[Infectious factor in transuretral surgery of benign prostate hyperplasia: a systematic review and meta-analysis].

PURPOSE: To assess postoperative bacteriuria and infectious complications in terms of antibiotic prophylaxis (ABP) regimens, preoperative urine bacterial status and total prostate-specific antigen (PSA) level in patients with benign prostate hyperplasia (BPH) undergoing transurethral prostate surgery. MATERIALS AND METHODS: The PubMed, ClinicalKey, Google Scholar and the Cochrane bibliographic databases were searched from 1992 to 2022. The Mantel-Haenszel method was used to calculate the odds ratio (OR) and inverse variance method was used to calculate mean difference (MD) with 95% confidence interval (CI). Primary outcome was the development of asymptomatic bacteriuria, secondary - development of infectious complications. RESULTS: This meta-analysis showed that ABP significantly decreased level of postoperative bacteriuria and infection complications. This meta-analysis was in favour of prolonged ABP ( more or equal 3 days) in lowering postoperative infectious complications rate compared to short regimens ( less or equal 24 hours). Preoperative bacteriuria was not significantly associated with postoperative bacteriuria level and infectious complications. Mean preoperative PSA level significantly differed in patients with and without postoperative bacteriuria. CONCLUSION: This meta-analysis demonstrated significant gaps in the knowledge of perioperative bacterial status and antibiotic prophylaxis strategies efficacy in the group of patients undergoing transurethral prostate surgery. There is no consensus on optimal ABP regimen. Most of included studies had significant heterogeneity. Further studies are required.

[Minimally invasive methods of surgical reconstruction of vesicouterine fistulas].

INTRODUCTION: Vesicouterine fistula (VVF) is a rare disease. In 83-93% of cases it develops due to caesarean section. VVF is characterized by non-physiological communication between the bladder and the uterus. This disorder has a significant social impact, causing incontinence, persistent medical and psychological maladaptation. The gold standard for treating VVF is surgical reconstruction. Early and late results of minimally invasive approaches do not differ from open procedure, but only if the surgical team has sufficient experience. AIM: To evaluate the efficiency of surgical treatment of VUF using a minimally invasive technique. MATERIALS AND METHODS: From 2010 to 2021 a total of 15 patients with VVF were treated. The age of the patients varied from 18 to 37 years (mean 26.4 years). The average body mass index was 26.3 kg/m2. The mean maximum fistula diameter was 10.7 mm (from 2 to 25 mm). The predominant cause of VVF was cesarean section (93%; n=14). In one case (7%), radiation-induced VVF was seen. Patients were randomized according to the Jwik and Jwik classification based on clinical manifestations. A type I of VVF was diagnosed in 4 patients (27%), type II in 9 patients (60%), type III in one woman. Recurrent urinary tract infection was observed in 53% (n=8) of cases. Four women were complaint of chronic pelvic pain syndrome (27%). The pain score on VAS did not exceed 6 points. All patients were undergone to minimally invasive procedures, including robot-assisted approach (n=5; 33%) and laparoscopic access (n=10; 67%). RESULTS: During the follow-up from 4 weeks to 10 years there was no recurrence of VVF. No indications for hysterectomy were found in any of the cases, however, it was carried out in two women after obtaining the informed consent. The average duration of robot-assisted procedure was 118 min (80-140), compared to 125.5 min (90-160) for laparoscopic access (p>0.05). The average length of stay after robotic procedure was 5.2 days (range 4 to 8 days) and 6.7 days (from 5 to 10 days; p> 0.05), respectively. Intraoperative blood loss did not exceed 130 ml. The mean value for laparoscopy was 97 ml, compared to 82 ml for robot-assisted approach (p>0.05). In both groups, there were no intra- and postoperative complications according to the Clavien-Dindo classification. Thus, there was no significant difference in the results of VVF closure between robot-assisted and laparoscopic approaches. CONCLUSION: The results of minimally invasive surgical reconstruction of VVF do not differ from open procedure and depend on timely diagnosis, adherence to strict surgical techniques, and surgical experience, regardless of the approach.

