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This article presents a clinical case of a rare pathology in urological practice – idiopathic stricture of the female urethra, considers the tactics of patient management and the method of surgical correction.

Introduction. Transurethral resection of bladder tumor (TURBT) is the gold standard treatment for patients with non-muscle invasive bladder cancer (NMIBC). However, the high recurrence rate after TURBT makes necessary not only regular following to reveal recurrence disease timely, but it also talks about a necessity of adjuvant antitumor therapy in some cases, that allows to prevent disease recurrence and progression. In this regard, patients belonging to high- and sometimes intermediate- risk progression groups are shown to undergo postoperative adjuvant intravesical Bacillus Calmette–Guérin (BCG) therapy. Despite the long experience of using BCG therapy for NMIBC treatment the question of the existence of possible prognostic markers and response predictors to intravesical BCG therapy remains open.Objective. To review cutting-edge data on different markers that can be used as predictive response markers to ongoing intravesical BCG therapy in NMIBC-patients.Materials and methods. A literature search was conducted using PubMed/ Medline and Google Scholar databases. We used terms 'bladder cancer', 'non-muscle-invasive bladder cancer' in conjunction with 'recurrence', 'progression', 'BCG', 'intravesical therapy', 'immune response', 'molecular markers' to choose relevant articles published between 2000 and 2022.Results. Clinical and pathological characteristics of the tumor and the patient himself remain leading in predicting the response to intravesical BCG therapy in NMIBC-patients. However, to improve the effectiveness of assessing the risk of developing adverse BC outcomes and choosing the most appropriate strategy for monitoring and treatment in each case, it is necessary to introduce additional assessment parameters. Molecular and genetic markers could be considered as such parameters, make it possible to reveal differences between tumors at a deeper level.Conclusion. Currently, there are no markers that have high-evidence in predicting response to intravesical BCG therapy in NMIBC-patients compared with the cliniсal and pathological characteristics of the tumor and the patient himself. The clearer awareness of molecular genetic pathways of BC pathogenesis, the mechanism of BCG antitumor effect will make it possible to competently select markers that have the highest specificity for BC, which will increase the predictive ability of currently existing tools to assess the risks of BC recurrence and progression.

Background. Prostate cancer is the most common malignant condition among oncological diseases of the genitourinary tract, which occupies the second place in male mortality from malignant neoplasms. At the same time, population of patients with prostate cancer is heterogeneous: in some patients, the disease does not require active treatment, while in others it progresses rapidly with the formation of metastatic castration-resistant prostate cancer. Therefore, the search for new predictive markers remains relevant.Objective. Analysis of the prognostic significance of the loss of heterozygosity of PTEN, RB1, TP53, BRCA1 and BRCA2 genes in patients with localized and locally advanced prostate cancer.Materials and methods. The study included 52 patients with prostate cancer, 31 (59.6 %) of whom had a localized form (T1-2N0M0), and 21 (40.4 %) - locally advanced (T3a-bN0/1M0). All patients underwent radical prostatectomy, followed by genotyping of postoperative and biopsy specimens to determine genetic alterations in the studied genes. Detection of deletions in the studied genes was carried out using the method of multiplex ligation-dependent probe amplification.Results. In 13 (25.0 %) patients in the postoperative specimen was detected deletion of PTEN gene, in 6 (11.5 %) - deletion of RB1 gene, and in 1 (1.9 %) - deletion of BRCA2 gene. At the same time, patients with loss of PTEN heterozygosity were more likely to have perineural invasion (p = 0.01) and lymph node involvement (p = 0.0003). Deletion of RB1 gene is associated with more frequent detection of high-grade tumors (p = 0.013), cribriform growth component (p = 0.002), and invasion of the periprostatic tissue (p = 0.005).Conclusion. Detection of loss of heterozygosity of PTEN and RB1 genes is a promising tool for clarifying the prognosis of the disease, which in the future will allow more accurately stratify patients into risk groups for biochemical relapse.

A comparative analysis of the detection of CagA-positive strains of H. pylori by immunochromatographic and molecular genetic methods was carried out. We used H. pylori strains isolated from individuals with diseases of the gastrointestinal tract. The immunochromatographic method was implemented using a developed experimental model of an immunochromatographic test system for detecting the H. pylori CagA protein in various biological materials. Determination of the pathogenicity gene cagA of H. pylori was carried out using the «Helikopol SA» test system («Litekh», Russia). The assessment of the comparability of the results of detecting CagA-positive strains of H. pylori was carried out using statistical methods: Monte-Carlo, calculation of the chi-square test (χ2) and Kendall’s τ-b and Somer’s d coefficients. Statistical analysis was performed using the software packages «Microsoft Office Excel», «Statistica 10.0», «WinBUGS 1.4.0.» The study showed the absence of a statistically significant difference and the presence of a direct strong correlation between the results of detecting CagA-positive strains by molecular genetic and immunochromatographic methods, which indicates that these methods provide similar results in identifying highly pathogenic strains of H. pylori.

