Search

Objective of the study. To evaluate results of robot-assisted laparoscopic radical prostatectomy in the framework of a surgeon’s learning curve; to evaluate the effect of reconstruction of the ligamentous apparatus of the lower pelvis on early recovery of urine retention.Materials and methods. 246 patients were divided into 3 groups depending on the surgery date. The analyzed data was accumulated prospectively and retrospectively. Preoperative characteristics (TNM stage, PSA, ISUP), intraoperative characteristics (surgical time, blood loss volume, surgery type and character, type of reconstruction of the ligamentous apparatus of the lower pelvis) and postoperative characteristics (duration of bladder drainage with a urethral catheter, level and time of recovery for urine retention and erectile function) were evaluated. Reconstruction of the ligamentous apparatus of the lower pelvis was performed through reconstruction of the Denonvillier fascia (Rocco stitch), as well as through suturing fibers of the bladder neck with periurethral tissues and residual puboprostatic ligaments for stabilization of the urethrovesical complex.Results. All operations were successfully completed without conversions or transfusions. Median surgical time was 160 minutes (p = 0.0001). Median blood loss was 173.3 cm3 (p = 0.0002). Mean prostatic volume was 36 cm3 (29–47.5 cm3), and overall frequency of positive surgical margin was 12.82 %. Overall frequency of urine retention recovery was 51.6 % after 3 months, 63.7 % after 6 months (p >0.05). In the patient group with reconstruction of the ligamentous apparatus of the lower pelvis, frequency of urine retention recovery was higher than in the group without reconstruction: 64.1 % vs 45.3 % (after 3 months, р = 0.041) and 74.7 % vs 62.3 % (after 6 months, р = 0.034). Conclusion. Surgical time, blood loss were significantly decreased with the number of performed operative interventions. Significant improvement of early urine retention recovery was observed in the patient group with reconstruction of the ligamentous apparatus of the lower pelvis.

Objective: We sought to improve the educational and pre-operative training on various stages of percutaneous nephrolithotomy (PCNL) under fluoroscopic and ultrasound guidance. We developed a three-...

Lecture is devoted to the main provisions of perineal prostatectomy. At present, laparoscopic and robotic prostatectomy techniques have been widely developed. Nevertheless, the use of perineal access surgery remains indisputable for carefully selected patient groups. Undoubtedly, this type of intervention has obvious advantages, which are described amply in the lecture, in particular such as minimally invasive and economical expediency. The article presents modern functional and oncological results of perineal radical prostatectomy. This lecture will be useful for urologists and oncologists for improving their skills in performing this type of radical prostatectomy.Disclosure: The study did not have sponsorship. The author have declared no conflicts of interest.

Background. Pelvic floor muscle exercises are used as a first-line treatment for urinary incontinence after radical prostatectomy. Their efficacy is still being investigated. The use of biofeedback when teaching pelvic floor muscle exercises to patients increases the effectiveness of therapy.Objective: to assess the efficacy of biofeedback-assisted pelvic floor muscle training in patients with urinary incontinence after laparoscopic and robot-assisted radical prostatectomy and to compare the results of teaching.Materials and methods. A total of 64 patients with urinary incontinence after nerve sparing prostatectomy underwent biofeedback-assisted pelvic floor muscle rehabilitation. Radical laparoscopic surgery was performed in 48 (75 %) patients, whereas robot-assisted surgery was performed in 16 (25 %) patients. The patients started their training 2 months postoperatively. We used two-channel electromyography with the Neurotrack ETS system (United Kingdom) to teach the patients isolated pelvic floor muscle contractions. After achieving a minimum activity of abdominal muscles during pelvic floor muscle contractions, the patients started exercises.Results. There was no significant difference in age between patients who underwent laparoscopic and robot-assisted radical prostatectomy (р = 0.79). Fifty-five patients (85.9%) acquired the skill of isolated pelvic floor muscle contractions and could perform training on their own. The remaining 9 patients (14.1 %) required regular support from healthcare professionals at an outpatient unit (1–2 biofeedback-assisted trainings per month). Thus, the type of surgery did not affect the process of training. The type of radical prostatectomy had no impact on the acquisition of the pelvic floor muscle contraction skill.Conclusion. The time for restoration of urinary continence by biofeedback-assisted pelvic floor muscle training did not vary between patients after laparoscopic and robot-assisted radical prostatectomy.

