imaging quality, facilitate both accessing the cavitary system and suturing the parenchyma. However, WRI can lead to the ischemic reperfusion injury of the preserved nephrons. Superselective embolization (SSE) of the tumor-feeding branch of renal artery is currently being considered as the alternative method of intraoperative hemostasis. Aim. To evaluate the results of organ-preserving surgery of localized kidney cancer in the conditions of SSE. Materials and methods. Three patients who had undergone laparoscopic kidney resection (LKR) with SSE were included in the study. Parameters for assessment were as follows: surgery duration, surgery workflow, intraoperative blood loss volume, the degree of radical surgery according to the histological data, the presence of postoperative complications, and the duration of hospitalization. Results. Compared with the LKR with WRI (n=78, data from a previous own study), the features of the LRK with SSE (n=3) were as follows: 1) the same surgery duration; 2) three times less intraoperative blood loss; 3) the absence of infectious and inflammatory complications; 4) comparable duration of hospitalization. Also, additional advantages of the LKR with SSE were described: 1) the radicality of surgery; 2) the absence of the risk of renal pedicle injury; 3) the absence of the risk of ischemic reperfusion alteration of the preserved renal tissue. Conclusion. Preliminary SSE of the tumor-feeding branch of renal artery may improve functional results of the organ-preserving surgery of localized kidney cancer via reducing the intraoperative blood loss, exclusion the possibility of renal pedicle injury, and provision of the functional activity of the preserved nephrons.

Introduction. The three-dimensional (3D) imaging during laparoscopic procedures can improve the quality of that surgeries. There is a shortage of publications about the potential benefits of 3D navigation in laparoscopic surgery with urological diseases. Radical prostatectomy (RPE) is known as the gold standard of treatment of localized prostate cancer (PC), and investigation of imaging technologies in laparoscopic surgery in PC patients is a hot topic. Aim. To compare the perioperative outcomes of laparoscopic RPE performed with 3D and two-dimensional (2D) imaging. Materials and methods. We performed retrospective analysis of perioperative outcomes in 146 patients who had undergone radical surgery with localized PC. All the patients were divided into 4 groups by the surgery features: 1) 2D imaging with the technique for neurovascular bundles preservation (TNVBP) (n=52); 2) 2D without TNVBP (n=46); 3) 3D with TNVBP (n=23); 4) 3D without TNVBP (n=25). We assessed operative time, intraoperative blood loss volume (IBLV), duration of the bladder drainage, positive surgical margin (PSM) detection rate, duration of the postoperative inpatient period, urinary continence recovery rate, erectile function recovery (EFR) rate. Results and discussion. In groups 1, 2, 3, 4 the operative time was 171,4±21,1, 168,3±23,2, 98,7±17,3, 92,2±22,2 min, and the IBLV was 294,2±62,1, 281,2±53,2, 144,2±31,7, 148,5±33,0 mL, respectively. PSM detection rate was 1,92±0,11%, 2,17±0,04% in groups 1, 2, while PSM had not been detected in groups 3, 4. In all the participants, duration of the bladder drainage was 5–7 days, and the full recovery of urinary continence was detected at both 6 and 12 months after the surgery. The postoperative inpatient period was 8–10 days in groups 1, 2, and 8–9 days in groups 3, 4. The EFR at 3 months after the surgery was detected in 38,4%, 28,3%, 34.8%, 28.0% of patients, while at 12 months it was detected in 59,6%, 41,3%, 82,6%, 56,0% of patients in groups 1, 2, 3, 4, respectively. Conclusion. We revealed the following features of perioperative period of laparoscopic RPE performed with 3D imaging compared to 2D: 1) the operative time was reduced by 42–45% (р<0,05); 2) the IBLV was reduced by 47–51% (р<0,05); 3) the PSM had not been detected; 4) there was the tendency to the shorter postoperative inpatient period; 5) the EFR rate was increased by 1,3–1,4 times (р<0,05), and the best EFR outcomes were obtained via 3D imaging together with TNVBP. Thus, our study demonstrates the advisability of usage of both 3D imaging and TNVBP during the laparoscopic RPE.