The OBJECTIVE of the study was to analyze the results and to introduce our experience of the laparoscopic pyeloplasty regarding the stricture of the pyeloureteral segment.METHODS and MATERIALS. Our study represents results of treatment of 114 patients who had surgical treatment during the years 2013–2018. In that period, we made 114 primaries and 9 secondaries laparoscopic pyeloplasties with transperitoneal access. In this account, there were 43 men aged from 19 to 64 years, average age was (34.9±3.7), and 71 women aged from 19 to 77 years, average age was (39.2±4.2). All patients underwent ultrasound examination of the kidneys on the day of discharge and 3-5 days after stent extraction. Control examination, which included history taking, examination, clinical and biochemical blood analyses, clinical urine analysis and ultrasound of the kidneys were performed after 3 months. Plain and excretory urography were performed 6 and 18 months after surgical intervention. RESULTS. Operative removal of the stricture of the pyeloureteral segment was successful in 105 (92.2 %) out of 114 cases. 9 patients (7.8 % of the total number of operated patients) underwent repeated laparoscopic pyeloplasty. Duration stay after primary laparoscopic pyeloplasty was from 3 to 5 days, on average (3.9±0.7) days. Postoperative period after secondary pyeloplasty was without complications, the bed-day was from 3 to 6 days, on average (4.3±0.6) days.CONCLUSION. Our opinion is that the optimal method for surgical treatment of patients with primary and secondary strictures of the pyeloureteral segment is laparoscopic pyeloplasty. This kind of surgery has a favorable security profile and optimal postoperative results. Considering the possible causes of relapse of the stricture of the pyeloureteral segment, we came to the conclusion that the frequency of relapse is mainly connected with selected suture material, which determines the severity of scar changes.

Encrusted cystitis (IC) is a rare chronic inflammatory disorder of the bladder characterized by mucosal inflammation with encrustations. This pathological process is directly related to the activity of urea-splitting bacteria in the urine. Bladder encrustations are deposits of ammonium and magnesium phosphate, as well as struvite, on the surface of the urothelium. However, the pathogenesis of this disease has not been thoroughly studied. Treatment of encrusted cystitis is aimed to complete eradication of the uropathogen, surgical removal of encrustations, and lowering urine pH. Early diagnosis is a key prerequisite for effective treatment.

Background. High-risk prostate cancer (PCa) occurs in 15-25 % of newly diagnosed cases and is a life-threatening condition that requires active treatment. In recent years, the percentage of high-risk PCa has significantly increased, as well as the number of prostatectomies performed in patients with unfavorable morphologic features. However, the high-risk group criteria are not fully defined yet. According to various medical associations, a locally advanced or localized disease may have a high risk of progression. Study objective: to evaluate early and long-term results of treatment of patients with high-risk PCa depending on the high-risk group criteria. Materials and methods. The analysis includes results of radical surgical treatment of 832 patients with localized or locally advanced high-risk PCa treated in three medical institutions in St. Petersburg in the period from 2001 to 2019. Clinically high-risk group included patients with one of the following criteria: prostate specific antigen level >20 ng/ml, Gleason score >8, stage (cT); according to the last criterion two groups of patients were identified: HR-EAU (≥cT2c; n = 408) and HR-NCCN (≥cT3a; n = 282). Results. The average prostate specific antigen level was 21.09 and 26.63 ng/ml, respectively, in HR-EAU and HR-NCCN groups (p< 0.0001). The incidence of positive surgical margin, positive lymph nodes (pN+), five-year recurrence-free, cancer-specific, and overall survival did not differ significantly between the clinically high-risk groups. When evaluated according to the criteria obtained from pathomorphological examination of the removed prostate, the HR-NCCN group showed higher frequency of positive surgical margin (24.8 % vs. 19.2 %) and frequency of pN+ (22.4 % vs. 10.4 %). Analysis of long-term outcomes showed less favorable 5-year results in the HR-NCCN group (recurrence-free, cancerspecific, overall survival - 54.8, 87.0, 83.7 %) compared to the HR-EAU group (recurrence-free, cancer-specific, overall survival - 71.0, 92.1, 88.2 %) (p Conclusion. Differences in the high-risk group criteria by clinical indicators between associations do not affect early (frequency of positive surgical margin, pN+) and long-term (recurrence-free, cancer-specific, overall survival) outcomes. Pathomorphological indicators are less favorable when evaluated according to NCCN. According to our results, any of the proposed models can be used before radical prostatectomy to determine the prognosis of high-risk PCa patients. However, the NCCN morphological prognostic factors allow better prediction of outcomes and, in accordance with them, prescribe treatment that corresponds to the aggressiveness of the disease.

