[Clinical and morphological assessment of the results of a standard robot-assisted nerve-sparing radical prostatectomy and with the use of Retzius-sparing technique].

OBJECTIVE: To compare the perioperative, functional, clinical and morphological results of a standard robot-assisted nerve-sparing radical prostatectomy and with the use of the Retzius-sparing technique. MATERIALS AND METHODS: A prospective analysis was performed of two groups of patients (n=54) who underwent nerve-sparing robot-assisted radical prostatectomy (period from 2017 to 2018). The first group included 29 patients who underwent nerve-sparing robot-assisted radical prostatectomy with Retzius-sparing technique, the second - 25 patients operated on according to the standard method of bilateral nerve-sparing radical prostatectomy. All patients were comparable in baseline characteristics. In all cases, patients had histologically verified localized prostate cancer pT2a-2c. RESULTS: In cases with use Retzius-sparing technique there is no statistically significant difference in the operation time (243.60 min vs 236.64 min, in groups 1 and 2, p>0.05) and intraoperative blood loss (131.20 ml vs 122.57 ml , in groups 1 and 2, p>0.05). Regarding the dynamics of the urinary continence recovery, the Retzius-sparing technique demonstrates advantages in speed and frequency at all follow-up periods (54.13% vs 41.81%; 68.12% vs 59.21%; 94.15% vs 90 , 63%; 98.54% vs 97.12%; 98.62% vs 97.31%; 98.83% vs 97.82% - in one week after removal of the urethral catheter, 1, 3, 6, 9, and 12 months in the first and second group, respectively). The frequency of erectile function recovery after 12 months was 82.17% and 71.14% in the first and second groups, respectively. CONCLUSIONS: Retzius-sparing robot-assisted prostatectomy superior to standard operation in the speed and timing of recovery of urine continence and erectile function.

[Diagnostic performance of 68GA-PSMA PET/CTin patients with prostate cancer].

INTRODUCTION: and aim. Most of the patients with biochemical recurrence after radical prostatectomy undergo salvage radiotherapy without guidance from imaging. In recent years, there has been an increasing role of Gallium-68 prostate specific membrane antigen (68Ga-PSMA) positron emission tomography/computed tomography (PET/CT) imaging in the management of prostate cancer. This study aimed to investigate diagnostic performance of 68Ga-PSMA PET/CT in patients with biochemical recurrence after radical prostatectomy. MATERIALS AND METHODS: From 2016 to 2017, 19 prostate cancer patients were evaluated by 68Ga-PSMA PET/CT at the Urology Clinic of S.P Botkin City Clinical Hospital; 17 of them had a biochemical recurrence and needed restaging of the disease. The age, prostate specific antigen (PSA) values, therapy at the time of the study, and maximum standard uptake value (SUVmax) were evaluated. RESULTS: The median age of patients was 65 years (interquartile range (IQR) 58.5-70.5), the median total PSA level was 2.36 ng/mL (IQR 1.5-4.19). In 8 of 17 patients, the PSA values did not exceed 2 ng/ml. The median time after radical prostatectomy was 33.2 months. (IQR 12-54.5). Positive PET/CT sites of recurrence were detected in 15 of 17 patients. Nine patients had only one positive site, and in six patients several positive sites were detected. Four patients with PET/CT positive pelvic lymph nodes and/or retroperitoneal space underwent salvage lymphadenectomy. Histological findings confirmed the presence of malignant growth in 3 out of 4 cases. CONCLUSION: 68Ga-PSMA PET/CT is an effective tool for the early detection of oligometastatic lesions in recurrent prostate cancer.

[Experience of male transobturator AdVance sling implantation in patients with stress urinary incontinence after radical prostatectomy].

For the period from April 2008 to March 2012, 12 men with mild-to-moderate and severe stress urinary incontinence underwent transobturator AdVance sling implantation. In the preoperative period, all patients underwent assessment, including history taking, physical, and instrumental and laboratory examination. Daily pad test was used as an objective method for the assessment of the degree of urinary incontinence. The use no more than one pad a day was considered as recovery, no more than 2 pads or reduction of the loss of urine by more than 50%--as an improvement. Median follow-up period was 28 months. The success of the operation was achieved in 91.7% of cases. Implantation of the sling led to the significant decrease of urine loss, the number of used pads and improvement of quality of life of patients. Infectious and inflammatory complications of acute urinary retention were not observed. Implantation of male transobturator AdVance sling is effective and safe treatment for patients with stress urinary incontinence after radical prostatectomy.

[Combined treatment of patients with lower urinary tract symptoms and erectile dysfunction].