[Unilateral combined lap partial nephrectomy and pyelolithotomy for ipsilateral tumor & kidney staghorn stone]

OBJECTIVE: To discuss the feasibility, safety, and effectiveness of conventional laparoscopic partial nephrectomy combined with pyelolithotomy for patients with ipsilateral renal tumor and staghorn kidney stone. MATERIALS AND METHODS: Retrospective multicentral comparative study. Group "Combo" was presented by patients with the mentioned combined pathology (n=15). Group "Standart" (n=69) formed from common patients who underwent standard lap partial nephrectomy for renal tumor in the absence of kidney stones. Perioperative factors and results were studied and compared. Video presentation of combined surgical technique is available at: https://youtu.be/fAfYJDvGzsU. RESULTS: Of all patients, no positive margins, no conversions to open surgery or nephrectomy & any complications Clavien >III were detected. There were no any significant differences between the two groups except for OR time (150 [120; 210] vs 130 [100; 180] min; p=0,001). Differences between indexes of WIT (16,27+/-3,8 vs 15,9+/-4,5 min; p=0,107), EBL (200 [150; 300] vs 200 [150; 300] cc; p=0,981), length of stay (7 [6;9] vs 8[6;9] days; p=0,611), intraop complications (0,00 vs 4,3%; p=0,411) and values of postop Clavien III rate (0,00 vs 4,3%; p=0,411) for "Combo" & "Standart" respectively were comparable as well as oncological outcomes. Stone-free rate for combined procedures reached 93,3%. CONCLUSION: conventional laparoscopic partial nephrectomy combined with pyelolithotomy for patients with ipsilateral renal tumor and staghorn kidney stone is safe and efficient alternative to 2-step treatment of this rare disease.

[Morphological analysis of the structure of parafistulous tissues in patients with vesicovaginal fistulas by the local interstitial application of platelet-rich plasma].

The issue of complications of fistuloplasty of vesicovaginal fistulas (VVF) remains extremely relevant both for modern surgeons and for patients. Optimization of morphological characteristics by local interstitial application of Platelet-Rich Plasma (PRP) can positively affect the results of surgical treatment of VVF. PURPOSE OF THE STUDY: to conduct a comparative assessment of the morphological parameters of parafistulous tissues before and after local interstitial application of PRP. MATERIALS AND METHODS: Study included 52 patients who underwent fistuloplasty. Group I included 30 women who were treated according to the standard method. Group II included 22 patients who underwent PRP therapy prior to surgery. All patients underwent an excisional biopsy of the VVF edges. After performing an excisional biopsy, Group II patients received 9-10 parafistulic injections of activated PRP with a frequency of one every seven days for five weeks before fistuloplasty. Repeated biopsy of the VVF edges was performed in Group II patients immediately before fistuloplasty. For histological study, tissue sections were stained with hematoxylin and eosin according to standard technology. RESULTS: Primary biopsy revealed keratinization disorders in eight (37 percent) patients from Group II, and after PRP therapy in four (18 percent) patients (p>0.05). In all patients of Group II, after PRP therapy, the epithelial layer had a normal histological structure (p<0.05). Erosive and ulcerative lesions of the integumentary epithelium were initially detected in 14 patients (64 percent) from Group II. No erosions were detected during control biopsy (p<0.05). The thickness of fibrous tissue in Group II before the therapy was 886.3+/-113.5 M, and 830.1+/-119.9 M (p=0.66) after. Lymphoid infiltration was initially present in 20 patients from Group II, in eight of them (40 percent) it decreased (p<0.05) after the therapy. Cell density decreased after PRP therapy in 11 patients (50 percent), but in four (18 percent) patients it increased from low to moderate (p<0.05). Microvascular density before therapy was 29+/-3,3, and 19.9+/-1.9 after. The difference has statistical validity at the trend level (p=0.078). CONCLUSION: Taking into account a statistically significant decrease in the activity of the inflammatory process, complete relief of erosive and ulcerative lesions, and decrease in the thickness of fibrosis in the stromal layer in fistula tissues, application of PRP therapy in the surgical treatment of VVF should be considered appropriate and justified.

