[Anesthetic management of robot-assisted radical prostatectomy].

The authors have an experience in performing of 700 radical prostatectomies by using of daVinci-robot. The main factors determining parameters of operation and anesthesia are presented in the article. The authors give recommendations for optimization of anesthetic management. The main features of patient preparation for robot-assisted radical prostatectomy, parameters of anesthesia and postoperative management of patients are presented in the article.

[Determinants of risk of the development of erectile dysfunction in the Russian Federation: analysis of epidemiological studies].

According to the results of epidemiological studies of prevalence of erectile dysfunction in the Russian Federation, the search for the determinants of risk of its development was performed. It was found that the leading risk factors for the development of erectile dysfunction, in descending order of statistical significance, include the amount of accumulation of points according to the IPSS score, arterial hypertension, L(IPSS) quality of life index, age, diabetes, and overweight and obesity.

[Correction of erectile dysfunction in patients undergoing radical prostatectomy].

Radical prostatectomy (RPE) is a widespread surgery in the world performed in patients with localized prostate cancer. Despite the widespread introduction of nerve-sparing radical prostatectomy techniques, erectile dysfunction after radical prostatectomy occurs very frequently, which seriously affect the quality of life of patients. At the present stage of development of medicine, differentiated approach to each patient is required. "Patient's expectation management" is an important prerequisite for successful sexual rehabilitation. The use of conventional methods for correction of erectile dysfunction after radical prostatectomy has its own characteristics. Currently, phosphodiesterase type 5 inhibitors, however, are still first-line agents for the recovery of erectile function. Their combined use with other methods has encouraging results.

[Perineal saturation biopsy of the prostate].

The effectiveness of perineal biopsy for the detection of prostate cancer (PC) using an array for brachytherapy/cryotherapy was evaluated. It is shown that perineal saturation biopsy provides high detection rate of prostate cancer in patients with suspected cancer after negative transrectal biopsies, does not increase the detection of clinically insignificant cancer and incidence of complications, but requires a lot of time and cost.

[Individual learning curve for radical robot-assisted prostatectomy based on the example of three professionals working in one clinic].

The appearance of new surgical technique always requires evaluation of its effectiveness and ease of acquisition. A comparative study of the results of the first three series of successive robot-assisted radical prostatectomy (RARP) performed on at time by three surgeons, was conducted. The series consisted of 40 procedures, and were divided into 4 groups of 10 operations for the analysis. When comparing data, statistically significant improvement of intra- and postoperative performance in each series was revealed, with increase in the number of operations performed, and in each subsequent series compared with the preceding one. We recommend to perform the planned conversion at the first operation. In our study, previous laparoscopic experience did not provide any significant advantages in the acquisition of robot-assisted technology. To characterize the individual learning curve, we recommend the use of the number of operations that the surgeon looked in the life-surgery regimen and/or in which he participated as an assistant before his own surgical activity, as well as the indicator "technical defect". In addition to the term "individual learning curve", we propose to introduce the terms "surgeon's individual training phase", and "clinic's learning curve".

[Benign mimics of prostatic adenocarcinoma].

Prostate cancer occupies 2nd place on the prevalence and 6th place on mortality among all cancers in men. That is not to deny the social importance of prostate cancer, but attention is drawn to significant advantage of newly detected cases above the cancer-specific mortality. "Gold standard" for diagnosis includes morphological study of tissue fragments after transrectal multifocal prostate biopsy. The importance of the differential diagnosis is particularly relevant when analyzing fragments of prostate tissue obtained from biopsies as a false positive result may cause unnecessary and excessive treatment. This article presents the most common benign processes that can simulate various grade adenocarcinoma. Awareness about the presence of such cancer mimics and careful examination of micropreparations in most cases allows to come to the correct conclusion.

[Treatment of prostate cancer using cryoablation: a prospective study].