INTRODUCTION:Currently, there are paucity of reports on the success of medical prevention of venous thromboembolic complications after urological procedures.AIM:To evaluate the efficiency of enoxaparin sodium for prevention of postoperative venous thromboembolic complications in urological patients.MATERIALS AND METHODS:According to the medical records of 151 men and women aged 22 to 92 years old who were undergone to elective surgical treatment in April 2021, the results of the thrombin generation assay and ultrasound study of the inferior vena cava were retrospectively analyzed. All patients were divided into 6 study groups depending on the degree of risk of postoperative venous thromboembolism (very low, low, moderate, high, very high and extremely high). The data obtained during the thrombin generation assay in patients from different groups were compared with those in healthy volunteers (n=30, control group) and evaluated in dynamics. In addition, intergroup comparison was done.RESULTS:All study participants prior to surgery had a significant increase in peak thrombin and endogenous thrombin potential (ETP) by 5-26% and 13.5-21.5%, respectively. The postoperative findings were as following: 1) one hour after the procedure, a significant (by 9-28.6%) decrease in the normal bleeding time (Lag time); 2) a significant increase in the peak thrombin by 4.8-10.6% 1 hour after surgery and by 11-40.2% at the end of the first postoperative week; 3) reducing the time to peak thrombin (ttPeak) by 13-15%; 4) increase in ETP. According to the ultrasonic data, all study participants had no signs of thrombosis of the inferior vena cava system.CONCLUSION:In urological patients requiring surgical treatment, before and after procedure, there is almost always a shift in the hemostasis towards the predominance of the blood coagulation system. Under such conditions, to prevent the development of postoperative VTE, it is expedient and pathogenetically justified to use enoxaparin sodium in a single dose of 0.4 ml or 4000 anti-Xa IU administered once a day s/c 24 hours before the procedure and till full activation of a patient.

Background. Currently, in men suffering from prostate cancer, histological examination of the material obtained during pelvic lymphadenectomy (PLAE) is the most accurate and reliable method for staging the tumor process and postoperative prognosis of disease outcomes, an important factor influencing the choice of the most rational treatment tactics after radical prostatectomy. However, today questions about the therapeutic (oncological) expediency of PLAE and its safety in terms of the development of intra- and postoperative complications remain debatable.Aim. To was to compare the perioperative and therapeutic (oncological) results of radical prostat ectomy performed in combination with standard or extended PLAE.Materials and methods. The study materials were the data of medical records of 812 men aged 43 to 78 years, at different times (from January 2009 to December 2018) who were hospitalized for localized or locally advanced prostate cancer in stages cT1a–cT3bN0M0. The research method was a retrospective analysis of the data contained in the selected medical records.Results and conclusion. The results of our studies, firstly, confirm the conclusions of the European Association of Urology (EAU) experts on the justification and necessity of performing an extended PLAE with radical prostatectomy in order to diagnose metastatic lesions of the pelvic lymph nodes in individuals with an intermediate or high risk of prostate cancer progression; secondly, they indicate a higher therapeutic efficacy of extended PLAE compared to that for standard PLAE, which is expressed in a statistically significantly three times lower incidence of biochemical relapses and an 11.4 % longer relapse-free period after extended PLAE than after standard PLAE. Extended PLAE, performed in one surgical session with radical prostatectomy, is not a risk factor for the development of various intra- and postoperative complications, with the exception of the lymphocele, which is formed in 3.7–13.5 % of cases of extended PLAE due to intraoperative transection of lymphatic vessels and lymph accumulation at the site of the removed adipose tissue.

The paper demonstrates the results of the application of fluorescent and diffuse reflectance measurements in laparoscopic renal surgeries during the warm ischemia. The experimental setup and results of the combined use of optical modalities for cellular metabolism and tissue saturation assessment are described.