Relevance. A wide variety of oral care products is available nowadays. Sometimes aggressive advertising rather than doctor’s advice determines our patients’ choice. In our research, we provide evidence of the clinical use of toothpaste containing fluoride and sodium bicarbonate.Materials and methods. During four weeks, we followed up a group of students who used the toothpaste containing 1400 ppm fluoride and 67% aqueous sodium bicarbonate solution. The clinical, biochemical and microbiological tests and saliva crystallization score assessed the characteristics stated by the manufacturer.Results. The statistically significant correlation between all studied criteria is evidence of the effectiveness of the toothpaste. In addition to the significant remineralization and antiplaque effect, biochemical and microbiological tests confirmed the anti-inflammatory effect of the toothpaste. An immediate cleaning effect was observed after the first brushing as well as in long-term use.Conclusion. Improvement of oral hygiene indices and reduction of periodontal inflammation confirmed the successful result of the comprehensive treatment of chronic gingivitis.

Background. Prostate cancer holds one of the leading positions among malignant neoplasms in men. One of the most well-studied tumor-specific maskers is the PCA3 score in urine obtained after prostate massage. However, the study of the PCA3 score without prostate massage can significantly simplify the preanalytical phase of the study and minimize discomfort for the patient. Objective . Investigation of the diagnostic significance of PCA3, determined in urine sediment without prostate massage and its comparison with the PCA3 score after prostate massage. Materials and methods . The study included 2 groups of patients. In the first group (n = 50), the PCA3 score was assessed without prostate massage, and in the second group (n = 15) PCA3 was assessed in urine obtained before and after massage. Results. The area under the ROC-curve (AUC) for the PCA3 score without prostate massage was 0.722 (95 % confidence interval 0.579—0.865; p = 0.008). Using the ROC analysis, the threshold value, sensitivity and specificity were determined: 25, 72.41 % (95 % confidence interval 54.28— 85.30 %) and 57.14 % (95 % confidence interval 36.55—75.53 %), respectively. The PCA3 score after massage was found to be more sensitive than without prostate massage. A small volume of material, less than 20 ml, significantly affects the sensitivity of PCA3 without massage. Conclusion . PCA3 without prostate massage may serve as an option to improve the early diagnosis of prostate cancer, but its advantage over PCA3 after prostate massage has not been shown.

Prostate cancer (PCa) is a second of the most commonly diagnosed carcinoma in the male population. Usually sites of secondary lesions are lymph nodes and bones. Most cases of testicular metastases are incidentally diagnosed after orchiectomy. We present a case of 62-year-old man with metastatic castration-resistant PCa and symptomatic testicular metastasis with contralateral epididymal metastasis. Right site radical orchiectomy and left site orchiectomy was performed. The pathology report identified PCa metastases in the right testis and in the left epididymis. Testicular and epididymal metastases are uncommon in PCa. Therefore, a testicular physical examination is necessary for patients with PCa. Physicians have to keep in mind the possibility of testicular metastasis in cases of biochemical recurrence and progression of the disease.

Aim to evaluate the efficiency and usefulness of augmented reality (AR) technology using HoloLens glasses for laparoscopic partial nephrectomy (LPN). Materials and methods From July to December 2019, a total of 5 patients with localized kidney cancer (cT1aN0M0) underwent AR-assisted LRP. The mean RENAL score was 6 points (5-8). Preoperatively, all patients underwent contrast-enhanced multispiral computed tomography (MSCT). The three-dimensional reconstructions of the kidney, tumor, part of the abdominal aorta with the renal artery and its branches, part of the inferior vena cava with the renal vein were segmented with color coding and connected into a single virtual 3D model, which was loaded into the program in order to display image in AR glasses. The duration of surgery and thermal ischemia, type and frequency of intraoperative complications, as well as the time spent on preparing the 3D model and the Microsoft HoloLens device were evaluated. To assess the feasibility of using AR technology intraoperatively, a Likert scale was filled out by the surgeon. Results It took 10 (9-11) hours to prepare the model, including time to optimize the model and to set up its display and interactions. The setup of HoloLens required an average of 7.8 (5- 12) min. The total duration of the operation and the period of warm ischemia was 108 (90-120) and 20 (15-25) min, respectively, while intraoperative blood loss was 160 (110-250) ml. In all cases, a negative surgical margin was found. The surgeon who performed all the operations assessed the use of AR technology with the HoloLens device as highly beneficial in all clinical cases. Conclusion The use of AR technology with a HoloLens holographic device during LPN can lead to improved treatment outcomes.

