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Background. Currently, about 80 % of men with low-grade prostate cancer (per ISUP 1 (International Society of Urological Pathology)) have indications for radical treatment. Overdiagnosis of low-grade cancer is associated with the use of systematic biopsy methods (standard transrectal, saturation) under ultrasound control for diagnosis verification. To improve prostate cancer diagnosis, the European Association of Urology (2019) recommended multiparametric magnetic resonance imaging before biopsy, and in case of detection of a suspicious lesion magnetic resonance imaging (MRI)-targeted biopsy. In clinical practice, the most common method of MRI-targeted biopsy is multiparametric MRI ultrasound-guided (mpMRI/US) fusion biopsy. However, some studies show contradictory results in detection of prostate cancer using systematic and MRI-targeted biopsy techniques.Aim. To compare detection of clinically significant prostate cancer (ISUP ≥2) using mpMRI/US fusion, standard, and saturation biopsy.Materials and methods. The study included 96 patients. The following inclusion criteria were applied: prostate-specific antigen >2 ng/mL and/or detection of a suspicious lesion during digital rectal and/or transrectal ultrasound examination, and PI-RADS (Prostate Imaging Reporting and Data System) v.2.1 score ≥3. At the first stage, “unblinded” urologist performed a transperineal mpMRI/US fusion and saturation biopsies. At the second stage, “blinded” urologist performed standard transrectal biopsy. Clinically significant cancer was defined as ISUP ≥2.Results. Median age was 63 years, prostate volume – 47 cm3, prostate-specific antigen – 6.82 ng/mL. MpMRI/US fusion, standard, and saturation biopsies were comparable in regard to the rate of detection of clinically significant (29, 24, 28 %; p = 0.81) and clinically insignificant (25, 26, 35 %; p = 0.43) cancer. Overall prostate cancer detection rates were also similar: 54, 50, 63 %, respectively (p = 0.59). The percentages of positive cores in mpMRI/US fusion, standard, and saturation biopsies were 33, 10 and 13 %, respectively (p p = 0.7).Conclusion. Detection rates of clinically significant, clinically insignificant prostate cancer and overall detection rate are comparable between systematic biopsy techniques and mpMRI/US fusion biopsy.

According to the recommendations of the European Association of Urology the presence of a suspicious lesion on MRI is an indication for both primary and secondary MR-targeted biopsies. At the same time, the Russian Society of Urologists recommends to perform mpMR/US fusion biopsy only in patients with a prior negative biopsy. In clinical practice, mpMR/US fusion and cognitive biopsies are the most frequently performed. However, when comparing them, contradictory data on detection of clinically significant prostate cancer is obtained.to compare the detection rate of clinically significant prostate cancer performing cognitive and mpMR/US fusion biopsies.Inclusion criteria: PSA2 ng/mL and/or a positive DRE, and/or a suspicious lesion on TRUS, and PI-RADSv2.1 lesion more or equal 3. At first, "unblinded" urologist performed a transperineal mpMR/ultrasound fusion and saturation biopsy. Then "blinded" urologist obtained transrectal cognitive biopsy Clinically significant cancer was defined as ISUP more or equal 2.We enrolled 96 patients. Median age was 63 years, prostate volume - 47 cm3 and PSA - 6.82 ng/mL. MpMR/US fusion and cognitive biopsies were comparable in regard to the detection rate of clinically significant (32.3% vs 25.0%; p=0.264), clinically insignificant cancer (25.0% and 26.0%; p=0.869) and overall detection rate (57.3% and 51%;p=0.385). Both biopsies missed clinically significant cancer with equal frequency (5.2%; p=0.839). Histological efficacy also was comparable. The number of positive cores between mpMR/US fusion and cognitive biopsy was equal (34.1% and 31.1% respectively; p= 0.415). At the same time, no statistically significant difference was found with respect to maximum cancer core length (53.1% vs 47.7%, respectively; p=0.293).The results suggest that both cognitive and mpMR/US fusion biopsies are equally accurate diagnostic methods for clinically significant prostate cancer detection, thus their wider introduction into clinical practice is necessary.

The current prostate cancer screening program results in unnecessary biopsies in a quarter of patients, overdiagnosis of clinically insignificant prostate cancer (ISUP 1) and overtreatment. Intoducing multiparametric magnetic resonance imaging into routine practice before biopsy allows to decrease the number of biopsies, thereby reducing the burden on clinicians and increasing the likelihood of detecting clinically significant forms of prostate cancer (ISUP >2). The objective of this literature review is to compare targeted biopsy techniques and to determine their current role in the prostate cancer diagnosis.

An analysis of domestic and foreign literature on the predictors of prostate cancer recurrence are presented in the article. A deep analysis of both pathological and histological risk factors for progression was provided, as well as of laboratory and clinical predictors.