[Determination of calcium metabolism markers concentration in patients with calcium oxalate nephrolithiasis].

THE AIM OF THE RESEARCH: to reveal the relationship of various markers of calcium metabolism (osteopontin (OPN), parathyroid hormone-related protein (PTHrP), vitamin D, parathyroid hormone (PTH)) on the course of urolithiasis (Urolithiasis) in patients with calcium oxalate nephrolithiasis. MATERIALS AND METHODS: 100 people were examined, the following groups were included: group 1 - patients with calcium oxalate primary nephrolithiasis (n=41), group 2 - with calcium oxalate recurrent nephrolithiasis (n=39). Group 3 included conditionally healthy volunteers (n=20). The studies were carried out by the immunoenzymometric ELIZA and biochemical methods using appropriate test systems. RESULTS: in patients with recurrent nephrolithiasis, the serum PTHrP level is 54.6 (25.4-78.2) pg / ml, which is 3.7 times higher than in conventionally healthy individuals; the level of osteopontin is more than 1.5 times higher and amounts to 1.820 (0.991-2.212) pg / ml. In the group of primary nephrolithiasis, the level of PTHrP is 2-2.5 times higher than in conventionally healthy people. In patients with primary nephrolithiasis, the blood calcium level does not correlate with the level of PTHrP in the blood (r=- 0.0173, p> 0.05), as in the group with recurrent nephrolithiasis (r=0.0223, p>0.05). DISCUSSION: in patients with recurrent nephrolithiasis in the preoperative period, the serum levels of osteopontin and PTHrP in the blood serum were higher than in patients who were first diagnosed with urolithiasis, the data obtained can be used as a criterion for predicting the risk of recurrence of urolithiasis in the postoperative period. The blood calcium level does not have a statistically significant relationship with PTHrP, which allows us to assume that PTHrP has other mechanisms of influence on the development of urolithiasis, given the data obtained that the PTHrP level in patients with primary and recurrent nephrolithiasis is higher than in conditionally healthy people. CONCLUSION: Determination of the level of PTHrP and osteopontin in patients with urolithiasis allows predicting the risk of recurrence of urolithiasis at the stage of primary calcium oxalate nephrolithiasis. Determination of the level of PTHrP makes it possible to predict the risks of developing urolithiasis in conventionally healthy individuals, which can be used for targeted prevention of an unfavorable course of urolithiasis by prescribing timely adequate rational therapy and correcting the patients diet. At the same time, no correlation was found between the level of PTHrP and the level of blood calcium in patients with calcium oxalate nephrolithiasis; therefore, further studies of the role of this protein in the pathogenesis of urolithiasis are needed.

[The use of herbal supplement Renotinex based on terpenes for the complex treatment of patients with urinary stone disease].

AIM: to evaluate the efficiency of dietary supplements Renotinex for the complex treatment of patients with urinary stone disease who undergone to extracorporeal shock wave lithotripsy (ESWL). MATERIALS AND METHODS: a total of 60 patients with uncomplicated form of the urinary stone disease with the first stone episode (of size up to 1 cm) were evaluated. Patients were divided into two groups of 30 people and treated by ESWL. In the first group, patients additionally received Renotinex. In the second group, standard complex therapy (antispasmodics, analgesics, non-steroidal anti-inflammatory drugs) was prescribed. The urinary level of 2-microglobulin and serum level of tocopherol were considered as markers of damage and inflammation. Pain intensity was assessed using visual analogue scale. Follow-up studies were carried out on the 1st, 7th and 14th day of therapy. Duration of treatment and follow-up was 1 month. The average number of ESWL sessions was 2.6 in both groups. RESULTS: according to the study, it was established that components of Renotinex had antiseptic, antispasmodic, anti-inflammatory effects on the genitourinary system, enhancing renal blood flow and decreasing the permeability of the kidney capillaries. In addition, Renotinex has diuretic effect and nephroprotective effect, and improves renal function, alleviating aggressive therapeutic influence of ESWL. Antioxidant and nephroprotective effect are among the main mechanisms of action of Renotinex. CONCLUSION: In patients who received Renotinex as dietary supplements fragments after ESWL pass twice as fast, while in patients who did not receive Renotinex, there was more pronounced damage to the kidney parenchyma diagnosed by urine level of 2-microglobulin. The serum concentration of vitamin E increases, while taking Renotinex, which may prevent the peroxidation of polyunsaturated lipids in cell membranes and enhances the nephroprotective effect of Renotinex.