Objective : to compare the predictive value of RENAL, PADUA, C-index nephrometry score systems according to projection of complexity of operative measure in terms of warm ischaemic time, extent of blood loss and rate of postoperative complications. Materials and methods . Information for the research was collected from 314 patients with localized kidney cancer, who had laparoscopic partial nephrectomy from January 2012 to May 2017. In 210 (66.8 %) cases, in addition to the routine examinations, 3D modelling and operative measure planning were carried out. The average tumor volume of the patients was equal to 62.5 ± 33.5 mm 3 . All patients before the operation were estimated the complexity of operative measure on the nephrometry score systems: PADUA, RENAL, C-index. The average sum of balls according to scale RENAL – 7.56 ± 1.12, on scale PADUA – 7.98 ± 1.55, on scale C-index – 2.76 ± 1.14. Then in retrospect by the method of logistic regression analysis was determined predictive value of RENAL, PADUA, C-index nephrometry score systems for prediction of warm ischaemic time, duration of operative measure, extent of intraoperative blood loss and possibility of rate of postoperative complications. Results. In 265 (84.4) cases transperitoneal approach was perfomed and in 49 (15.6 %) cases it was retroperitoneal approach. The average time of laparoscopic partial nephrectomy is 140.15 ± 55.8 min, the average time of ischaemic warm is 13.35 ± 7,65 min. The average extent of blood loss during the laparoscopic partial nephrectomy is 291.95 ± 196.5 ml. Intraoperative complications were found in 8 (2.54 %) cases. Postoperative complications were estimated according to the Clavien–Dindo classification of surgical complications and were found in 31 (9.9 %) cases, among them 12 (3.8 %) patients had surgical complications. The index of the RENAL nephrometry scoring system had the highest predictive value in the multivariant analysis for warm ischaemic time, extent of intraoperative blood loss and possibility of development after complications (p = 0.049; 0.028; 0.046). None of indices were significant for multivariant analysis of prognosis the duration of laparoscopic partial nephrectomy. The indices of the RENAL (p = 0.032) and C-index (p = 0.040) nephrometry score systems were significant for univariate analysis of prognosis the duration of the laparoscopic partial nephrectomy. Conclusion. The usage of RENAL, PADUA, C-index nephrometry score systems is useful for the prediction of warm ischaemic time, extent of blood loss, duration of operative measure and possibility of rate of postoperative complications at laparoscopic partial nephrectomy. According to our data the index of RENAL nephrometry scoring system has the highest predictive value. Applications of 3D modelling for counting nephrometry indices in preoperative period makes the process of counting balls easier on all three nephrometry score systems.

