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Introduction. There are a wide range of techniques available for the removal of hyperplastic prostate tissue. However, the choice of method rarely considers its effect on ejaculatory function.Objectives. To evaluate the effect of surgery for benign prostatic hyperplasia (BPH) by endovideosurgical posterior adenomectomy (EVS AE) and transurethral electroenucleation of the prostate (TUEB) on copulatory function and its ejaculatory component.Materials & methods. Sixty sexually active patients aged 58 to 78 years with indications for surgical treatment of BPH were included in the study. The patients were randomized into two equal groups. The first group (30 patients) underwent EVS AE by standard technique without preservation of the prostatic urethra. The second group (30 patients) underwent TUEB. Before treatment, standard questionnaires used in urologic practice were completed: IIEF-5, IPSS-QOL, and the scale of quantitative assessment of male copulatory function (scale “MCF”). The block of questions specifically characterizing the ejaculatory component and the "Male Sexual Health Questionnaire", namely the section " Ejaculatory function domain", were analyzed separately. The assessment was conducted before treatment and at the 12th week following surgery. No significant differences were found between the groups on any of the questionnaires prior to surgery.Results. Three months following surgery, there was a significant improvement in the IPSS-QOL scores for the EVS AE group, by 24 points and 4.3, respectively, and for the TUEB group, 25.6 points and 4.3 (both p < 0.0001). No change was observed in the IIEF-5 questionnaire (p > 0.05). A slight reduction in scores was noted on the MCF scale for the TUEB group (by 2.9 points, p < 0.05), indicating that the general state of erectile function remained unchanged. However, reductions were seen in the "MCF — Ejaculatory Component" and "Male Sexual Health Questionnaire — Ejaculatory function domain" scales for the TUEB group, with ballpark scores decreasing by 3.2 and 6.8 points, respectively (both p = 0.0326 and p = 0.0254), indicating a worsening in ejaculatory function following TUEB treatment.Conclusion. When selecting a specific surgical approach for BPH management, consideration should be given to the patient's tolerance for the degree of invasiveness of the procedure while preserving ejaculatory function, and adherence to a treatment strategy that aligns with the patient's individual preferences and expectations.

The history of the development of urinary diversion methods dates over than 170 years. During this time, many methods of urinary diversion have been invented. Some never made it out of the research centres, while others were widely accepted by urologists and still in use today. In modern bladder cancer, doctors are not only concerned about saving human life in the immediate period, but also about how the patient will live after the cystectomy, which is a crippling surgery that affects both the quality of life and the patients’ social adaptation. The article presents the historical stages of urinary diversion techniques from the first attempts at derivation into the undisturbed colon to the creation of a low-pressure high-capacity neobladders.

Introduction. DPatients diagnosed with T4b bladder cancer represent a relatively limited group of patients presenting to the urology clinic. Besides, this category of patients is rarely selected for cystectomy. patients with T4b should be referred for chemotherapy and/or radiation therapy and only later, ultimately, for cystectomy. However, there are currently no studies on the real impact of various organ invasions in terms of survival and complications associated with surgery in T4b patients. Also, in this subgroup of patients, cystectomy helps alleviate current or future symptoms of bladder cancer, and it is suggested that surgery after chemotherapy may improve survival compared to chemotherapy alone.Purpose of the study. To evaluate the effectiveness of consolidating the surgery for bladder cancer cT4b, given the experience of cystectomy in terms of clinical and oncological results.Materials and methods. The study included 29 patients with bladder cancer who underwent palliative cystectomy (pc) and 404 patients after radical cystectomy (RcE) with lymphadenectomy and various methods of urine diversion in the period 1995 - 2019. Palliative treatment was determined by the extreme stages of the oncological process (the presence of stage T4b).Results. Preoperatively, the PC was planned to be performed in only 10 patients, whereas after the RCE it was palliative in 29 cases. According to our study, differences in the main treatment outcomes were not in favour of patients with PC. During the observation period, the overwhelming majority of patients — 24 of 29 (82.8%) died, while in the group after RCE, only 34.0% of patients died (p 0.05). It was comparable with the data of modern literature in both cases (3.4% and 3.0%). This reflects the equal degree of safety of performing cystectomy in patients with bladder cancer at stage T4b in comparison with patients undergoing RCE, to a certain extent. The duration of the survivors' follow-up in the PC group ranges from 3 to 51 months with a median of 25.7 ± 13.9 months versus 73.9 ± 3.9 months in the RCE group in surviving patients (p