[Horseshoe kidney tumor laparoscopic surgery. First 19 cases].

INTRODUCTION: Although horseshoe kidney (HSK) is the most common congenital anomaly of the upper urinary tract, renal cell cancer (RCC) in HSK develops extremely rarely. Until 2012 y. there were less than 200 cases of RCC in HSK published in PubMed. Only five cases of laparoscopic partial nephrectomies and some cases of heminephrectomies have been described in PubMed. AIM: To conduct a multicenter retrospective analysis of laparoscopic surgery for tumors in HSK. MATERIAL AND METHODS: From January 2013 to December 2018 a total of 19 conventional laparoscopic interventions were performed in patients with RCC in HSK, including 1 isthmusectomy, 5 partial nephrectomies and 13 heminefrectomies. In addition, 16 divisions of isthmus were done in 15 patients. The video describing our operation technique is available on: http://youtu.be/nk-WlbjNtIs . RESULTS: There were no conversions to open surgery and mortality as well as intra- and postoperative complications of Clavien grade 3 or higher. Warm ischemia time during partial nephrectomy didnt exceed 19 minutes. Operative time ranged from 110 to 270 min, while max estimated blood loss was 400 ml. All patients were followed for 6 month and no case of disease recurrence or progression was noted. CONCLUSIONS: The small number of laparoscopic interventions in patients with RCC in HSK doesnt allow to carry out a proper statistical analysis and draw certain conclusions. We presented the largest experience available in the literature and our results demonstrate the efficacy and safety of conventional laparoscopic technologies in the treatment of RCC in HSK.

[LUTS/BPH who treats?. The results of the epidemiologic study].

INTRODUCTION: In this study an attempt was made to determine some reasons that prompted the urologist to make a choice in favor of particular drug or combination from a wide variety of available drugs. The prescribing habits and subjective evaluation of efficiency and safety of the drugs for the treatment of lower urinary tract symptoms/benign prostatic hyperplasia by the urologists in Russia was analyzed. MATERIALS AND METHODS: a prospective multicenter epidemiological study "LUTS/BPH - who treats?" was carried out in 12 centers using data obtained from May 1 to July 31, 2018 with anonymous survey of 500 urologists living in 9 cities of the Russian Federation. The survey consisted of 46 questions reflecting a level of education, involvement in scientific life of urologic community, membership in various professional organizations, and subjective assessment of safety and efficiency of drugs used in Russian Federation for the treatment of urinary disorders. The obtained data was analyzed for a whole group and further in the subgroups. RESULTS: Alpha-blockers are the most commonly prescribed drugs. These drugs constitute 63.4% of all appointments, followed by the 5-a-reductase inhibitors (23.98%) and combined therapy by the both drugs (24.68%). The most frequently used alpha-blocker is tamsulosin, but professors, MD and urologists, who read special literature at a regular basis, prescribed tamsulosin and silodosin equally. In primary cases and in patients with concomitant cardiac pathology, silodosin was prescribed more commonly in comparison with other alpha-blockers. CONCLUSION: the results of the study indicate a concordance with global trends in the treatment of these patients. Our data reflect a significant influence of the level of education, work experience and involvement in scientific professional life of urologic community on the choice of a particular drug for the treatment of LUTS/BPH and prove the feasibility of further work which should be aimed at popularization of the modern medical knowledges among the urologists and organization of a process of continuous medical education.