Background. High intensity focused ultrasound (HIFU) is a method of delivering acoustic energy to a focal point, thus destroying it and causing coagulation necrosis. Repeating the fires, the whole needed volume of organ can be treated without damaging the adjacent tissue. Objective. To establish the clinical efficacy and safety of HIFU in the treatment of prostate cancer on the basis of the authors’ 3-year experience in applying this technique.Materials and methods. A total of 101 patients with biopsy-proven prostate cancer (and 2 more patients had only high-grade PIN) have been treated in our clinic using an Ablatherm® device. Seventy-one of them were enrolled in this study. They were followed from sixth months to three years at a regular interval, the follow-up included PSA measurement and control sextant biopsies.Results. The median PSA nadir 1.5Р3.0 months after treatment ranged from 0.10 (in the low-risk localized prostate cancer group) to 2.50 ng/mL (in patients with a disseminated process). Negative control biopsies were in 75—80% of patients with localized prostate cancer and in 64—75% of the patients with disseminated process. Of all the patients, 91% underwent transurethral resection of the prostate before HIFU treatment. Such combination improved the efficacy of HIFU and reduced the treatment-related morbidity significantly. Grades 2 and 3 stress incontinence was observed in 1.9 and 0.9% of the patients, respectively. No other severe complications were recorded. Erectile function was preserved in 69.94% of the patients.Conclusion. Our results demonstrated the efficacy and low-associated morbidity of HIFU. HIFU does not exclude other treatment options and is repeatable if needed. HIFU seems to be a valid alternative treatment for patients who are not suitable for radical surgery.

Currently, prostate cancer (PCa) is one of the most important problem of modern medicine, including economical issue. The detection of PCa compared to any other cancers progressively increases with age. Currently, PCa is the most commonly diagnosed solid tumor. Radical prostatectomy and radiation therapy are considered standard of treatment for PCa. However, while excellent long-term oncologic results can be achieved, these methods are often associated with significant complication rate, which negatively affects the quality of life of patients. Technological advancement and their implementation in medicine have increased treatment opportunities in oncourology. The purpose of this literature review is to study alternative treatment methods of localized PCa and compare their efficiency with conventional therapy.

The aim of this literature review was to demonstrate the pluses and minuses of each kind of biopsy, which can be helpful for preparing an algorithm and determining the indications and contraindications for each prostate biopsy (PB). Prostate biopsy is the main method of diagnosing prostate cancer (PC), and it remains relevant even in spite of the appearance of a number of new diagnostic tests and methods. Transrectal 12-core biopsy without pre-biopsy mpMRI remains a routine sampling of prostate material. But with the appearance of a great variety of PB and their introduction into practice, there arises the need to compare these methods with each other. At present, all available studies dealing with the informativity of some biopsy method or another, were conducted in different time periods and cannot reliably reflect their informativity for making a comparison. In our opinion, further research into this problem is required and research works should study the informativity of various kinds of biopsy depending on visualization of a pathological site for suspected prostate cancer, in TRUS and its location coincidence in mpMRI, in Pi-RADSv2.1 classification. Key words: prostate biopsy, prostate cancer, transrectal ultrasound

An analysis of national and foreign literature dedicated to recurrence of prostate cancer, is presented in the article. The diagnostic utility of positronic emission tomography, fused with computer tomography and magnetic resonance tomography in case of biochemical recurrences of prostate cancer is discussed.

to improve the differential diagnosis of infected cysts in patients with ADPKD and to reduce false-positive rate of MR-urography.a total of 33 patients with ADPKD who underwent bilateral nephrectomy from 2015 to 2020 were included in the retrospective single-center study. In the group 1 (n=17) patients with histologically confirmed infected cyst (s) were included, while in the group 2 (n=16) there were patients without infected cysts. The frequency of symptoms (pain in the loin area, fever), the level of leukocytes in blood and urine, C-reactive protein (CRP) and the results of kidney MRI were compared.Pain, fever, leukocytosis, leukocyturia, and increased CRP levels were significantly associated with infected cysts. The sensitivity and specificity of MRI was 88.2% and 43.8%, respectively. The infected cysts were characterized by a significantly (p=0.004) lower value of the apparent diffusion coefficient (ADC): 0.67+/-0.2110-3 mm2/s (95% confidence interval (CI) 0.56-0.79), versus 1.2+/-0.5910-3 mm2/s (95% CI 0.89-1.5) in group 2. According to ROC analysis, the ADC value at the cut-off point was 0.8310-3 mm2/s. The frequency of infected cysts during histological examination increased when the volume of the cyst was more than 13 ml. In multivariate analysis, only the CRP level was a reliable predictor of the presence of infected cysts. ROC analysis showed that the CRP level at the cut-off point was 83 mg/L (sensitivity 70.6%, specificity 75%).In case of fever, pain in the loin area and high CRP level in patients with ADPKD, it is necessary to exclude infected cysts. MRI of the kidneys with the determination of the ADC level in cysts with limited diffusion on diffusion-weighted images is a highly informative method that allows to clarify the content of cysts.