Currently, the choice of tactics of treatment of the patient with prostate cancer (PCa) requires to take into account the degree of differentiation and stage of tumor, age of the patient and his somatic diseases, the risk of complications, as well as the patient's desire and physician's experience. Due to the progressive development of medical technology, interest in minimally invasive treatments for prostate cancer, such as cryoablation, interstitial brachytherapy and HIFU-therapy, has grown. Cryoablation of the prostate gland is a tissue ablation by local effects of very low temperatures and is minimally invasive, highly effective treatment for prostate cancer that can be used as the primary treatment, and in the case of tumor recurrence after radiotherapy. Focal cryoablation of the prostate allows to selectively destroy the known tumor with preservation of organ function and without reducing the quality of life of the patient. Focal therapy for prostate cancer is an alternative to radical treatment and active surveillance, occupying an intermediate position between them. Due to the lack of long-term results, focal cryoablation is an experimental type of treatment. First cryoablation of the prostate using modern equipment was carried out in Russia in March 2010, at the Department of Urology MSMSU. Since that time, we performed this procedure in 122 patients with prostate cancer; cryoablation was primary treatment in 110 patients and was used as salvage treatment in 12 patients. In most cases, the operation was performed under epidural or spinal anesthesia. According to the protocol, all the patients underwent 2 cycles of freezing and thawing under transrectal ultrasound guidance. A significant improvement of equipment for cryosurgery, the use of cryoneedles with smaller diameter, and the use of temperature sensors and catheters to warm the urethral mucosa have allowed to minimize the number of complications in comparison with other methods of treatment of prostate cancer and achieve a high disease-free survival. Our prospective study was aimed to analyze our own results cryoablation of the prostate gland.

[Analysis of the results of urinary incontinence treatment in women using free suburethral synthetic sling: the experience of 1000 operations].

The study presents an analysis of the experience of treatment of urinary incontinence in women using free synthetic suburethral sling. Between 2001 and 2008, 1081 patients underwent surgery. Of these, 841 (77.8%) suffered from stress urinary incontinence, 202 (18.62%) suffered from the mixed form of urinary incontinence with a predominance of the stress component, and 38 (3.52%) had recurrent urinary incontinence. Group 1 included patients with stress urinary incontinence who underwent surgery using suburethral synthetic sling with retropubic access (TVT operation); Group 2 included patients, who underwent surgery using suburethral sling implanted with transobturator access (TVT-O operation). Group 3 consisted of patients with mixed urinary incontinence, who underwent TVT-O operation. Retropubic suburethral TVT sling was implanted in 273 (25.25%) patients, transobturator TVT-O sling--in 740 (68,45%) patients, and other synthetic suburethral slings--in 68 (6.3%) patients. The average follow-up period was 50.1, 31.1 and 32,6 months in each group, respectively. Cough test was used for the objective evaluation of the effectiveness, and visual analogue scale--for the subjective evaluation of effectiveness. In the TVT group, the negative cough test in the postoperative period remained at 85.58% of the patients, and in in TVT-O group--in 84.36% of patients. Analysis of the frequency of intraoperative complications showed that the probability of occurrence of complications was not associated with age, body mass index and obstetric history of patients. It was noted that the perforation of the bladder and pelvic hematoma were more likely to occur when using the retropubic access. Transobturator access is associated with a higher risk of injury of the lateral vaginal fornix, although bladder injury is not ruled out. Objective and subjective indicators of efficacy of treatment of mixed form of urinary incontinence were 86.15 and 87.69%, respectively. The study suggests that the operations using suburethral TVT and TVT-O slings are safe and effective methods of treatment of stress urinary incontinence in women.

[Development of a diagnostic test system for early non-invasive detection of prostate cancer based on PCA3 mRNA levels in urine sediment using quantitative reverse tanscription polymerase chain reaction (qRT-PCR)].

The wide introduction of prostatic specific antigen (PSA) determination into clinical practice has resulted in a larger number of prostate biopsies, while the lower age threshold for PSA has led to a larger number of unnecessary prostate biopsies. Hence, there is a need for new biomarkers that can detect prostate cancer. PCA3 is a noncoding messenger ribonucleic acid (mRNA) that is expressed exclusively in prostate cells. The aim of the study has been to develop a diagnostic test system for early non-invasive detection of prostate cancer based on PCA3 mRNA levels in urine sediment using quantitative reverse transcription polymerase chain reaction (qRT-PCR). As part of the study, a laboratory diagnostic test system prototype has been designed, an application methodology has been developed and specificity and sensitivity data of the method has been assessed. The diagnostic system has demonstrated its ability to detect significantly elevated levels of PCA 3/KLK 3 in samples from prostate cancer (PCa) patients compared with those from healthy men. The findings have shown relatively high diagnostic sensitivity, specificity and negative-predictive values for an early non-invasive screening of prostate cancer

[The evaluation of efficacy and safety of treatment with dalfaz SR in patients with prostatic adenoma].