Background. Prostate cancer (PCa) is one of the most common malignancy in men. A traditional marker in the laboratory diagnosis ofPCa is the prostatic specific antigen (PSA). However, the low specificity of this marker leads to a large number of unnecessary biopsies. The emergence of various modifications of PSA and tumor-specific genetic markers such as PCA3 and TMPRSS2ERG, have improved the diagnosis of PCa.Objective. Investigation of the diagnostic significance of molecular genetic markers, PCA3 and TMPRSS2:ERG, and their comparison with markers based on PSA isoforms: free/total PSA ratio (%fPSA) and prostate health index (PHI).Materials and methods. The study included 58 men with suspected PCa. All patients were defined PCA3 score and the presence of TMPRSS2:ERG fusion transcript in the urine sediment. Also, PHI and %fPSA were determined in 48 and 51 men, respectively.Results. The area under the ROC-curve regardless of the value of PSA was higher for PCA3 score (0.773, p 95 % PCA3 score had the highest specificity, positive and negative predictive values in men, regardless of the level of PSA: 65.22, 80.95, and 93.75 %, respectively. In men with PSA level of 2—10 ng/ml the area under the ROC-curve for PCA3, %fPSA and PHI was 0.776 (p = 0.001), 0.629 (p = 0.144) and 0.729 (p = 0.009), respectively. At high sensitivity (>95 %) characteristics of the diagnostic test PCA3 in men with a PSA level of 2—10 ng/ml also also exceeded those for PHIand %>fPSA. The negative predictive valuefor PCA3score in this group ofmen was 100 %. The sensitivity ofdetection ofthe TMPRSS2:ERG fusion transcript in urine was 37.14 %, specificity 86.96 %, and the positive predictive value was 81.25 %.Conclusion. The use ofthe PCA3 score in combination with the detection of TMPRSS2:ERG fusion will improve the assessment of PCa risk in men with PSA levels between 2 and 10ng/ml (the “grey zone”).

AIM to evaluate the efficiency and safety of phenazopyridine for the treatment of patients with uncomplicated lower urinary tract infection, accompanied by pain. MATERIALS AND METHODS A multicenter double-blind, randomized, placebo-controlled study with parallel groups to evaluate the efficacy and safety of phenazopyridine in patients with acute uncomplicated cystitis was performed. A total of 60 women were divided into two groups of 30 patients. In the main group (average age 32.6+/-7.4 years) phenazopyridine was prescribed (2 tablets of 100 mg p.o., with a total dose of 200 mg, once). In the control group, patients (mean age 35.53+/-8.79 years) received a placebo according to the same scheme. To evaluate the efficiency of treatment, the severity of the main symptoms 6 hours after taking the drug was analyzed. After that, patients started antibiotic therapy. They were followed-up for the next three days. The tolerance of therapy was evaluated by the presence of adverse events. RESULTS All 30 patients taking phenazopyridine had an improvement after 6 hours, and the most frequent response was "significant improvement" (43.3%). The responses of patients in the main group significantly (p

TolsotogoSt., Saint Petersburg 197022, RussiaBackground.Prostate cancer (PCa) of a high and very high risk is a potentially fatal disease that requires an active multimodal approach, including the use of neoadjuvant drug treatment. As option for this treatment is neoadjuvant chemohormonal therapy (NCHT) followed by radical prostatectomy (RPE). However, data on the oncological results of treatment of such patients are still limited and the role of neoadjuvant therapy in the treatment of high and very high-risk PCa remains not fully understood.Objective:toassesstheoncologicalresultsoftreatmentpatientswithlocalizedandlocallyadvancedPCaofhighandveryhighriskafterNCHT.Materials and methods.This was a prospective randomized study: patients with PCa of high and very high-risk groups (prostate specific antigen levels (PSA) >20 ng/ml and/or Gleason score³8and/or clinical stage >T2c) were treated with RPE only (group RPE; n = 35) or NCHT followed by RPE (NCHT/RPE group; n = 36). The neoadjuvant course included the intravenous administration of docetaxel once every 21 days (75 mg/m2 up to 6 cycles) and the antagonist of the gonadotropin releasing hormone degarelix according to the standard scheme (6 subcutaneous injections every 28 days). After a follow-up examination evaluating the result of the neoadjuvant regimen, patients underwent RPE with extanded lymphadenectomy.Results.A mean follow-up was 37.08 ± 20.46 months. A statistically significant reduction of prostate specific antigen >50 % post-chemohormonal therapy was observed in all 36 cases. Lower postoperative stage was noticed in 38.5 % in NCHT/RPE group compared with 2.7 % in RPE group. Similarly, positive surgical margin rate was higher in group without neoadjuvant therapy – 40 and 25 % (RPE group). Cancerspecific survival was 97.2 % in NCHT/RPE group and 87.56 % in the RP group (p = 0.037), cancer specific survival rate – 91.4 % and97.2 % respectively (log-rank test p = 0.22). At the same time, no statistically significant differences were obtained in 3-year recurrence free survival between groups: 38.8 % in NCHT/RPE group versus 43.6 % in the RPE group (log-rank test p = 0.36).Conclusion.Conducting NCHT before RPE is a safe and effective strategy in patients with PCa of high and very high risk groups and could improve oncological results.