Background Prostate HistoScanning (PHS) is a tissue characterization system used to enhance prostate cancer (PCa) detection via transrectal ultrasound imaging. Objective To assess the impact of supplementing systematic transrectal biopsy with up to three PHS true targeting (TT) guided biopsies on the PCa detection rate and preclinical patient assessment. Design, setting, and participants This was a prospective study involving a cohort of 611 consecutive patients referred for transrectal prostate biopsy following suspicion of PCa. PHS-TT guided cores were obtained from up to three PHS lesions of ≥0.5cm 3 per prostate and only one core per single PHS lesion. Histological outcomes from a systematic extended 12-core biopsy (Bx) scheme and additional PHS-TT guided cores were compared. Outcome measurements and statistical analysis Comparison of PHS results and histopathology was performed per sextant. The χ 2 and Mann-Whitney test were used to assess differences. Statistical significance was set at p Results and limitations PHS showed lesions of ≥0.5cm 3 in 312 out of the 611 patients recruited. In this group, Bx detected PCa in 59% (185/312) and PHS-TT in 87% (270/312; p 0.001). The detection rate was 25% (944/3744 cores) for Bx and 68% (387/573 cores) for PHS-TT ( p 0.001). Preclinical assessment was significantly better when using PHS-TT: Bx found 18.6% (58/312) and 8.3% (26/312), while PHS-TT found 42.3% (132/312) and 20.8% (65/312) of Gleason 7 and 8 cases, respectively ( p p =0.0021). Conclusions Patients with a suspicion of PCa may benefit from addition of a few PHS-TT cores to the standard Bx workflow. Patient summary Targeted biopsies of the prostate are proving to be equivalent to or better than standard systematic random sampling in many studies. Our study results support supplementing the standard schematic transrectal ultrasound-guided biopsy with a few guided cores harvested using the ultrasound-based prostate HistoScanning true targeting approach in cases for which multiparametric magnetic resonance imaging is not available.

Background: In patients with autosomal dominant polycystic kidney disease (ADPKD) and end-stage kidney disease, bilateral nephrectomy (BN) is currently performed predominantly via the laparoscopic approach. We analysed the results of BN depending on the approach and preoperative and perioperative factors. Patients and Methods: This was a single-centre retrospective study carried out from April 2010 to March 2020, including a total of 142 patients presenting with ADPKD who were treated by BN. Of these, 108 patients meeting the inclusion criteria were selected to analyse the results. We compared therapeutic outcomes depending on the surgical approach (laparotomy or laparoscopy) and the type of the operation (emergent or elective). Results: Of the 108 eligible patients, 36 (group I) underwent laparoscopic BN and the remaining 72 patients (group II) were subjected to midline laparotomy. Sixty-nine patients underwent elective surgery and 39 endured emergent operations. The most frequent indications (87 patients, 80.6%) for surgical treatment were urinary tract infection and infected cysts. The median length of hospital stay for group I and group II patients amounted to 8 days (IQR: 7.5–9) and 12.5 days (IQR: 9–16.5), respectively (p < 0.001). However, comparing the patients operated on electively, the actual difference in the length of hospital stay was inconsiderable: median 8 days (IQR: 7–9) in group I and 9 days (IQR: 9–11.5) in group II. The median duration of the operation was significantly (p < 0.001) longer in group I amounting to 217.5 min (IQR: 197.5–305) than in group II equalling 115 min (IQR: 107.5–145). The frequency of postoperative complications, lethal outcomes, and blood loss volume did not statistically significantly differ depending on the surgical approach. Only patients operated on emergency underwent releparotomy due to intraoperative large bowel injury. Lethal outcomes (n = 18, 16.7%) after surgery were observed only in emergent patients. Sepsis prior to surgery, systemic inflammation response syndrome (SIRS) with the CRP level above 173 mg/mL, prolonged preoperative antibacterial therapy, and undiagnosed large bowel injury were associated with a lethal outcome after BN. Conclusion: The results of open and laparoscopic BN in elective surgery were comparable. Emergency operations for infected renal cysts and SIRS were associated with increased incidence of large bowel injury and lethal outcomes.