An open non-comparative multicenter study-observation according the program involving 190 patients (mean age--62.3 +/- 9.7 years) with benign prostatic hyperplasia (BPH) and severe urination disorders was performed. All of the patients received alfuzosin (dalfaz SR) 10 mg daily for 12 months. The primary criterion for evaluation of treatment effectiveness was the change of the total IPSS score. As secondary criteria, change of QoL score, total number of urination per day and subjective patient's satisfaction with the treatment results were registered. Safety was assessed by recording the adverse events. The treatment led to the progressive decrease in the total IPSS score--from 16.4 +/- 4.8 at baseline to 7.7 +/- 2.6 at the final visit (P < 0.001). The average QoL score has decreased by 67% - from 3.9 +/- 1.1 to 1.3 +/- 0.7 at the end of the study (P < 0.001). In general, 94.2% of respondents positively assessed the results of treatment. The frequency of urination at night has decreased by 56%. Adverse effects (dizziness and slight fatigue) were recorded only in 1 (0.5%) patient. The present study has demonstrated a high efficacy and a favorable safety profile of dalfaz SR at a dose of 10 mg in the treatment of patients with BPH. Of particular note is the high proportion of patients who continued to receive the drug for 12 months, showing a good tolerability ofdalfaz SR and high treatment compliance.

[Pathomorphological features of prostate diseases].

Currently, the "gold" standard for the diagnosis of PCa is a histological examination of biopsy specimens obtained by transrectal ultrasound guided prostate fine-needle biopsy. As a result, a greater number of tumors have been detected at early stages (T1c). The key point is the correct preparation of microsections and their subsequent examination.

[Complications of mesh-vaginopexy: results of a multicenter trial].

A retrospective multicenter trial with participation of 7 large clinics of Moscow and Moscow Region has been performed to characterize complications after correction of genital prolapse with application of the PROLIFT system. The trial enrolled women with uterine and vaginal prolapse of stage II-IV by POP-Q classification. The women also had anatomic and functional defects of the adjacent organs. From January 2005 to March 2008 all the patients have undergone vaginal extraperitoneal colpopexy using Prolift system. The results of the trial showed that extraperitoneal colpopexy with application of the Prolift system should not be considered as a low-invasive intervention and therefore it is not valid to use this technique as a routine method of genital prolapse treatment as in 29.5% cases the operation is accompanied with complications of different severity.

[Analysis of the results of epidemiological study on prevalence of erectile dysfunction in the Russian Federation].

With the aim of evaluation of prevalence of erectile dysfunction (ED) and other violations of the sexual function of men in the Russian Federation, anonymous questionnaire survey of 1400 men was performed. The study involved seven centers located in the most densely populated regions of the country. 1225 questionnaires were analyzed. It was found that ED symptoms were present in 1101 (89.9%) respondents. Age-related symptoms (by AMS questionnaire) were detected in 554 (45.2%) patients, most of whom were aged 45-59 years. The importance of active detection of ED in men, as it can be one of manifestation of a more serious disease, was demonstrated.

[Current state, challenges and prospects for the development of the Russian urological service].

The present study was dedicated to the analysis of the incidence, prevalence and mortality from diseases of the urogenital system. The data on the effectiveness of the hospital bed usage, the patient profile at hospital, the treatment timing and outcomes, surgical activities in urological hospitals, the state of staff assistance in urological service, the efficacy of usage of working time of urologist and human resource of Russian urological service were analyzed. Data analysis revealed a number of issues of administrative and legal nature, which cause modest efficiency of activity of urological service. The ways for solutions of these problems are presented.

[Mini-invasive operations for correction of urinary incontinence in females].

We compared efficacy of surgical treatment of urinary incontinence in women depending on the size of the synthetic sling and technique of its installation. From January to September 2009 we made 75 operations with synthetic suburethral slings: TVT-SECUR (TVT-S)--group 1 (n = 35) and TVT-O- group 2 (n = 40). The sling was installed in U position in 14 patients of group 1 and in H position in 21 patients. The control examinations included questionnaire survey, cough stress test (in bladder volume more than 150 ml), vaginal investigation, uroflowmetry, in urgency--complex urodynamic examination. A total of 32 patients of group 1 and 40 patients of group 2 were examined postoperatively. A positive result was achieved in 20 (62%) and 38 (95%) (p = 0.0006) patients of group 1 and 2, respectively. Quality of life was assessed as good and very good by 22 (68%) and 37 (93%) patients of groups 1 and 2 (p = 0.0105), respectively. The control examination after 6 months of follow-up showed good result in 7 (53%) and 13 (68%) patients of group 1 (subgroups U and H, respectively). Reoperation for urinary incontinence was made in 4 (30%) patients of subgroup U and 1 (5%)--of subgroup H. Thus, surgical treatment of urinary incontinence in women according to TVT-0 technique is more effective than in TVT-S surgery, but minisling TVT-S is more effective in patients with bad somatic status and in H position.