[Robot-assisted left-side partial nephrectomy with a segmental resection of left lower ureter and Boari reconstruction].

Renal cell carcinoma (RCC) accounts for more than 90% of cases of malignant kidney tumors and represents 2-3% of all malignancies worldwide. Clear cell renal cell carcinoma (ccRCC), the most common type of RCC, comprising 70-80% of cases. RCC most commonly metastasizes to the lungs, bones, lymph nodes, liver, adrenal glands, and brain. Synchronous metastasis of RCC to the ipsilateral ureter represents an extremely rare event. Ureteral metastasis is a significant diagnostic challenge, since it is quite difficult to determine whether it has metastatic origin (RCC) or it is a primary urothelial tumor. Moreover, due to the rarity of disease, treatment strategy is not well established. We present a rare case of patient with the RCC of a single left kidney and metachronous metastasis to the ipsilateral ureter that was initially assumed to be primary urothelial carcinoma. The robotic-assisted left-side partial nephrectomy with a segmental resection of left lower ureter and Boari reconstruction was performed. This case of successful treatment with robotic-assisted approach shows a great organ-sparing potential of robotic surgery in the treatment of complex oncological patients for whom it is extremely important to preserve the maximum volume of functioning renal tissue, particularly in those with a metastatic RCC of a single kidney.

[Clinical case: bladder necrosis after prostate embolization in a patient with prostatic hyperplasia].

This article describes a clinical case of bladder necrosis developed after X-ray endovascular embolization of prostatic arteries of a 62-year-old patient with a verified diagnosis of BPH (benign prostatic hyperplasia). The complication resulted in the necessity of urgent surgical intervention, namely, laparotomy, cystprostatectomy and bilateral percutaneous nephrostomy. In the early postoperative period the patient had intense cutting pain in the left side of the abdomen. Examination revealed the inflow of small intestinal contents through the pelvic drainage, which was the reason for relaparotomy, abdominal cavity revision, uturing the small intestine perforation, suturing the small intestine pre-perforation, sanation and drainage of the abdominal cavity in an emergency procedure. The patient was discharged in a satisfactory condition under the supervision of a urologist by m/w on the 36th day after endovascular embolization of prostatic arteries. The eight months after discharge, the patient underwent a successful Brickers operation on creating an alternative urinary diversion route at the First Sechenov Moscow State Medical University of the Russian Federation.

[Carboxycryobiopsy and carboxycryoextraction of bladder tumor. Experimental study].

AIM: To evaluate the possibility of performing transurethral carboxycryobiopsy (CCB) and carboxycryoextraction (CCE) of a bladder tumor for pathomorphological examination, as well as to perform a comparative analysis of the safety (quality) of biopsy material (tumor tissue) during standard transurethral biopsy and carboxycryobiopsy. MATERIALS AND METHODS: In the first experiment in vitro, CCE of bladder tumor fragments obtained after transurethral resection was performed. In the second pilot study, cystoscopy followed by CCB and CCE in a patient with multiple bladder tumors was done. The procedure was performed by transurethral access. During cryopreservation of the bladder tumor, a biopsy was performed. After freezing, the tumor was removed from the bladder and sent for histological examination. RESULTS: The first experiment showed that cryoextraction of the fragments of a bladder tumor using carbon dioxide (CCE) in vitro is a feasible procedure and allows the evacuation of tumor tissues of various sizes. According to the second experiment, CCB and CCE of the bladder tumor using carbon dioxide allows to obtain a biopsy of a bladder tumor of sufficient size without compression or coagulation artifacts, which contributes to a more accurate histological evaluation. CONCLUSION: Our experiments showed that CCB and CCE of a bladder tumor using carbon dioxide are feasible procedures that contribute to obtaining better biopsy material for pathomorphological examination, and also allows to evaluate the effect of low temperatures of carbon dioxide on the biopsy material (tumor tissue).

[Minimizing the number of trocars during laparoscopic partial nephrectomy. Surgical technique].

INTRODUCTION: During last 20 years in urology there has been a number of significant advancements, which were due to the introduction into practice and improvement of minimally invasive techniques. Development of laparoscopic surgery allowed to actively introduce these procedures in various kidney disorders, including renal tumors. Laparoscopic partial nephrectomy is also undergoing changes in order to improve the technique. Standard technique requires four or more trocars, where fourth (additional) trocar is put for the assistant. However, there is an opinion that in most cases it is possible to perform partial nephrectomy without an assistant trocar, while maintaining the safety and efficiency of the procedure and improving some perioperative outcomes. The aim of our study was to compare the safety and efficiency of the three-trocar and four-trocar techniques during transperitoneal partial nephrectomy. This article also presents the technical features of laparoscopic partial nephrectomy. MATERIALS AND METHODS: Between 2021 and 2023, a total of 200 patients were included in the study comparing three- and four-trocar partial nephrectomy. RESULTS: There was no difference in the rate of achieving renal trifecta between the two groups. In the three-trocar group, 94 cases of renal trifecta were found, while in the four-trocar group, there were 95 patients with renal trifecta. CONCLUSIONS: The three-trocar technique is not inferior in safety and efficiency to the standard four-trocar technique. The main advantages of the three-trocar technique are less pain, cost and post-operative scarring.