The contemporary interpretation of the pathogenesis of varicose vein transformation in young patients indicates the genetically determined pattern of this process. According to the diagnostic criteria proposed by T.I. Kadurina, varicose veins of different localization belong to the so-called minor phenomena of undifferentiated connective tissue dysplasia (UCTD) syndrome. However, its impact on the development of varicose vein transformation is taken into account by not all researchers probably due to the fact that its clinical manifestations remain somewhat unclear.To prove the role of UCTD syndrome in the development of varicose transformation of veins, by examining their wall biopsy specimens at the ultrastructural level.Vein wall fragments removed from 25 male patients were examined; their mean age was 19 years. All the patients were divided into 3 groups: 1) cases of left-sided varicocele (VC), 2) those of varicose veins in the lower extremities (VVLE), 3) control cases. Electron microscopy examination (EME) and morphometric and statistical analyses were performed.EME showed similar changes in the vein wall biopsy specimens obtained from both pediatric and adult patients with VC and VVLE. Analysis of the qualitative parameters of collagen fiber bundles revealed considerable differences in their thickness compared to those in the control group; the phenomenon of structural chaos; variability of their number in the bundles; uneven bundle thickness; abruptness of individual fibers due to their tortuous course; bundle disorganization areas and an expanded part of interfiber spaces. Morphometric analysis demonstrated a pronounced variability of numerical series when measuring their bundle thickness. The above changes indicate primary incompetence of the connective tissue framework of the varicose vein walls. The measurements of smooth muscle cells showed a decrease in their volume compared to that in the control group; there was an excessive proliferation of connective tissue between them. No substantial difference was found in the arithmetic mean of the measurements in different degrees of VC and VVLE and in the age groups for these diseases.The ultrastructural analysis and morphometric results confirm the key role of UCTD syndrome in the pathogenesis of VC and VVLE and make it possible to combine these diseases into one - systemic varicose veins.Современная трактовка патогенеза варикозной трансформации вен у пациентов молодого возраста указывает на генетически детерминированный характер этого процесса. Согласно диагностическим критериям Т.И. Кадуриной, варикозное расширение вен различной локализации относится к так называемым малым феномам синдрома недифференцированной дисплазии соединительной ткани (НДСТ). Однако его влияние на развитие варикозной трансформации вен учитывается не всеми исследователями, вероятно, вследствие того, что его клинические проявления до сих пор остаются несколько размытыми.Доказать роль синдрома НДСТ в развитии варикозной трансформации вен посредством изучения биоптатов их стенок на ультраструктурном уровне.Исследованы фрагменты стенок вен, удаленных у 25 пациентов мужского пола; средний возраст составил 19 лет. Все больные разделены на три группы: 1-я — пациенты с левосторонним варикоцеле (ВЦ), 2-я — пациенты с варикозным расширением вен нижних конечностей ВРВНК, 3-я — контроль. Проведены электронно-микроскопическое исследование (ЭМИ), морфометрический и статистический анализы.При ЭМИ биоптатов стенок вен пациентов с ВЦ и ВРВНК как у детей, так и у взрослых пациентов обнаружены схожие изменения. Анализ качественных параметров пучков коллагеновых волокон выявил существенные отличия их толщины по сравнению с группой контроля, феномен «структурного хаоса», вариабельность их количества в пучках, неравномерную толщину пучков, обрывистость отдельных волокон за счет их извилистого хода, участки дезорганизации пучков и расширение части межволоконных пространств. Морфометрический анализ показал выраженную вариабельность числового ряда при замере толщины их пучков. Перечисленные изменения указывают на первичную несостоятельность соединительнотканного каркаса стенок варикозно-расширенных вен. Результаты замеров гладкомышечных клеток показали уменьшение их объема по сравнению с контрольной группой; имело место избыточное разрастание соединительной ткани между ними. Не обнаружена существенная разница средних арифметических значений результатов промеров при различных степени ВЦ и ВРВНК и возрастных группах при этих заболеваниях.Ультраструктурный анализ и результаты морфометрии подтверждают ключевую роль синдрома НДСТ в патогенезе ВЦ и ВРВНК и дают возможность объединить эти заболевания в одно — системную варикозную болезнь.

To study the survival rate of patients without biochemical recurrence according to the Stuttgart and Phoenix criteria in terms of their correlation with four different PSA nadir values as predictors of clinical recurrence in patients with localized prostate cancer who underwent total HIFU prostate ablation.The object of the study was patients with morphologically proven localized RP by biopsy results, who were treated with prostate cancer by HIFU ablation on the Ablatherm Integrated Imaging apparatus (EDAP TMS, France). The study included 658 patients in whom HIFU ablation was used as primary treatment of localized prostate cancer (stages T1 - T2) without previous use of other methods (hormonal, radiation therapy) For the analysis, a continuous sample of patients was selected, which were divided into four groups depending on the PSA nadir level: less or equal 0.2 ng / ml (1 group), 0.21-0.5 ng / ml (group 2), 0.51-1 ng / ml (group 3) and1 ng / ml (group 4). sensitivity, specificity, predictive value, and 5-year biochemical relapse-free survival according to the Stuttgart definition and the Phoenix definition in the PSA nadir groups.The median (range) of the observation period for the patients was 5.3 (3-7) years, the mean time to reaching PSA nadir was 14.5+/-2.6 weeks. PSA nadirs less or equal 0.2, 0.21-0.5, 0.51-1.0 and1 ng/ml were achieved in 231 (35.1%), 132 (20.0%), 105 (15, 9%) and 190 (28.8%) patients, respectively. Survival without biochemical relapse in accordance with the Stuttgart definition in the four groups allocated for the PSA nadir was 82, 65, 43 and 32%, respectively (p0.001), according to the Phoenix definition - 94, 74, 66 and 47% (p0.001) respectively. According to the results of the control biopsy, 601 (91.3%) patients in the 1st and 2nd groups had a negative oncological status (approximately 85%).This study confirms that PSA nadir after HIFU ablation predicts biochemical recurrence-free survival and is a reliable marker that is easy to integrate into routine clinical practice.

The topic of renal cystic lesions is described in the article. The localization and structure of solitary, parapelvic and multiple sinus cysts are discussed. The Bosniak classification (1986) is presented, as well as the updated Bosniak classification, in which a number of modifications in 2019 were made. The contemporary diagnostic methods are mentioned, as well as factors that allow to select patient for active surveillance. Current surgical procedures are presented.

Currently, prostate cancer (PCa) is one of the most important problem of modern medicine, including economical issue. The detection of PCa compared to any other cancers progressively increases with age. Currently, PCa is the most commonly diagnosed solid tumor. Radical prostatectomy and radiation therapy are considered standard of treatment for PCa. However, while excellent long-term oncologic results can be achieved, these methods are often associated with significant complication rate, which negatively affects the quality of life of patients. Technological advancement and their implementation in medicine have increased treatment opportunities in oncourology. The purpose of this literature review is to study alternative treatment methods of localized PCa and compare their efficiency with conventional therapy.