Postoperative progression of prostatic cancer (PC) after radical prostatectomy (RPE) may be caused by a residual tumor that is suggested by the presence of tumor cells in the resection positive surgical edge (PSE), regional and distant metastases.Objective. To reveal the preoperative prognostic factors of PSE occurrence during retropubic RPE in patients with clinically localized PC. Subjects and methods. The incidence of PSE was analyzed in 288 PC patients treated with retropubic RPE between November 1997 and May 2006. The correlation between the results of transrectal multifocal prostatic biopsy and the incidence of PSE was assessed.Results. PSE was detected in 87 (30.2%) of the 288 patients. Single and multiple PSEs were found in 70 (80.5%) and 17 (19.5%) patients, respectively. The commonest site of PSE was the posterolateral prostate surface [n = 26 (37.1%)]. In males who had less than 30.0% positive biopsies, PSE was diagnosed in 10.4% of cases. With the positive columns exceeding 30.0%, it was revealed in 52.5% of cases. In patients with PSE, the mean maximum tumor amount in the biopsy specimen was 84.8% (84.8±5.2%). PSE was detected in 71.1% of the patients with a Gleason grade of 7 or more, whereas in patients with lower grades, it was found in 19.9%. In the groups of patients with positive and negative surgical edges, perineural invasion was identified in 63 (73.3%) and 12 (5.9%) cases, respectively. In patients with PSE, the signs of capsular tumor invasion were detected in 58 (67.4%) cases and in those without PSE it was present in 20 (9.95%) cases only.Conclusion. The incidence of PSE during retropubic RPE was associated with a number of positive columns of over 30.0%, the tumor amount in the biopsy specimen of more than 80.0%, a Gleason grade of 7 or more, capsular and perineural invasion.

Increased incidence of radical prostatectomies in the treatment of patients with prostatic cancer (PC) necessitates analysis of causes of the disease relapses after surgery. Positive surgical margin (PSM) is considered as one of the main causes. Aim — study of the incidence of PSM in patients with a history of retropubic radical prostatectomy for clinically local and locally disseminated PC and evaluation of prognostic factors. The incidence of PSM was analyzed in 271 patients with a history of retropubic prostatectomy, with consideration for the preoperative level of PSA, tumor differentiation and dissemination; the efficiency of neoadjuvant therapy (NAT) for PSM reduction was evaluated. PSM was detected in 84 (31.0%) patients. Significant criteria for PSM prognosis are clinical stage of disease, Glisson sum, and relative number of positive biopsy columns. NAT significantly reduced the incidence of PSM only in patients with local PC. NAT is indicated for patients with clinical signs of extraprostatic extension. It is ineffective in patients with locally disseminated PC because it cannot change the incidence of PSM.

Quality of life (QL) is a highly informative health index that is based on the self-assessment of general well-being and used in clinical practice to evaluate and enhance the efficiency of health care delivered to patients. The present review gives data on various QL studies mainly based on the principles of the psychometric test theory that provided data collection, by applying self-questionnaires or by interviewing patients. Studies of QL in cancer patients use a diversity of specialized test systems considering not only the specificity of various diseases, but also the nature of impact of various treatment modalities on the followed-up patients.Currently available treatments for prostate cancer adversely affect LQ in patients very frequently. The preponderance of these or those abnormalities depends on a treatment option; therefore its selection for a specific patient should be determined, by taking into account their possible impact on quality of life in patients with prostate cancer.

Purpose: The benefit of pelvic lymph node dissection in patients with bladder cancer remains controversial. We have compared these methods of dissection in regard to the following parameters: number of extracted lymph nodes, frequency and location of identifiable metastases, complications rate, and time before development of relapses. Also we have estimated influence of clinical and intra-operative regional changes on a choice of a extent of lymph node dissection.Materials and methods: Analysis included data on 59 patients who underwent radical cystectomy for bladder cancer between 2002 and 2008. Extended lymph node dissection was carried out in 18 patients (30,5%), and limited lymph node dissection — in 41 (69,5 %) patients.Results: The average quantity of removed lymph nodes was 11,2 in cases of limited and 20,8 — in cases of extended lymph node dissection. Consequently, the number of revealed metastases has increased from 21,9 to 33,3%. Complex estimation of preoperative and intraoperative data has demonstrated the greatest efficiency in diagnostics of changes in lymph nodes. Among perioperative complications only frequency of lymphorrhea has appeared to be higher in patients after extended lymph node dissection. Disease-free survival rate was 9,8 months (9,4 in cases of limited and 10,1 — in cases of extended dissection).Conclusions: Extended pelvic lymph node dissection should be recommended as a component of radical cystectomy with diagnostic and, probably, with the therapeutic purpose, especially in patients with suspicion for lymph nodes involvement arisen pre- and/or intra-operatively. Both clinical examination and intra-operative and qualitative pathomorphologic evaluation of regional lymph nodes are very important for full value staging of bladder cancer.