Background. Treatment of patients with bladder cancer remains one of the most pressing problems of oncourology. It is important to understand that the risks caused by the radical cystectomy are determined not only and even not so much by the technical difficulties of removal of the bladder, as by the somatic status of the patient who needs cystectomy. It is important to understand that radical cystectomy and urine derivation are essentially two stages of a single surgery intervetion. However, in the publications describing postoperative cystectomy complications often ignore the fact that the maximum number of complications develops and is associated with the complexity of the urinary diversion method. In a relatively recent long-term study on the results of radical cystectomy, the authors reported a 3% postoperative mortality rate and a 28% level of early postoperative complications (within 3 months after surgery). The authors paid attention to the fact that late complications was more often caused by the urinary diversion methods, whereas early complications are more often associated with radical cystectomy. In general, it is determined that morbidity and mortality are lower the more experience the clinic staff and the surgeon have in terms of patient management. The combination of these factors causes a slower recovery and a longer postoperative day. Despite the decrease in mortality, the level of complications of this procedure remains high even in the best centers of the world.Objective. Assessment of the prerequisites for the development of complications after radical cystectomy using different methods of urine diversion.Materials and methods. Oncological treatment results of 458 patients with bladder tumors were subjected to a detailed analysis.Results. The number of patients with comorbidities was significantly pronounced and noted in practically every patient (381 patients - 83.1%). At the same time, it was found that in the whole group of patients the average value of the Charlson's comorbidity index corrected for age turned out to be 2.6 ± 1.6 (from 0 to 8). Early postoperative complications were detected in 197 patients (43.0%). Early complications NOT associated with urinary diversion prevailed - 36.2%, while the frequency of early complications associated with urinary diversion was statistically significantly less on average 3 times and amounted 12.9%. The incidence of late postoperative complications (associated and NOT associated with the derivation of urine) was generally lower compared to early complications by almost 5 times (9.1%). At the same time, unlike the early postoperative period, among the late postoperative complications, mainly complications associated with the urine diversion of were recorded in 6.5% of cases. It is important that in the studied group of patients were recorded predominantly mild and moderate degrees of complication (Clavien-Dindo I-II) and amounted 41.7%.Conclusion. Obviously, radical cystectomy with urinary diversion are complex surgery with expected high rates of postoperative complications. In this regard, these indicators along with functional and oncological results should be taken into account when discussing a treatment strategy. Early postoperative complications are mainly related to technique of radical cystectomy performing, whereas late complications are more often due to used method of urinary diversion, while high indicators of the planned long-term survival indicate that it is not necessary to perform radical cystectomy. Thus, our findings unequivocally confirm the opinion of international experts and most researchers that achieving optimal optimal results in performing radical cystectomy with urinary intestinal diversion, maximizing morbidity and postoperative lethality is possible only with the accumulation of sufficient experience in this operation types.

Laparoscopic (including robot-assisted) radical prostatectomy has become an alternative to open radical retropubic surgery. The main surgical techniques for reducing the period of urinary incontinence after radical prostatectomy are aimed at preserving, reconstructing and strengthening the structures that provide a complex mechanism for urine retention, namely, the pubo-prostate-vesicular ligaments, bladder neck, Denonvilliers` fascia, in procuring the functional length of the urethra, etc. Despite advances in the study of urinary continence mechanism there exists a large number of problems that need to be discussed. Therefore, researchers continue to search for solutions to create an optimal technique that ensures the earliest possible of urine retention, which is one of the main tasks in the social and medical rehabilitation of a patient who has undergone radical prostatectomy. This article describes the main modern techniques and methods for performing radical laparoscopic prostatectomy, which are aimed at achieving the earliest possible recovery of the urine retention mechanism.

Introduction. Modern studies show an impressive 5-year absence of pelvic recurrence in 80% to 90% of cases and a 5-year overall and cancer-specific survival of 59% to 60% and 55% to 65% for radical cystectomy (RCE), respectively.Objective. Analysis of the results of radical and palliative treatment in patients with bladder cancer.Materials and methods. The study included 349 patients exposed to RCE, of which three groups were identified: RCE primary (n = 206), salvage RCE (n = 119) and CE palliative (n = 24). Calculation of survival rates for the years of follow-up was performed according to the Kaplan-Meier method, taking into account consecutive elimination from the analysis of patients.Results. Based on the results of the performed analysis, it was established that significantly worse indices for all types of survival were revealed in palliative CE. Comparing the oncological effectiveness of primary and salvage RCE, there is no statistically significant difference in survival rates in the compared groups.Conclusions. RCE should not be considered as second-line therapy, but in the presence of indications as a primary medical approach. The performance of early salvage RCE with progression of bladder cancer against the background of organ-preserving treatment provides oncological results similar to those in primary RCE.