An analysis of national and foreign literature dedicated to recurrence of prostate cancer, is presented in the article. The diagnostic utility of positronic emission tomography, fused with computer tomography and magnetic resonance tomography in case of biochemical recurrences of prostate cancer is discussed.

Introduction Prostate cancer is one of the most common types of cancer in men. The gold standard for the detection of prostate cancer is ultrasound guided transrectal prostate biopsy. The detectability of cancer using this method is from 30 to 50%. As a result, many men undergo multiple repeat biopsies for suspected prostate cancer. The European Association of Urology does not give any recommendations on this matter. A revolutionary new method in the diagnosis of prostate cancer is a targeted prostate biopsy using a fusion of multiparametric magnetic resonance imaging (MRI) and ultrasound. Materials and methods At the R.M. Fronstein Clinic of Urology, 55 patients with suspected prostate cancer from September 2017 to January 2018 underwent fusion prostate biopsy. Of them, 21 patients had negative primary biopsies. Two patients had verified prostate cancer. 32 patients did not undergo primary biopsies. Results The findings of the study suggest that using MRI-ultrasound fusion for guidance of targeted prostate biopsy improves the quality of the histological material, allows patients to avoid unnecessary biopsy, reduces the number of punctures, thereby offering higher diagnostic performance in detecting prostate cancer. MRI-ultrasound fusion targeted biopsy has a high sensitivity in detecting clinically significant cancer and low for clinically insignificant cancers. Conclusion The technique affords accurate detection of the location and extent of pathological lesions in the prostate thus allowing focal therapy for prostate cancer.

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.

Currently, thorough understanding of multidisciplinary approach is required in all areas of healthcare, including education, science and practice. This article is dedicated to the actual problem of interdisciplinary communications in current educational process in the Medical University.

Prostate cancer (PrC) is one of the most common tumors diagnosed in men. The detection rate of localized PrC has been dramatically enhanced by screening and the development of visualization methods. There are currently several techniques for focal treatment available, among which the most interesting in our opinion is high-intensity focused ultrasound (HIFU). Currently, HIFU hemiablation of PrC is not an established treatment, although evidence of its effectiveness and safety is growing. We have been performing HIFU hemiablation since 2013 and here report our results to add to the evidence on the effectiveness of the technique. Between October 2013 and December 2016, we performed HIFU hemiablation of the prostate for a total of 35 patients with confirmed PrC stage p < 0.001). The pathological focus seen on MRI before the procedure in each case was absent after 3 months. Control biopsy after 12 months revealed residual cancer in the contralateral lobe in 4 patients. The findings obtained during follow-up and from control biopsies indicate that the treatment was highly efficacious with a low rate of nonserious postoperative complications. HIFU hemiablation proved to be a reliable therapeutic modality for localized PrC and was associated with a low rate of complications and comparable risk of recurrence. Despite the fact that this method of treatment is currently experimental, the results of this case series and other studies indicate its feasibility and safety.

Introduction. The shear wave ultrasound elastography is a recently developed ultrasound-based method in the clinical practice, which allows the qualitative visual and quantitative measurements of tissue stiffness. In the 2010 this technology of the shear wave was called Shear Wave Elastograhpy. Due to the front of the shear waves the qualitative and quantitative assessment of the tissue stiffness is possible. Objective is to examine the efficacy of the shear wave ultrasound elastography in the evaluation of the prevalence of the oncological disease in patients with the prostate cancer and to compare the obtained results with the routine method X-ray diagnostics. Materials and methods. From the april 2015 in the I.M. Sechenov First Moscow State Medical University Urology Clinic there were conducted 314 shear wave ultrasound elastography examinations of the prostate. The ultrasound system Aixplorer® by SuperSonic Imagine was used. This system provides information provided by B-mode and shear wave ultrasound elastography mode. The transrectal echograms were made in 6 dimensions, so called Q-boxes (3 demensions in the every lobe on the segments from the base to the apex, according to the biopsy zone). The unit of measurement was the mean value in the kilopaskals (kPa). All the patients were randomized into 3 groups. There were 146 men with the possible prostate cancer in the first group (prospective study), 120 men with the certain diagnosis of the prostate cancer in the second group (retrospective study) and 48 healthy men in the third group (control study). In all the patients of the first and the second groups the routine complete examination, including the prostate specific antigen (PSA) level examination, digital rectal examination (DRE), doppler transrectal ultrasonography (TRUS), histoscanning and ultrasound shear wave elastography (SWE), was conducted. In the 229 patients of the first and the second groups the prostatectomy with the morphological verification of postoperative material was made. In the 63 patients of the first and the second groups the contrast-enhanced magnetic resonance imaging (MRI) of the pelvic organs was made. In the health men’s group, besides the ultrasound shear wave elastography, only the routine diagnosis methods of the prostate cancer (PSA level, TRUS and DRE) were used. Results. According to the results of our study, the threshold values for the normal prostate tissue stiffness due to the ultrasound shear wave elastography were from 0 to 23 kPa, for the hyperplastic prostate – from 23.4 to 50 kPa, for the prostate cancer – from 50.5 kPa. The data analysis of the 212 patients with the verified prostate cancer showed the increase of the mean degree of tissue stiffness due to the clinical stage and tumor differentiation (Gleason scale total score). All the patients were divided into the subgroups with the certain correlation values. In patients with the Gleason scale total score < 7, the mean degree of tissue stiffness was 72 kPa (n = 63). In 57 patients with the Gleason scale total score 7, the mean degree of tissue stiffness was 69 kPa. In 48 patients with the Gleason scale total score from 8 to 10, the tissue stiffness was averagely 119 kPa. The locally advanced stage Т3–4 was determined in 44 examined patients. The tissue stiffness value correlated with the tumor differentiation rate: the index variations were from 120 to 295 kPa. On the results of this method analysis, its resistance was 90,8 % and specificity was 94,6 %. According to the comparative assessment with the other examination technics, the informative value of the ultrasound shear wave elastography is far above the DRE, the doppler TRUS and the histoscanning, but is lower than the contrast-enhanced magnetic resonance imaging. Conclusion. In view of the above, the ultrasound shear wave elastography is a very informative method of the prostate cancer detection and it has a high rate of the agreement of the results with the contrast-enhanced magnetic resonance imaging and is more specific than the histoscanning.