[Quality of life in patients with lower urinary tract symptoms after TURP for benign prostatic hyperplasia].

INTRODUCTION: To date, the gold standard for the surgical management of BPH is transurethral resection of the prostate (TURP). Most patients who undergo TURP for BPH experience immediate effects and complete relief of lower urinary tract symptoms and do not need further urological care. However, some patients after this operation have some level of persistent residual lower urinary tract symptoms, which may require additional therapy. AIM: To investigate voiding function and the need for medical therapy in patients who underwent TURP for LUTS due to BPH. MATERIALS AND METHODS: This study was performed as an anonymous survey among male patients presenting to a urology clinic. During the visit, the patients were offered to fill out I-PSS and SF-36 questionnaires. Also, they were asked about their socio-economic status, history of BPH, their perception of surgery and the postoperative period up to the day of the interview, presence or absence of symptoms of voiding dysfunction and any drug therapy at the time of the interview or after surgery. The patients also rated the severity of the symptoms using the IPSS questionnaire. The study comprised patients after 12 months to 3 years following successful TURP for LUTS due to BPH. A total of 1100 questionnaires were forwarded to researchers for interviewing patients who underwent TURP for prostatic hyperplasia. RESULTS: After collecting and reviewing all the questionnaires, 921 questionnaires were found eligible. The findings of the survey showed that a significant proportion of patients who underwent TURP require a long-term postoperative medical therapy. At the same time, in the Russian Federation, there are no standard approaches to medical management of this category of patients.

[Laparoscopic pyelolithotomy for staghorn kidney stones. multi-center study].

AIM: To analyze the effectiveness and safety of laparoscopic pyelolithotomy (LP) in treating staghorn stones. MATERIALS AND METHODS: A multicentre retrospective analysis of the results of LP performed from January 2004 to December 2016 was conducted. INCLUSION CRITERIA: patients with staghorn calculi K3-K4, who underwent LP as an alternative to percutaneous nephrolithotripsy. The analysis included the incidence and structure of intra- and postoperative complications, the causes of access conversion, operating time, duration of postoperative hospital stay and stone clearance. RESULTS: A total of 137 patients met the inclusion criteria, including 78 (56.93%) men. There was no mortality and access conversion. Intraoperative complications occurred in 2 (1.46%) patients. Operating time was 130 [100; 150] min, blood loss was 150 [100; 200] ml. No need for blood transfusion was observed. The cumulative rate of postoperative complications was 5.11%, stone clearance was achieved in 86.13% of observations, the duration of postoperative hospital stay was 7 [7; 11] days. CONCLUSION: In cases of dense staghorn calculi located in a large "extra-renal" pelvis and have calyceal branches equal to the diameter of their necks, laparoscopic pyelolithotomy is an alternative not only to open, but also to percutaneous surgery.

[Early diagnostic signs of complicated course of hypermobile kidney].

AIM: To develop a method for early diagnosis of renal venous blood flow disorders as a factor determining complicated course of hypermobile kidney (HK). MATERIAL AND METHODS: Rotation angles in the three coordinate planes and six static conditions were determined in 92 patients with HK (in 3312 coordinate planes and in 1104 the static state). The fixed probe and "dancing kidney" method was used. The same 92 patients underwent polypositional Doppler sonography in six static states. Statistical analysis was performed using the statistical software STATISTICA 7.0 (Statsoft Inc., USA). RESULTS: In 226 (93%) patients with HK SAD exceeded 30 mm Hg in at least one static state. Evaluation of 552 variants in assessing hemodynamic features of hypermobile kidney revealed that 92 patients had signs of impaired unilateral or bilateral renal vein outflow as determined by RMS and dVven. in 415 (75.18%) cases. The accuracy in determining belonging to the group, according to the classification matrices of STATISTICA 7.0 software was 89.13%. DISCUSSION: The developed methods for evaluating kidney rotation make it possible to diagnose significant disturbances of the renal major blood flow and monitor dynamics of the process in real-time. All disturbances of the renal major blood flow occur only in ptosis and rotation; that confirms the need for early diagnosis of these conditions. CONCLUSION: The findings of the multi-positional study of HK and the results of the data mathematical processing suggest that our method of HK imaging enables screening to determine the group of patients in need of further examination and observation.

