The male urethral stricture disease treatment despite all successful achievements and treatment options still remains one of the most actual and complex problems of modern urology. The presence of prolonged urethral strictures complicated with such factors as expressed scared deformation, infection, fistulae, previous unsuccessful urethral interventions, total urethral obliteration require the use of two- or multistage operations. In the light of recent times, the improvement methods dedicated to buccal mucosa graft adaptation assessment and autotransplant microvascularity evaluation are very relevant nowadays. In this study we made an attempt to estimate the dermatoscopy role in objective assessment of buccal mucosa graft microvascular network after two staged substitutive urethroplasty.The analysis of graft microphotos made in different time periods after urethroplasty allows us to define the main thing. In our point of view, the absence of evaluation changes after 90–120 postoperative days allows us to estimate a correct time for the second stage of urethroplasty-tubularization. stages of microvasculature evolution.Considering the statement that microvasculature evolution is the evolution of its graft, we think that the correct research direction is to study microangiogenesis stimulation methods.

Objective. To study the results of laparoscopic heminephrureterectomy (LHNE), ureteropyelostomy (LUPS) and ureteroureterostomy (LUUS) in the laparoscopic treatments of megaurete of a duplex system in children. Methods. The records of patients (n=102) who underwent LHNE and LUPS (LUUS) were retrospectively analyzed (26 (25,5%) boys and 76(74,5%) girls). The age of patients was from 3 months to 17 years (median - 17.9 months). Megaureter of the upper pole was observed in 82 (80.4%) patients, of the lower pole - in 20 (19.6%). LHNE was performed in 68 patients (66.7%), LUPA (LUUA) - in 34 (33.3%). Results. Intraoperative complications occurred in 2 patients (2.0%), conversion was required in both cases. Median operative LHNE time was 146,0±46,2 minutes (median - 120 minutes); in LUPS(LUUS) - 160,1±44,7 minutes (median - 150 minutes). One patient after LUUA developed the urinary leakage due to stent obstruction and required nephrostomy (IIIb, Clavien-Dindo classification). The remote results were traced for a period from 10 months to 6 years.The patients after LHNE (n=15) (22.1%) had a significant decrease of kidney function (>5%), including one patient (1.5%) with a complete loss of the function. An inflammatory process after partial ureteral resection was observed in the stump , which required relaparoscopy in 3 children (6.5%). The ipsilateral ureter injury during the total ureterectomy in the lateral position occurred in 2 children (6.9%). Conclusion. LHNE and LUPA (LUUA) are considered to be the effective surgical methods of duplex system megaureter in children. The disadvantage of LHNE is the high risk of significant decrease of kidney function; LUPA (LUUA) are the safer methods. Total ureterectomy in the supine position of a patient can prevent the complications associated with the healthy ureter injury and leaving the ureteral stump. What this paper adds For the first time, it has been proven that laparoscopic heminephrectomy in comparison with laparoscopic ipsilateral ureteropyeloanastomosis or ureteroureteroanastomosis is considered to be an unsafe operation, since this can cause kidney failure. It has been established that total ureterectomy in the supine position of a patient can prevent the complications associated with the healthy ureter injury and leaving the ureteral stump.

The objective was to improve the results of surgical treatment of vesicoureteral reflux in children, using laparoscopic access. The prospective study was performed in 111 children (137 ureters) with the primary III–IV grade vesicoureteral reflux. The mean age was 34.7 months. The modified laparoscopic antireflux technique was performed on 73 children (91 ureters). We compared the perioperative complications and the medium-term outcome with a group of 38 children (46 ureters) who underwent classical laparoscopic extravesical reimplantation.3 In the modified group, the mean surgery time was 109.8 ± 31.5 minutes for unilateral cases and 176.5 ± 47.6 minutes for bilateral cases; in the classical group, it was 118.6 ± 34.3 and 209.5 ± 51.2 minutes respectively (p > 0.05). Postoperative vesicoureteral reflux had 2 (2.7 %) patients in the main group and 8 (21.1 %) children in the control group (p = 0.002). There was no ureteral obstruction in the both groups. The success rate for ureters was 97.8 % with modified technique versus 82.6 % after classical laparoscopic reimplantation (p = 0.003). Laparoscopic extravesical ureteral reimplantation is a safe and effective surgical procedure. The modified technique may improve the surgical treatment results.

To evaluate the role of the repeat transurethral resection (TUR) of the bladder in the management of non-muscle invasive bladder cancer (NMIBC), the medical literature was sought for, by using the PubMed database. The selected full text sources were analyzed. Repeat TUR carried out 1-6 weeks after primary surgery permits detection of residual tumor in 33-76% of cases, identification of muscle invasive bladder cancer in 4-28% of the patients with the primary diagnosis of NMIBC, more precise estimation of tumor extent, and modification of treatment policy in 4-33% of cases. Furthermore, repeat TUR allows estimation of the risk of further cancer progression and selection of patients for immediate radical cystectomy. Overall, this approach can improve the results of treatment of patients with NMIBC.

To evaluate the role of the repeat transurethral resection (TUR) of the bladder in the management of non-muscle invasive bladder cancer (NMIBC), the medical literature was sought for, by using the PubMed database. The selected full text sources were analyzed.Repeat TUR carried out 1-6 weeks after primary surgery permits detection of residual tumor in 33-76% of cases, identification of muscle invasive bladder cancer in 4-28% of the patients with the primary diagnosis of NMIBC, more precise estimation of tumor extent, and modification of treatment policy in 4-33% of cases. Furthermore, repeat TUR allows estimation of the risk of further cancer progression and selection of patients for immediate radical cystectomy. Overall, this approach can improve the results of treatment of patients with NMIBC.

In 32 out of 49 patients with bladder tumors, a decrease in immunity was revealed, more pronounced in patients with tumors at the T4 stage. In 12 patients, nonspecific immunostimulation with BCG vaccine was carried out 12-30 days before chemoradiation treatment. Due to this, in 6 of them, the level of the nonspecific immune system slightly increased and the immunosuppressive effect of chemoradiation therapy decreased. 5 patients with advanced stages of bladder cancer received nonspecific immunotherapy with BCG vaccine according to Toris. 2 of them showed subjective, and 1 - objective improvement. The results of the study give reason to consider the use of immunostimulation in the complex treatment of patients with bladder cancer advisable. Further development of indications and schemes of immunotherapy in patients with advanced stages of the disease is required.