The article presents an analysis of domestic and international literature on local recurrence of prostate cancer after radical prostatectomy. The authors describe the most advanced methods of diagnosis and treatment of local recurrence commonly used in clinical practice.

Modern medicine tends to use minimally invasive treatments. Selected patients with prostate cancer may be treated using irreversible electroporation that involves the application of a NanoKnife device. The procedure directs short electrical pulses that open microscopic pores in the cells in the treatment area and effectively destroy cancer cells. This literature review outlines the history of irreversible electroporation, its use in surgery for treating cancers of the pancreas, liver, lung, kidney and brain. This technique is relatively new and is not yet applied in routine urologic practice, but has been increasingly used in Europe and North America and, no doubt, will find an appropriate utilization in Russia.

Early detection of prostate cancer (PCa) remains a challenging issue. There are studies underway aimed to develop and implement new methods for prostate cancer screening by tumor imaging and obtaining tissue samples from suspicious areas for morphological examination. One of these new methods is shear wave ultrasound elastography (SWUE). The current literature is lacking sufficient coverage of informativeness and specificity of SWUE in the prostate cancer detection, there is no clear criteria for assessing tissue stiffness at different values of PSA and tumor grade, and in prostate hyperplasia and prostatitis.To evaluate the informativeness and specificity of SWUE compared with other diagnostic methods.SWUE has been used in the Clinic of Urology of Sechenov First MSMU since October 2015. During this period, 302 patients were examined using SWUE. SWUE was performed with Aixplorer ultrasound system (Super Sonic Imagine), which provides a single-stage SWUE imaging with both B-mode and real-time mode. The first group (prospective study) included 134 men aged 47 to 81 years with suspected prostate cancer scheduled to either initial or repeat prostate biopsy. PSA levels ranged from 4 to 24 ng/ml. The second group (retrospective study) comprised 120 men with confirmed prostate cancer and PSA levels between 4 and 90 ng/ml. The third group (the control group), comprised 48 healthy men whose PSA level did not exceed 3 ng/ml. All patients of the groups 1 and 2 underwent a standard comprehensive examination. Patients in group 1 were subsequently subjected to transrectal prostate biopsy guided by localization of areas with abnormal tissue stiffness. PCa was detected in 100 of 134 patients. 217 patients of groups 1 and 2 underwent radical prostatectomy. In 28 of them, the match between the cancer location and differentiation in the removed prostate and SWUE findings before surgery was examined. Contrast-enhanced magnetic resonance imaging of pelvic organs was performed in 63 patients of groups 1 and 2.Threshold values of stiffness (Emean) were determined, which normally range from 0 to 23 kPa, from 23.4 to 50 kPa in prostatic hyperplasia and 50.5 kPa and greater in prostate cancer. A total of 220 patients in groups 1 and 2 were found to have prostate cancer. The findings showed increased stiffness of prostate tissue depending on tumor differentiation, Gleason score, and hence, cancer risk. The sensitivity (Se), specificity (Sp), positive predictive value (PPV), negative predictive value (NPV) were calculated for SWUE, biopsy based on 6 peripheral points used during SWUE, and for histologic findings from prostate cross sections. When compared to needle biopsy, Se, Sp, PPV, NPV for SWUE were 90.8, 94.6, 56.6 and 97.9%, respectively.The study findings suggest a high diagnostic performance of SWUE in detecting prostate cancer.

Prevention of prostate cancer (PCa) is a vital problem dictated by the obvious benefit of prevention compared to the complexity of treatment. To date, a tremendous amount of research both in vitro, and in vivo assessment of different prophylactic measures has been published. They included consumption of protein, carbohydrate, fat, fiber, vegetable extracts and other solid products, and combinations thereof in the diet, vitamins, minerals, and biologically active substances, medicaments. The optimal preventive agent has not been found, and that prompted us to conduct our own research of dietary supplement ProstaDoz. The study was performed on a group of 58 patients with elevated prostate-specific antigen and the results of the histological study confirming the absence of prostate cancer and the presence of a high degree PIN. After 6 month course of ProstaDoz histological analysis of repeated biopsy samples revealed a significantly lower incidence of prostate cancer and atypical small acinar proliferation in the group receiving ProstaDoz (10.4%) compared to control group (20,7%; p0,024), and in some cases even regression of PIN (32%) in the study group (p = 0.5). Also, there was a significant reduction in prostate-specific antigen after receiving ProstaDoz. These data show the potential effectiveness of ProstaDoz use as a means of PCa chemoprevention.