While performing surgical treatment of the localized form of renal cell cancer by means of open or laparoscopic partial nephrectomy, renal warm ischemia is an important issue. Using renal warm ischemia allows to prevent parenchymal bleeding, to optimize conditions for resection of the tumor and to increase significantly the efficiency of hemostasis. However, an important problem is the probability of ischemic hypoxic damage of the remaining part of the kidney tissue during renal warm ischemia and renal functional impairment in the postoperative period.AIM:To compare nephroprotective activity of sodium fumarate, mannitol and furosemide using experimental model of 30- and 60-minute renal warm ischemia in rabbits.MATERIALS AND METHODS:The experiments were carried out on 360 conventional male-rabbits of the "Chinchilla" breed weighed 2,6+/-0,3 kg which were allocated into 10 groups. The control group No1 included intact animals, the control group No2 included the rabbits in which renal artery was not clamped. For the animals from the trial groups (No3-No10) the experimental model of 30- and 60-minute renal warm ischemia was used. In groups No3 and No4 no drugs were provided. Other rabbits undergone renal warm ischemia with a protection by sodium fumarate (groups No5 and No6 - 1,5 ml/kg IV), lasix (groups No7 and No8 - 3,0 mg/kg IV) and mannitol (No9 and No10 - 1,0 g/kg IV). The influence of renal warm ischemia on the renal tissue ultrastructure and the levels of NGAL, Cystatin-C and creatinine in blood and urine were studied.RESULTS:During experimental pharmacologically uncorrected 30-minute renal warm ischemia in animals, edema of the terminal part of microvilli of the proximal tubules epithelium, an increase of lysosome number in the hyaloplasm of epithelial cells, appearance of flaky content of medium electronic density in the lumens of distal tubules and collecting tubules, as well as sharp peak-like increase of NGAL and cystatin-C in blood and urine were observed. Increasing the time of ischemia up to 60 minutes was accompanied by more severe disturbances. In groups where sodium fumarate, lasix and mannitol were used the observed ultrastructural disturbances were expressed to lesser extent, whereas sodium fumarate demonstrated the best nephroprotective activity. After using mannitol the severity of disturbances was less than in the groups where mannitol, lasix or sodium fumarate were not given. Lasix and sodium salt of fumaric acid showed a higher nephroprotective activity. The best results were received in the animals received sodium fumarate.CONCLUSIONS:The studied drugs provided a nephroprotective effect regarding ischemia of rabbit kidney. The effect of sodium fumarate was the most pronounced, followed by furosemide and, to a lesser extent, mannitol. Use of sodium fumarate allows to protect and stimulate the kidney tissue effectively during oxygen deprivation under ischemic state.

To compile this literature review, we studied at least 100 publications devoted to the genetic basis of clear cell, papillary, and chromophobic sporadic kidney cancer pathogenesis. Each of them considered the role of somatic gene and chromosomal mutations in the initiation, promotion, and tumor progression of sporadic renal cell carcinoma, emphasized the importance of determining the mutagenic profile of renal cell carcinoma for the future fate of patients.

Background. Radical prostatectomy in treatment of locally advanced prostate cancer is currently recommended as one of the stages of multimodal therapy. Despite this, the expediency of surgical intervention remains a subject of discussion: based on the results of their own research, supporters of surgical tactics for treatment of locally advanced prostate cancer point to the effectiveness and relative safety of radical prostatectomy, opponents point to the high probability of a positive surgical edge associated with the operation, local tumor recurrence, lymphogenic metastasis, and formation of distant metastases. Aim. To evaluate the outcomes of laparoscopic radical prostatectomy performed in combination with expanded pelvic lymphadenectomy in treatment of prostate adenocarcinoma T3a–3bN0M0. Materials and methods. The perioperative, functional, and oncological results of surgical treatment of patients with locally advanced prostate cancer ( n = 32) aged between 46 years to 71 years were analyzed. The follow-up period averaged 9–36 months (median 13 months). Results. Mean total duration of surgical intervention and mean volume of intraoperative blood loss were 182.69 ± 3.99 minutes and 253.06 ± 9.80 ml, respectively. Overestimation of the clinical stage of the disease, according to histological examination of the surgical material, was observed in 6.3 % of patients. After the intervention, the function of urinary retention was preserved and did not require correction in 65.6 % of men. In all patients 6 months after the operation, the urinary volume, maximum and mean urine flow rates were normalized, and there was a trend toward a decrease in the post-void residual volume. During the entire follow-up period, there were no signs of biochemical relapse in 78.1 % of patients. None of the participants dropped out of the study due to death. Conclusion. Over the last 20 years in specialized medical periodicals, author teams from various countries have shown the immediate and remote (follow-up period from 3 to 20 years) outcomes of radical surgical treatment of locally advanced prostate cancer in at least 80,000 patients in total, while the criterion for exclusion from research was adjuvant therapy. The authors’ conclusions indicate the effectiveness and relative safety of surgical treatment of locally advanced prostate cancer, as well as the importance of extended pelvic lymphadenectomy, which allows to optimize the tactics of adjuvant therapy if necessary. The results of our own observations are completely comparable with the literature data. Currently, scientific research is continuing with the aim of improving the outcomes of surgical treatment of locally advanced prostate cancer, in particular clarifying the role of individual prognostic factors, improving prediction techniques and choosing a rational scheme of treatment measures.