Materials and Methods. The results of transrectal multifocal prostatic rebiopsy made under ultrasound guidance at the Clinic of Urology, Military Medical Academy, in 1998 to 2004 were studied.A total of 2352 males were examined; of them, 125 patients underwent rebiopsy. The patients’ age was 54 to 87 years (mean age 60.3 years). The patients were divided into 4 age groups: 1) 51-60 years [11% (14/125)]; 2) 61-70 years [47% (59/125)]; 3) 71-80 years [35% (44/125)]; 4) > 81 years [0.3% (4/125)]. There were 6 to 14 biopsy probes.Results. The study showed that rebiopsy of the prostate identified its cancer in 23% of the patients having a negative primary histological result. It was also established that the patients in whom primary biopsy revealed prostatic intraepithelial neoplasia (PIN) and/or an increase in PSA of > 0.75 ng/ml per year and its density > 0.15 ng/ml/cm3 should be referred to a repeated histological study within 6 to 12 months. When these rules were observed, there were the most favorable prognostic signs: no capsular invasion, lower Glisson scores, and none metastasis.Conclusion. The study has provided the following indications for rebiopsy:— a continually elevating PSA level or its preservation after primary negative biopsy;— abnormal findings on rectal examination and transrectal ultrasound study;— high-grade PIN in the prior biopsy specimen.

Materials and Methods. The results of examination and treatment of 163 males who had undergone radical retropubic prostatectomy (RRP) with bilateral pelvic lymphadenectomy for clinically locally advanced prostate cancer (PC) (T1aN0M0-to-cT2bN0M0) were studied. The patients’ mean age was 63.5 years and ranged from 41 to 74 years. After RRP, the duration of a follow-up averaged 46.6±2.7 months and ranged from 24 to 81 months. Digital rectal study, determination of serum prostate-specific antigen (PSA) and its density, transrectal multifocal prostate biopsy under ultrasound guidance, and, if required (PSA more than 20 ng/ml or a total of above 7 Glisson scores), computed tomography and scintigraphy of skeletal bones were performed in all the patients. The postoperative examination involved postmortem examination and measurement of serum PSA levels over time.Results. The study has revealed that there is an clear tendency for an increase in the frequency of other poor signs with elevated preoperative PSA levels.Conclusion. The findings have indicated that there is a direct and statistically significant correlation between the preoperative values of total PSA, its density, and the possible outcomes of RRP.

The study objective: estimation of two group patients, treated in N.N. Petrov National Medical Research Center of Oncology with renal cell carcinoma.Materials and methods. The 1st group include patients with standard postsurgical care management after open renal resection with lumbotomy access and warm renal ischemia. The 2nd group include the same treated patients with minimally invasive surgeries and fast track elements under induced hypotension. We analysed preparation of patient for surgery, differences in after treatment care management, frequencies and pain severity, after treatment complications, blood loss severity.Results and conclusion. Research suggests that the system of enhanced recovery after renal resection ensure early patients rehabilitation with two-time less hospitalization period.

Background. Extraperitoneal radical prostatectomy (RP) in patients with prostate cancer is useful when there are no oncological indications to lymph node dissection (e.g. in low and intermediate-low risk of the disease), and allows to perform precise anastomosis and facilitates the early postoperative period. However, even minimally invasive approach does not avoid such factors as a urinary catheter that may disturb patients.Objective. We assessed the possibility to remove the urinary catheter as early as possible.Materials and methods. 28 patients with low (n = 22) and low-intermediate (n = 6) prostate cancer risk (according to NCCN (National Comprehensive Cancer Network) criteria) underwent an extraperitoneal laparoscopic RP from March 2017 to November 2018. All operations were performed by the same surgeon (A. Nosov). The inclusion criteria were the following: localized prostate cancer, prostate specific antigen (PSA) Results. The average patient’s age was 63 years (52–71 years). The median preoperative PSA level was 7.6 ng/ml. The intraoperative technique was unremarkable with no blood transfusion or conversion. All early postoperative complications were classified as minor – grade I, II and IIIa in 2 (7.2 %), 5 (17.8 %) and 1 (3.6 %) patients, respectively. Related to the early catheter removal complications included 1 (3.6 %) patient with urinary leakage (resolved by repeated prolonged urinary catheter insertion) and 4 (14.3 %) with urinary obstruction – resolved by single catheterization (n = 2), percutaneous suprapubic cystostomy (n = 2). No major complications were noticed during the follow-up. Totally, 22 (78.6 %) patients were discharged on the next day after the catheter removal – on the 2nd postoperative day. All discharged patients did not need readmission during the follow-up. Remained 6 (21.4 %) patients stayed at the hospital for 5–18 days. The pathological investigation showed upgrading in 9 (32.1 %) patients with low risk and in 1 (3.6 %) patient with low-intermediate risk. Upstaging to locally advanced forms was noticed in 6 (21.4 %) patients. All patients had the PSA level of Conclusion. Despite the common widespread of minimally invasive RP, there is no consensus on the terms of a urinary catheter removal. According to our data, we suggested it might be of some benefit to remove a urinary catheter early in selected and well-informed patients. A thorough vesicourethral anastomosis pursuance, nerve-sparing, bladder neck sparing and Retzius sparing procedure, intraand postoperative assessment is necessary in all cases.