In men of middle and older age group, urination disorders and erectile dysfunction are often combined. The role of phosphodiesterase type 5 inhibitors in the treatment of these patients remains uninvestigated. Prospective study included 38 patients with urination disorders and erectile dysfunction. The average age of the patients was 63.6 +/- 5.3 years. During first three months of observation, all patients have received alpha-adrenoblocker doxazosin at a dose of 4 mg once daily per os, the next three months--phosphodiesterase type 5 inhibitor udenafil at a dose of 50 mg once daily per os was added to doxazosin. 3 months after treatment, majority of patients reported improvement of urination. The statistically significant changes in BP and heart rate were not recorded, indicating a satisfactory tolerability and safety of doxazosin. Against the background of combined treatment during next 3 months, progressive improvement of erectile function (IIEF score 12.8 +/- 3.4 vs 18.4 +/- 3.7; p < 0.05), and regression of urination disorders, according to IPSS score (13.4 +/- 1.2 vs 11.2 +/- 1.7; p < 0.05) were observed. Uroflowmetric indicators were not significantly changed. Based on experimental and clinical studies, it was suggested that the dysregulation of NO--cGMP system, pathological activation of Rho-kinase pathways, hyperactivity of autonomic innervation, atherosclerosis and impaired blood flow in the pelvic organs are the common pathophysiological mechanisms for LUTS and erectile dysfunction. The clinical efficacy of phosphodiesterase type 5 inhibitors in the treatment of patients with these diseases is explained by its effects on these mechanisms.

[Potentials for the combined therapy of urination disorders in men: the choice of optimal scheme of treatment].

Moderate to severe urination disorders occur in 13-29% of men, and their frequency increases progressively with age. The key for successful use of the capabilities of modern drug therapy is the understanding of the pathophysiological bases of urination disorders. Despite some successes of monotherapy with alpha-adrenoblockers and 5alpha-reductase inhibitors, combined use of drugs is appropriate, because the differences in mechanisms of action allows to simultaneously act on the smooth muscle tissue, causing its relax, and reduce the size of prostate by the induction of apoptosis, which ultimately allows to expect the maximum therapeutic effect. The goal of therapy in patients with BPH is not only a reduction in the severity of urination disorders, but the prevention of disease progression. Obviously, urination disorders in men are not always caused by an benign prostate hyperplasia. Hyperactive symptoms (primary and secondary, due to metabolic disorders in detrusor against the background of prolonged existence of bladder outlet obstruction) are revealed in significant proportion of men. In this cases, the use of M-anticholinergics is indicated. Administration of alpha-adrenoblockers and antimuscarinic drugs is one of potential variant of combined therapy. Thus, it is important to follow the principles of selectivity in patients with urination disorders. Modern pharmacotherapy has an arsenal of drugs, allowing to choose the drug therapy for patients with urination disorders depending on the prevalence of their types.

[Retropubic adenomectomy in patients with a high level of prostate-specific antigen after prostatic biopsy].

Results of examination and treatment were analysed for 58 patients after retropubic adenomectomy performed from February 2008 to June 2010. The examination protocol included assessment of a total score of the scales IPSS and QoL, parameters of uroflowmetry, total PSA, the size of the prostate, number of prostatic biopsies in a high PSA level. The removed adenomatous tissue was examined histologically. By a PSA level, all the patients were divided into 3 groups. Group 1 - 18 patients with a preoperative PSA level above 10 ng/ml, group 2 - 23 patients with a PSA level from 4 to 10 ng/ml, group 3 - 17 control patients with PSA under 4 ng/ml. Mean age of the examinees was 67.7 +/- 7, 68.7 +/- 7.7, 67.9 +/- 8.9 years (p>0.05), respectively. A mean PSA level was 20.9 (10.3-53), 6.6 (4.1-9.9) and 2.4 (1.3-3.9) ng/ml (p<0.01), respectively. A mean size of the prostate was larger in group 1 patients than in the controls: 127.3 (82-185) cm3 versus 100.7 (81-134) cm3 (p<0.05). Median of the number of transrectal multifocal biopsies was 2 (1-7), 1 (1-2) and 0 in groupl, 2 and 3, respectively. Histological examination of the adenomatous tissue detected prostatic adenocarcinoma in 0, 1(4.3%) and 1(5.9%) patients, respectively, while chronic prostatitis at different stages was diagnosed in 6(33.3%), 7(30.3%) and 7(41.2%) patients, respectively. Thus, the above protocol of examination of patients with prostatic adenoma including measurement of a PSA level, conduction of finger rectal examination followed by prostatic biopsy (transrectal saturation procedure is preferable) provides performance of adenomectomy without a risk to miss a clinically significant prostatic cancer even in a PSA level above 10 ng/ml.

[Administration of M-cholinoblockers after prostatic surgery].

Some patients after prostatic surgery demonstrate hyperactivity symptoms. These symptoms can be relieved by M-cholinoblockers. We analysed prospectively the results of treatment of 23 patients (mean age 69.8 years) with clinically localized prostatic cancer after radical retropubic prostatectomy. The patients were examined before and after 3 months of treatment. All the patients received tolterodin (urotol) per os in a dose 2 mg twice a day. The results of the therapy showed that M-cholinoblocker tolterodin (urotol) is effective and well tolerated in patients with hyperactive symptoms after radical prostatectomy.