Introduction. Urothelial carcinoma of the upper urinary tract in Western countries of Erope and USA occurs in 1-2 cases per 100,000 populations. Nephroretrectomy remains the main method of treatment of this pathology, however, the role of organ-sparing surgeries increases with the bilateral localization of the tumor process. Due to the rarity of bilateral upper urinary tract lesions with urothelial cancer and the lack of data evaluating the results of organ-sparing surgeries in such situations, each clinical case is of interest. Materials and methods. The article describes a case of surgical treatment of a patient with non-invasive papillary urothelial carcinomas of both ureters and the pelvis of the right kidney, which were manifested by macrohematuria. Results. The diagnosis was confirmed by computer tomography (CT) and ureteroscopy with tumor biopsy, which revealed a neoplasm of the right kidney pelvis, multiple tumors of the distal part of the right ureter and a solitary neoplasm of the middle part of left ureter. The patient underwent laparoscopic nephrureterectomy on the right with transurethral resection of the bladder wall in the area of the mouth of the right ureter and endoscopic removal of the neoplasm in the middle third of the left ureter using laser energy. At the control examination 1,5 months after the surgical treatment, according to the results of CT, cystoscopy with biopsy of the bladder and ureteroscopy, as well as histological examination of the biopsies, no data for tumor growth were found. At CT 6 months after the surgery, no data for the recurrence of cancer were obtained. Сonclusions. This clinical observation demonstrates the technical feasibility and oncological feasibility of using organ-preserving surgical treatment for bilateral localization of low-grade urothelial carcinoma.

Introduction. Contemporary diagnosis of prostate cancer is crucial to the patient’s further fate. Difficulties in the histological verification of the final diagnosis and false-negative results of biopsy research are often associated with the similarity of the prostate adenocarcinoma`s micromorphological picture and its benign lesions. Purpose of the study. Comprehending the possibilities of immunohistochemical identification of tumor cells and the basal epithelial layer of prostate glandular structures in prostate cancer suspected cases. Materials and methods. A biopsy material was taken from 134 patients. Prostate adenocarcinoma was verified by routine histological examination in 72 samples, in 62 samples there were no signs of malignant transformation. Subsequently, immunohistochemical analysis of biopsy specimens was performed using antibodies to α-methylacyl-CoA racemase, nuclear p63 protein and high-molecular cytokeratin. Results. The AMACR-positive reaction of malignant cells and a negative reaction of the basal epithelium to nuclear p63 protein antibodies and high-molecular cytokeratin were detected during prostate adenocarcinoma. Conclusion. If prostate cancer is suspected, immunohistochemical assays with monoclonal antibodies to AMACR, p63 and high-molecular cytokeratin greatly facilitate the detection of adenocarcinoma.

С.В. Попов1, Р.Г. Гусейнов1, О.Н. Скрябин1, В.А. Корячкин2, А.В. Крицкий1, А.С. Катунин1, А.В. Давыдов1, Р.С. Бархитдинов1, А.А. Ложкин1, М.М. Мирзабеков1, Г.С. Труфанов1, Н.М. Николаев1, Д.Д. Хозреванидзе1 1СПб ГБУЗ Клиническая больница Святителя Луки; Россия, 194044 Санкт-Петербург, ул. Чугунная, 46 2Кафедра анестезиологии, реанимации и неотложной педиатрии имени В.И. Гордеева ФГБОУ ВО «Санкт-Петербургский государственный педиатрический медицинский университет» Минздрава России; Россия,194100 Санкт-Петербург, ул. Литовская, 2

Background. Restoring the quality of life of patients to a level comparable to that of practically healthy people is the most important task of medicine in general. At this stage of development of science, the main goal in the treatment of malignant diseases remains the preservation of life. However, now in oncological practice, methods whose potential allows not only to preserve life as such, but also to ensure the high quality of this life in all its manifestations, are acquiring greater and greater significance.The objective of the study is to compare the quality of life of persons with localized kidney cancer in the early and late periods after surgical treatment by radical nephroectomy and laparoscopic resection of renal tissue.Materials and methods. A questionnaire survey using SF-36 (Short Form-36), designed for a comprehensive assessment of the quality of life associated with health.Results. The quality of life of patients with localized kidney cancer before treatment is reduced due to a number of physical and mental nature, limiting labor, domestic and social activity and causing a feeling of dissatisfaction with their lives in general. These problems are disorders of physical, social and emotional functioning, physical pain, deterioration of general and mental health, limitations of role functioning due to physical and emotional state. After surgical treatment with laparoscopic resection, complete satisfaction of patients with the quality of their life was achieved during the first 1–3 postoperative months; after radical nephroectomy – not earlier than 1–3 years.Conclusion. One of the advantages of laparoscopic resection over radical nephroectomy is a higher quality of life of patients in the early and late periods after the intervention.