[Modern diagnostic and management aspects of citrate therapy for uric acid nephrolithiasis].

INTRODUCTION: Iso-aciduria - long-term existence of urine pH within a narrow range (pH <0.8-1.2 units.) - activates certain enzymes for which these pH levels are favorable. Then, this activation induces precipitation of crystals corresponding to these enzymes. OBJECTIVE: To enable citrate therapy without a risk of altering the stone chemical composition and to identify indicators reflecting the degree of metabolic disorders in patients with uric acid nephrolithiasis. MATERIAL AND METHODS: Citrate therapy was provided with a mixture comprising "Potassium citrate monohydrate" and "Tri-sodium citrate di-hydrate" in a ratio of 2: 1. The study group included 64 patients, who had ultrasound-detected calyx stones and hyperechoic inclusions from 2 to 4 mm without acoustic shadow, located in the papillary region of the renal pyramids. Statistical analysis was performed by cross tabulations (pairing). RESULTS: The results of the statistical analysis have proven the legitimacy and feasibility of the proposed method of classifying patients into homogeneous groups according to the disease severity. CONCLUSION: Long-term citrate therapy should be carried out in such a way as to achieve maximum range of urine pH (from 5.4 to 7.8 units), which will allow to avoid deposition of other crystals upon the existing stone and identify indicators reflecting the degree of metabolic disorders in patients with uric acid nephrolithiasis. CONCLUSION: Long-term citrate therapy should be carried out in such a way as to achieve maximum range of urine pH (from 5.4 to 7.8 units), thus avoiding deposition of other crystals upon the existing stone.

[The use of NefroDoz in patients with urolithiasis who underwent extracorporeal shock wave lithotripsy].

The article presents the results of the multicenter clinical comparative open-label trial in three parallel groups, which was aimed to the evaluation of the efficacy and safety ofbiologically active food supplement NefroDoz after extracorporeal shock wave lithotripsy (ESWL) in patients with urolithiasis. NefroDoz was prescribed for the lithokinetic purpose. The study involved 114 patients from different regions of the Russian Federation aged from 18 to 75 years (mean age 45.56 +/- 12.49 years) with a diagnosis of urolithiasis who underwent ESWL. Patients were divided into 3 groups according to the type oftreatment. Evaluation of the effectiveness was performed using data from a blood test, urine analysis, and biochemical blood assay, ultrasound and KUB X-ray. The results showed that NefroDoz has diuretic, anti-inflammatory, and lithokinetic effects, and is effective and safe drug for the patients with urolithiasis who underwent ESWL.

[Positional changes of the magistral blood flow of the left kidney in men with varicocele and infertility].

This paper proves the correlation between characteristics of blood flow rate in the renal veins and resistance indices of the renal arteries. As a result of polypositional assessment of venous blood flow, it was found that the violations of magistral venous blood flow in the left kidney can affect the formation and progression of varicocele, and the severity of disorders of spermatogenesis. The necessity of assessment of testicular veins and the pressure in left renal vein not only in clin- and orthostasis or Valsalva maneuver, but in the six static positions is discussed; this can allow to register the violations of magistral renal blood flow at the early stages important for fertility disorders, improve the efficiency of diagnosis and treatment of patients with varicocele.

[Therapy of rapid ejaculation using dietary supplement "NeyroDoz": results of a multicenter non-randomized clinical study].