Aim: To study risks to public health of particular matter components in the atmospheric emissions of multifuel power plants (MPP). Methods: The study was performed on the territory of the Kirov region in the area of atmospheric emissions of the multifuel power plants. We ranked the chemicals included in the composition of atmospheric emissions from MPP by the level of carcinogenic and non-carcinogenic risk and modeled dispersion of emissions of MPP plants and estimation of carcinogenic and non-carcinogenic health risks. Results: Three typical scenarios of the fuel balance of MPP for 17 years of observation were identified: I - the share of solid fuel more than 50 %, II - the share of solid fuel less than 20 % and III, characterized by an increase in the share of solid fuel in the fuel balance to 30 %. During the implementation of scenario I, the carcinogenic risk (CI 95 %) was 3.8x10-4 - 4.8x10-4 for the population of the area with the highest pollution level, non-carcinogenic risk was 2.37-2.96, there was an increase in the frequency of hospital admissions and mortality due to diseases of the circulatory system and respiratory organs. In the transition to scenario II, there was a decrease in the level of carcinogenic risk to 1.4x10-4 - 1.7x10-4 and non-carcinogenic risk to 0.85-1.05, a decrease in the frequency of hospital admissions and mortality due to diseases of the circulatory system and respiratory organs. Conclusions: Changes in the fuel balance of multi-fuel CHP are associated with a significant influence on the level of health risk. Highlighting areas of increased risk for population health in the areas adjacent to MPP is recommended.

Percutaneous nephrolithotomy (PCNL) is the gold standard treatment of large and staghorn kidney stones. Despite technological progress and improvement of PCNL technique, this procedure is associated with complications and in some cases remain a challenge for endourologists. According to the time, complications can be divided into intra- and postoperative. Intraoperative complications include bleeding, injury of the renal collecting system, visceral organs, pulmonary complications, thromboembolic disorders, extrarenal migration of the stone fragments and incorrect nephrostomy tube placement. Postoperative complications include infection and sepsis, bleeding, persistent urinary fistula, infundibular stenosis and death of the patient. The different recommendations that might be useful for the timely diagnosis of various complications in patients undergoing PCNL are provided in the review. Additionally, information on treatment algorithms is included.

to evaluate the efficiency and safety of phenazopyridine for the treatment of patients with uncomplicated lower urinary tract infection, accompanied by pain.A multicenter double-blind, randomized, placebo-controlled study with parallel groups to evaluate the efficacy and safety of phenazopyridine in patients with acute uncomplicated cystitis was performed. A total of 60 women were divided into two groups of 30 patients. In the main group (average age 32.6+/-7.4 years) phenazopyridine was prescribed (2 tablets of 100 mg p.o., with a total dose of 200 mg, once). In the control group, patients (mean age 35.53+/-8.79 years) received a placebo according to the same scheme. To evaluate the efficiency of treatment, the severity of the main symptoms 6 hours after taking the drug was analyzed. After that, patients started antibiotic therapy. They were followed-up for the next three days. The tolerance of therapy was evaluated by the presence of adverse events.All 30 patients taking phenazopyridine had an improvement after 6 hours, and the most frequent response was "significant improvement" (43.3%). The responses of patients in the main group significantly (p0.05) differed from responses of patients in the control group. Six hours after taking phenazopyridine/placebo, the severity of all values according to VAS score, including the degree of general discomfort, pain during urination and increased frequency of urination improved significantly in the main group compared to the control group. The average assessment of general discomfort in the main group decreased by 53.4% in comparison with 28.8% in the control group, while the severity of pain during urination and urination frequency decreased by 57.4 vs. 35.9% and 39.6 vs. 27.6%, respectively. An analysis of the time before the complete absence of the general discomfort was performed. In the main group this period of time was significantly less than in the control group (p0.05). There were no serious adverse events while taking phenazopyridine. Rate of adverse events was comparable between two groups.The results of the study showed that phenazopyridine is an effective and well-tolerated drug for symptomatic therapy in patients with acute uncomplicated cystitis and can be recommended in addition to etiological therapy.