The review offers analysis of various methods used for urine derivation after cystectomy. It provides insight into the advisability of continent heterotopic urine derivation based on a comparison of complications, practical complexity, and quality of life following different variants of bladder reconstruction using intestinal segments. The problem of searching for new simpler methods for the formation of reservoir valve retention mechanisms is raised to encourage broader use of continent urine derivation forms.

Purpose: to estimate the risk of postoperative complications and frequency of them after radical cystectomy and to study the specific parameters of influence to survival and postoperative mortality.Materials and methods: 311 patients with urinary bladder cancer were underwent RCE, bilateral pelvic lymphadenectomy and urinary diversion’s various methods.Results: there are various complications after RCE accompanyed with different methods of urinary diversion were registered in 82.0% of patients with bladder cancer. In 18.0% of patients with bladder cancer who underwent RCE there were no observed any complications. During an early follow-up period the average frequency of complications associated with the urine reservoir was not exceed than 6.75 per 100 patients, whereas in the later period of observation it increased to 11 times and reached 71.93 per 100 patients.Summary: Orthotopic methods of derivation were performed in 47,0% of patients with bladder cancer and external methods were used in 37,6%. Among patients with external and especially internal forms of derivation the worst survival rates and high rates of various kinds of complications were registered.

From 1995 to 2012 radical cystectomy were performed to 326 patients. Orthotopic intestinocistoplastika performed by Studer 69 (18.7%) patients, including short mesostenium was in 48 (69.6%), which are combined into two groups. Group I - 15 (31.3%) patients with orthotopic intestinocistoplasticy by Studer, II group - 33 (68.7%) patients who made modification techniques Studer - inverts orthotopic ileocistoplastics. Cases of leak of the tank or anastomosis were not observed. Medium capacity of neobladder after removal of urethral catheter – 110 ml., in 3 months – 350 ml, in 12 months – 490.0 ml. Maximum pressure in the tank does not exceed 40 cm water column (average 30 cm H2O). Day retention – 94,7%, night confinement at a forced night miction – 79.0%. The proposed method of inverting orthotopic ileal neobladder can be recommended when overlapping of orthotopic urinary reservoir is impossible or associated with leaks of the anastomosis due to the insuf-ficient length of the mesentery using known techniques of orthotopic ileal bladder reconstruction.

Presents a clinical case of successful surgical treatment of kidney cancer with tumor thrombus of the inferior vena cava (IVC) to the level of the atrium, with simultaneous resection of segment I of the liver containing a single metastasis, in 57-year patient.

Introduction. Quality of life and survival rate of post-cystectomy patients depend on the urinary diversion methods [1,2].Purpose of the study. A comparison of morbidity, survival rate, and quality of life in patients after heterotopic continent or incontinent urinary diversions.Materials and methods. During the period from 1998 to 2016, 36 heterotopic intestinal diversions were performed using urine containment method according to the Kock pouch scheme in our modification, and 61 incontinent heterotopic intestinal Bricker diversions. We evaluated the comorbid conditions (Charlson comorbidity index), postoperative complications (acc. to Clavien-Dindo), survival rate (acc. to E.L. Kaplan, P. Meier), and the quality of life of patients (SF-36) using complex statistical analysis.Results. Early and late complications not related and related to urinary diversion prevailed in the group of patients after Bricker surgery without statistical significance. With longer postoperative monitoring periods the share of complications related to urinary diversion increases, while the frequency of delayed complications and survival rate show no statistical difference in both groups. No reliable differences were revealed in the quality of life in all cases of cutaneous urinary diversion.Discussion. 80% of patients after the Kock pouch surgery (mod.) throughout the medium follow-up period of over 5 years remain continent and enjoy high quality of life. It is necessary to develop and implement in clinical practice new and more advanced statistical tools for evaluation of the patients’ quality of life depending upon the type of urinary diversion after cystectomy.Conclusion. Heterotopic continent diversion (Kock pouch (mod.)) in comparison with the incontinent method (Bricker) does not increase morbidity or decrease the survival rate, and provides for higher quality of life.