The main aim of the study was to determine the effectiveness of a multicomponent dietary supplement NeyroDoz in patients with rapid ejaculation. We examined 50 patients with rapid ejaculation (premature ejaculation), who were recruited in 9 clinical centers in different regions of Russia. These patients received NeyroDoz, 2 capsules twice a day for one month, followed by a control observation for 1 month. In study group of patients, symptomatic improvement was achieved in 45 (90%) of 50 patients at 4-week observation target date. In assessing the impact of NeyroDoz on different groups of symptoms, it was found that it significantly increases the average time of sexual intercourse by 2 times, increases the orgasm brightness, reduces the severity of psychosomatic component and has a positive effect on all components of the copulative cycle. In assessing the afterimpression, this effect was maintained throughout the period of follow-up.

[The use of ProstaDoz in patients with chronic prostatitis. Results ofa multicenter nonrandomized clinical study].

The main purpose of the study was to determine the effectiveness of a multicomponent dietary supplement ProstaDoz in patients with chronic prostatitis. The study included 50 men with clinical symptoms of a chronic prostatitis, which were observed in 9 clinical centers in different regions of Russia. All patients have received 2 capsules of ProstaDoz twice a day for 1 month, followed by dynamic observation for 4 weeks. Symptomatic improvement was achieved in 46 (92%) patients. Evaluation of effects of ProstaDoz on various groups of symptoms has revealed that it reduces pain, promotes urination normalization and improvement of quality of life. These effects were maintained during all follow-up period.

[Condition of cavernous tissue of the penis after unilateral incomplete proximal intracavernous falloprosthesis].

Unilateral incomplete proximal intracavernous falloprosthesis (UIPIF) was followed by US-dopplerography of the intact penis and penis in medical erection induced by E1 prostoglandin introduction into the intact cavernous body. UIPIF preserves 89-90% of functionally active cavernous tissue with effective blood flow. Investigation 2 months and more after operation demonstrated that systolic blood flow rate in the cavernous artery of the cavernous tissue around the endoprosthersis can reach values registered in normal erection. The conclusion is made that after UIPIF quality of sexual life of the patient improves due to creation of additional density and axial stability of the trunk of the penis.

[Diagnosis and laparoscopic treatment of renal cysts of Bosniak type III and IV].

A total of 322 patients with cystic lesions were examined with contrast-enhanced computed tomography from 1998 to 2005. Of them, 104 patients have undergone transperitoneal or retroperitonial laparoscopic surgery. 21 patients of the latter were diagnosed to have cystic lesions Bosniak III and 4 patients--Bosniak IV. It is difficult to differentiate cysts Bocniak II and III even pathomorphologically. Cystic carcinoma was detected histologically in 8 Bosniak III cases. Partial nephrectomy was made in 7 cases and radical nephrectomy in 1 case. Renal cell carcinoma was detected in 3 of 4 Bosniak IV cases, oncocytoma--in 1 case. Thus, renal cancer was confirmed in 8 cases (38%) of Bosniak III and 3 cases of Bosniak IV. During the mean follow-up of 40 months no events of local recurrence, progression or tumor growth in places of trocar installation were detected. Cases of cancer specific mortality were not observed. Cystic lesion Bosniak III and IV are subject for surgical treatment. The method of choice is laparoscopic transperitoneal partial nephrectomy and radical nephrectomy.

[Criteria of efficacy of adjuvant immunotherapy of surface cancer of the urinary bladder].

Assessment of prognostic significance of interleukine-8 (L-8) urine levels was made in 12 patients with verified surface cancer of the urinary bladder (SCUB) on adjuvant intravesical immunotherapy. Quantitative enzyme immunoassay identified IL-8 in the urine before intravesical injection of BCG vaccine and 6 hours later. A total of 192 urine samples were studied ("Multiskan-Jems", 405 nm). Adjuvant immunotherapy raises an L-8 level in the urine of the patients. After 8-week immunotherapy IL-8 elevated from 169.4 pg/ml to 326 pg/ml. Four patients with minimal difference in IL-8 urine levels (120 pg/ml, on the average) before and 6 hours after intravesical injection of BCG vaccine developed recurrence. Thus, quantitative assessment of IL-8 in urine of SCUB patients given intravesical BCG therapy can serve as one of prognostic criteria of adjuvant immunotherapy efficacy.