Currently, extracorporeal shock wave lithotripsy (ESWL) is a minimally invasive treatment for patients with urolithiasis. With advancing medical technology, elastography has evolved as a method for measuring the elasticity of tissues.To investigate the elasticity of urinary stones for assessing their physical and chemical composition.The elasticity of urinary stones was determined before ESWL in 30 urolithiasis patients (18 men and 12 women, aged 25-65 years) using shear wave ultrasound elastography (SWUE). In 40%, 23.3% and 20% of patients, urinary stones were located in the renal pelvis, the middle calyceal group and the lower calyceal group, respectively.Elastography is a method of determining the elasticity of urinary stones, measured in kPa. Mean elasticity (Emean) of calcium oxalate monohydrate stones, uric acid stones and mixed urinary stones was 39.8, 14.6 and 26.3-29.8 kPa, respectively. Urinary stones smaller than 5 mm did not differ in the color spectrum. Excess body mass index (BMI) also reduced the informative value of the method.The findings of SWUE are comparable with the results of computer densitometry and physical and chemical composition of the investigated urinary stones.

The new potentialities of 3D transrectal ultrasound study were realized in a HistoScanning diagnostic unit. It has been used at the R.M. Fronshtein Urology Clinic, Research Institute of Uronephrology and Reproductive Health, I.M. Sechenov First Moscow State Medical University, since September 2011. A study of the sensitivity and specificity of the technique enrolled patients undergoing high-intensity focused ultrasound (HIFU) ablation of the prostate of for its (PC) in the period 1 to 7 years. Prostate biopsy study with subsequent histology was made to confirm the results of histoscanning. Statistical processing of the obtained data showed that the sensitivity and specificity of histoscanning were 96 −100 and 87.5 −100%, respectively. These results allow one to appreciate histoscanning as a highly sensitive technique that advantageously differs in its significance level and informative value from now routinely used methods. The study on the possibility of planning and monitoring patients after focal treatments for PC opens up great prospects in achieving a balance between the radicality of performed surgery and the maintenance of quality of life in patients.

In September 2011, the Research Institute of Uronephrology and Human Reproductive Health began to use an apparatus for the early diagnosis of prostate cancer. One hundred and fifty-six studies have been conducted by now. In the examinees, the level of prostate-specific antigen was estimated to be in the range of 1.09 to 209 ng/ml. The results of the studies confirm European data on the sensitivity and specificity of this procedure.

Robotic surgery is a future method of minimal invasive surgery. Robot-assisted radical prostatectomy (RARP) is a common method of surgical treatment of prostate cancer. Due to significant differences of the surgical technique of RARP compared to open or laparoscopic radical prostatectomy (LRP) new methods of training are needed. At the moment there are many opinions how to train physicians best. Which model is the most effective one remains nowadays controversial.Analyze currently available data of training methods of RARP. Determine the most effective training model and evaluate its advantages and disadvantages. Establish a standardized plan and criteria for proper training and certification of the entire surgical team.Literature review based on PubMed database, Web of Science and Scopus by keywords: robot-assisted radical prostatectomy, training of robot-assisted prostatectomy, training in robot-assisted operations, a learning curve of robot-assisted prostatectomy, virtual reality simulators (VR-simulators) in surgery.According to the literature in average 18 to 45 procedures are required for a surgeon to achieve the plateau of the learning curve of the RARP. Parallel training, pre-operative warm-up and the use of virtual reality simulators (VR-simulators) can significantly increase the learning curve. There are many described models of RARP training.The absence of accepted criteria of evaluation of the learning curve does not allow to use this parameter as a guide for the surgeon's experience. Proper training of robotic surgeons is necessary and requires new methods of training. There are different types of training programs. In our opinion the most effective training program is when a surgeon observes the performance of tasks or any steps of operation on the VR-simulator, then he performs them and analyzes mistakes by video recording. Then the surgeon observes real operations and performs some steps of the operation which are already leant on the simulator under supervision of the mentor and analyzes mistakes by video recording. Thus, mastering first the simple stages under supervision of a mentor, the surgeon effectively adopts the surgical experience from him. It is necessary to train not only the surgeons but also the entire surgical team.Роботическая хирургия - одно из будущих направлений малоинвазивной хирургии. Робот-ассистированная радикальная простатэктомия (РАРП) - распространенный метод хирургического лечения рака простаты. Поскольку хирургическая техника выполнения РАРП значительно отличается от открытой или лапароскопической радикальной простатэктомии (РПЭ), требуется создание новых методов обучения для надлежащей подготовки хирургов. В настоящий момент существует множество мнений касательно методики обучения выполнению робот-ассистированных операций, однако выбор наиболее эффективной модели остается спорным вопросом по сей день. Цель исследования - проанализировать имеющиеся на текущий момент сведения о методах обучения РАРП. Определить наиболее эффективную модель обучения, оценить ее преимущества и недостатки. Установить стандартизированный план и критерии надлежащего обучения, а также аттестации всей хирургической команды. Материал и методы. Произвести обзор литературы в базе данных PubMed, Web of Science и Scopus по ключевым словам: робот-ассистированная радикальная простатэктомия, обучение робот-ассистированной простатэктомии, обучение робот-ассистированным операциям, кривая обучения робот-ассистированной простатэктомии, симуляторы виртуальной реальности (VR-симуляторы) в хирургии. Результаты. По данным современной литературы для достижения уровня плато кривой обучения РАРП необходимо выполнение в среднем 18-45 операций. Параллельное модульное обучение, предоперационная разминка за роботической консолью и использование симуляторов виртуальной реальности значительно повышают скорость освоения хирургических техник при выполнении РАРП. Существует множество описанных моделей обучения робот-ассистированным операциям. Выводы. Отсутствие общепринятых критериев оценки кривой обучения хирургов не позволяет использовать данный параметр в качестве ориентира касательно опыта хирурга. Надлежащая подготовка роботических хирургов является необходимой и требует создания новых методов обучения. При этом существуют различные варианты учебных программ. На наш взгляд, наиболее удачной из них является программа, при которой хирург сначала следит за выполнением наставником тех или иных заданий или этапов операции на VR-симуляторе, затем сам выполняет их с последующим анализом ошибок по видеозаписи. Далее хирург наблюдает реальные операции, выполненные наставником, затем под его контролем выполняет те этапы, которым уже был обучен на симуляторе, и анализирует ошибки по видеозаписи. Таким образом, осваивая сначала легкие этапы, потом ключевые этапы операций под контролем наставника, хирург эффективнее перенимает хирургический опыт наставника. Обучение должны проходить не только сами хирурги, но и вся хирургическая команда.