Ureteral stents have a long history of use. Their main goal is to provide effective drainage of the upper urinary tract. Morbidity is mostly related to low biocompatibility of materials, from which stents are made. Since stent introduction, there have been many stages of evolution and modernization. However, there is a significant problem associated with their widespread use. Despite technological progress, stent-associated symptoms, incrustation, bacterial infection are the problems that still have to be resolved while creating an "ideal" stent. The continued development of new materials and coatings also will lead to the improvement of such an indispensable urological device as the ureteral stent.

Рак предстательной железы (РПЖ) является одним из самых распространенных онкологических заболеваний в мире. У пациентов с РПЖ достаточно часто отмечают рецидивы после радикального хирургического лечения. Поэтому расчет прогноза риска развития рецидива данного заболевания – крайне важная и актуальная задача в процессе подбора дальнейшей тактики лечения.

Renal cell carcinomas account for about 3% of all cancers in adults. The annual increase in the detection of this disease is 2,9%, which is due both to a true increase in the number of cases and to the widespread introduction of modern research methods (ultrasounds examination, computerized tomography, magnetic resonance imaging) that allow us to detect small asymptomatic lesions. This, in turn, makes it possible to perform organ-preserving surgical interventions. Comparative analysis of long-term results of treatment in patients after kidney resection does not differ from those after radical nephrectomy, at the same time, the functional results of organ-preserving surgical interventions are more attractive, especially in patients with an initially present renal dysfunction. Currently, there are three methods of performing organ-preserving operations: open, laparoscopic and robot-assisted kidney resection. Contrary to the general interest in the problem of nephron-preserving surgery of renal cell carcinomas, the choice of operative access while performing kidney resection remains the subject of discussion. In this light, the use of intermuscular mini-lumbotomy access can act as an optimal replacement for laparoscopic access or resection from traditional lumbotomy. This technique of operative intervention allows to combine the positive properties of both minimally invasive procedure (laparoscopic resection) and open surgical intervention: reduction of the volume of blood loss and duration of the operation, reduction of hospitalization time, fewer late complications, good cosmetic result. Also, the issues of processing the resected surface of the organ, the time of ischemia, and the choice of the vascular clamp when clamping the renal artery, the distance from the tumor edge to the line of resection are also disputable. In addition, the functional results of organ-preserving resections of the kidney are not sufficiently studied in the long term after surgical interventions.

The aim of the study was to assess the primary morbidity and prevalence of diseases of the circulatory and respiratory systems in the adult population living in the zone of influence of atmospheric emissions of multi-fuel thermal station. Metods: The study was carried out on the territory of Kirov, in the zone of influence of atmospheric emissions of urban heat and power plant. By means of cluster analysis in the fuel balance of thermal power plants 2 time periods differing on the ratio of fuel types in the fuel balance were allocated: the period from 2001 to 2008 (the share of solid fuel was 17-22 %) and the period from 2009 to 2015 - characterized by increase in the share of solid fuel in the fuel balance to 27-32 %. On the data basis of simulation of thermal station emission dispersion zonation of atmospheric emission influence from thermal station was carried out. Two districts (clusters) were pointed. They differ significantly on a level of a calculated ground level concentration of particulates, sulfur dioxide and carbonic oxide. In each pointed area and for each timeframe the analysis of primary disease incidence of circulatory and respiratory systems was carried out. Results: the increase in the share of solid fuel in the fuel balance is accompanied by an increase in the mass of dust emissions of fly ash, soot, sulfur dioxide and an increase in the level of primary morbidity and prevalence of diseases of the circulatory and respiratory systems in the population of residential areas directly adjacent to the sanitary protection zone of the multifuel thermal station and located in the direction of prevailing winds. Conclusion: management decisions on expansion of multi-fuel thermal power complexes and changes in the fuel balance must necessarily be accompanied by an assessment of the health risk of the population and measures to reduce risks to an acceptable level.

One of clinical and anatomical types of melanoblastoma is melanoma of the glans penis appearing on the skin or mucosa of the penis (external opening of the urethra or ureter, internal or external layer of the foreskin). It’s a rare disease, and most of specialists are unfamiliar with it, including oncologists and urologists. Thus, the conducted research has practical importance as it may improve diagnostics and treatment of patients with this oncological pathology.

Malignant tumors of the testicle comprise about 1–2 % of all neoplasms in males and 5 % of tumors of the urinary system and male genitals. At early stages, malignant tumors of the testicle have no clinical manifestations. Gradually increasing in size, they change the shape and density of the testicle. Men seeking medical consultation on infertility are recommended to undergo ultrasound examination of the scrotum. As a result, in patients with normal tumor marker levels and lack of symptoms small (less than1 cmin diameter) testicular tumors (incidentalomas of the testicle) and testicular microlithiasis are diagnosed. Lately, a number of studies has shown a possible need to expand indications for organ-preserving treatment, in particular, for incidentalomas of the testicle. Here we present a literature review on this subject and our clinical observations.