Introduction . Renal cancer constitutes 2–3 % of all tumors of the human body. Annually worldwide renal cancer morbidity increases by 2 %, about 90 % of cases are localized in the parenchyma. Currently, treatment of localized forms of kidney cancer increasingly incorporates kidney-preserving technologies. The objective is to evaluate the rate and causes of local renal cancer recurrence after laparoscopic resections of the organ for treatment of localized renal parenchymal cancer. Materials and methods . Retrospective analysis of 459 laparoscopic resections performed between June of 2011 to May of 2017 at the R. M. Fronstein Urology Clinic of the I. M. Sechenov First Moscow State Medical University of the Ministry of Health of Russia was performed. Results . Of 459 patients who underwent endoscopic surgical kidney resections with video, 399 patients were diagnosed with renal cancer during planned histological examination, among them 3 (0.75 %) patients had local recurrence. All patients were operated on with laparoscopic access, in 1 case the surgery was complicated by intraoperative bleeding which required conversion to nephrectomy. At the time of primary surgery, all patients with cancer recurrence were diagnosed with stage Т1b. Clear cell renal cell carcinoma was verified in all patients by morphological examination, and malignancy grade (nuclear differentiation) per the Furman grading system was 2 (in 2 patients) and 3 (in 1 patient). In 2 patients, local recurrence was diagnosed 6 months after the surgery, in 1 patient – 12 months after the surgery. One case of local recurrence in the area of previous resection was detected, in 1 case dissemination of the process through paranephric tissue (apart from local recurrence) was observed, and 1 case of recurrence in the bed of the removed kidney was diagnosed. All patients underwent repeat surgery in the clinic: 2 patients were operated on laparoscopically, 1 patient underwent open surgery. Conclusion. In our opinion, prevention of local recurrences requires careful selection of patients for laparoscopic kidney resections, especially if patients have stage Т1b or higher. Technically complicated resections for deep tumor invasion into the sinus, as well as for wide tumor base, are recommended for patients with invariable indications. Nephrectomy is preferable for relative indications for resection. In the preoperative period, the presence and thickness of tumor pseudocapsule must be evaluated, and multicenter localization should be ruled out. Good technical equipment for laparoscopic kidney resection and observation of oncological principles during surgery decrease renal cancer recurrence risk. During morphological verification of renal parenchymal tumors with high oncological potential for progression and in the presence of positive surgical margin and tumor pseudocapsule invasion, control spiral computer tomography of the abdominal organs with intravenous contrast should be performed in the first 3 months after the surgery.

Even in the mid-twentieth century, Huggins and Hodges proved the susceptibility of prostate cancer cells to hormonal manipulations, by using surgical castration as an example. An average of 18–36 months after initiation of first-line hormonal therapy, patients develop the castration resistance in prostate cancer, one of the causes of which was hyperproduction of the tumor receptors of prostate cancer cells and their hypersusceptibility to the castration levels of testosterone. Long-term treatment in patients with castration-refractory prostate cancer was extremely symptomatic and quality of life and overall survival were low. In the 2000s, investigations aimed at designing drugs to treat this category of patients were underway, which have culminated in the advent of three drugs (two of which belong to chemotherapy) that are now used in the Russian Federation. The second-line hormonal agent abiraterone acetate (Zytiga) is one of these drugs, which was officially registered in 2011. Its mechanism of action is due to inhibition of the enzyme CYP17, leading to the blocked synthesis of testosterone at all levels, including at the intracrine level, and achieving testosterone levels below the postcastration ones. The paper reviews the literature regarding abiraterone acetate and the first experience in using second-line hormonal therapy in three patients.

The diagnostic consideration of the most commonly used methods of radial diagnostics in identifying local recurrence of prostate cancer after radical prostatectomy in patients with biochemical recurrence is reflected in the literature review. The identified level of PSA after radical prostatectomy can argue for both local recurrence, the presence of tumor dissemination, and a residual prostate tissue without tumor that was left on the edge of the cut. With the purpose of early diagnosis of prostate cancer recurrence, it is advisable to monitor PSA levels after 3 months after radical prostatectomy. In case of growth of PSA levels after radical prostatectomy, it is necessary to answer the question: whether the recurrence is local or metastatic. Modern imaging methods, such as transrectal ultrasound examination, bone scanning, multislice computed tomography, positron emission tomography and endorectal magnetic resonance imaging provide excluding or establishing the presence of recurrence of prostate cancer after radical prostatectomy. It should be noted that none of the methods of radiodiagnostics are not ahead of the results of PSA in the identification of local recurrence of prostate cancer after radical prostatectomy; however, in their complex application, prostate cancer recurrent after radical prostatectomy can be visualized at its earliest stages.