Sixty patients with chronic prostatitis and sexual dysfunction were divided into two groups. All the patients received one-month standard course of physiotherapy. In addition, group I (n = 30) was given levitra (vardenafil; 5 mg per os each other day), the control group was not given this drug. Follow-up covered 6 months to 1.5 years. General urological examination, questionnaire survey, ultrasound investigation of male genital organs were made before, 1 and 6 months after treatment. The results were processed statistically. Levitra improves circulation in male sexual organs promoting increased arterial inflow to the prostate and penis. Aftertreatment effect persisted for half a year. Regular levitra intake (2-3 times a week) is recommended to correct circulation in the sexual system, including prostatic gland, but not only for correction of erectile dysfunction as a result of psychogenic and vascular disorders in the penis accompanying chronic prostatitis.

Ultrasonic dopplerography of prostatic, scrotal and penile vessels before and after intake of levitra in a dose 10 mg was made in 22 patients with chronic abacterial prostatitis in combination with erectile dysfunction and after their combined levitra treatment for a month taken each other day. It was found that levitra accelerates arterial inflow to the prostatic gland, testicles and penis (even in the absence of sexual stimulation and erection). This evidence indicates a distinct vasculogenic effect of levitra on male genitalia. Thus, levitra is a promising drug in the treatment of chronic prostatitis, excretory infertility. It is recommended to take levitra regularly 2-3 times a week to manage vascular genital disorders.

The article presents an analysis of domestic and international literature on local recurrence of prostate cancer after radical prostatectomy. The authors describe the most advanced methods of diagnosis and treatment of local recurrence commonly used in clinical practice.

OBJECTIVE To study the survival rate of patients without biochemical recurrence according to the Stuttgart and Phoenix criteria in terms of their correlation with four different PSA nadir values as predictors of clinical recurrence in patients with localized prostate cancer who underwent total HIFU prostate ablation. MATERIAL AND METHODS The object of the study was patients with morphologically proven localized RP by biopsy results, who were treated with prostate cancer by HIFU ablation on the Ablatherm Integrated Imaging apparatus (EDAP TMS, France). The study included 658 patients in whom HIFU ablation was used as primary treatment of localized prostate cancer (stages T1 - T2) without previous use of other methods (hormonal, radiation therapy) For the analysis, a continuous sample of patients was selected, which were divided into four groups depending on the PSA nadir level: less or equal 0.2 ng / ml (1 group), 0.21-0.5 ng / ml (group 2), 0.51-1 ng / ml (group 3) and> 1 ng / ml (group 4). sensitivity, specificity, predictive value, and 5-year biochemical relapse-free survival according to the Stuttgart definition and the Phoenix definition in the PSA nadir groups. RESULTS The median (range) of the observation period for the patients was 5.3 (3-7) years, the mean time to reaching PSA nadir was 14.5+/-2.6 weeks. PSA nadirs less or equal 0.2, 0.21-0.5, 0.51-1.0 and > 1 ng/ml were achieved in 231 (35.1%), 132 (20.0%), 105 (15, 9%) and 190 (28.8%) patients, respectively. Survival without biochemical relapse in accordance with the Stuttgart definition in the four groups allocated for the PSA nadir was 82, 65, 43 and 32%, respectively (p