[Early urethral catheter removal after robot-assisted radical prostatectomy].

BACKGROUND: Robot-assisted radical prostatectomy (RARP) is a widely used treatment method for patients with clinically localized prostate cancer. Posterior reconstruction of urethrovesical anastomosis (UVA) is one of the techniques that provides early recovery of urinary continence after surgery. Changes in the technique of performing posterior reconstruction of UVA may contribute to further improvement of functional results. AIM: To evaluate the functional results of early removal of the urethral catheter (after 3 days) after RARP using a modified surgical technique of performing posterior reconstruction of UVA compared with the standard catheterization time (7 days after surgery). MATERIALS AND METHODS: Patients who underwent RARP were randomly assigned to early catheter removal (3 days after surgery, main group, n=15) and standard catheterization time (7 days after surgery, control group, n=15). RARP was performed using the Da Vinci Si system. The primary end point was the rate of spontaneous voiding after catheter removal. Secondary endpoints were the incidence of urine leakage into the paravesical tissue during retrograde cystography, as well as complications according to the Clavien-Dindo system. The frequency and severity of stress urinary incontinence after catheter removal was assessed using the International Consultation on Incontinence Questionnaire - Urinary Incontinence Short Form (ICIQ-UI SF). RESULTS: There were no significant differences between groups in terms of baseline and perioperative parameters. After removal of the catheter, no acute urinary retention was observed in both groups. Also, there were no cases of urine leakage into the paravesical tissue during retrograde cystography. The ICIQ-UI SF questionnaire showed no significant differences between the groups at 1, 3, 6, and 12 months after surgery. CONCLUSIONS: The method of modified posterior reconstruction allows to remove the urethral catheter 3 days after RARP. Early removal of the urethral catheter did not adversely affect the early recovery of urinary continence, the quality of UVA, and did not increase the incidence of acute urinary retention. Further studies with longer follow-up periods are needed.

[Infiltrative endometriosis with ureteral lesion a clinical case of interaction between gynecologist and a urologist in diagnostics, surgical treatment and follow-up].

The article is focused on the problem of diagnosis and surgical treatment of infiltrative forms of endometriosis with lesions of both internal genitalia and urinary tract. A clinical observation of a young woman who underwent a robot-assisted operation on the internal genitals and organs of the urinary system is given. The article emphasizes the need for complete clinical examination in women with suspected endometriosis. The young age of patients, even the absence of bright clinic signs or absence of a long anamnesis of the disease should not exclude the possibility of severe case of endometriosis and the possibility of a combined lesions of pelvic organs. If infiltrative endometriosis is detected, the patients treatment should be carried out in a specialized hospital using modern surgical technologies.

[Simultaneous laparoscopic procedures in patients with synchronous multiple primary gastric and kidney cancer]. / Odnomomentnye laparoskopicheskie operatsii u bol'nykh s pervichno-mnozhestvennym sinkhronnym rakom zheludka i pochki.

OBJECTIVE: To evaluate an effectiveness of simultaneous laparoscopic procedures in patients with synchronous multiple primary cancer (SMPC). MATERIAL AND METHODS: We observed 3 patients (2 men and 1 woman) aged 61-78 years with synchronous multiple primary gastric and kidney cancer. Gastric tumors were localized in the lower third of the body (1) and the antrum (2), histological structure corresponded to adenocarcinoma G1 (1) and G2 (2). Kidney tumors were verified as light cell carcinoma and localized in the upper segment of the left kidney in 2 patient and right kidney in one patient. Mean dimension of tumor scheduled for resection was 4.65 cm, nephrectomy - 10.3 cm. Complexity of resection according to the RENAL scale was equal to 8 and 10. RESULTS: Three patients underwent laparoscopic Billroth-I distal gastrectomy, 2 - kidney resection and one patient - nephrectomy. Mean surgery time was 265±37 min, blood loss - 175±29 ml. There were no conversion and redo interventions within 30 days after surgery. Mean hospital-stay was 11±2 days. CONCLUSION: Minimally invasive technologies in patients with SMPC reduces blood loss, ICU- and hospital-stay. Earlier rehabilitation ensures the next stage of treatment in early postoperative period, while quality of life is better in comparison with traditional interventions.

[Clinical case of delayed diagnosis of tuberous sclerosis].

A clinical case of successful drug treatment of multiple renal angiomyolipomas in patient with tuberous sclerosis is presented, which suggests potential role of medical treatment of benign kidney tumors.

[Minimally invasive techniques of localized prostate cancer].

Currently, prostate cancer (PCa) is one of the most important problem of modern medicine, including economical issue. The detection of PCa compared to any other cancers progressively increases with age. Currently, PCa is the most commonly diagnosed solid tumor. Radical prostatectomy and radiation therapy are considered standard of treatment for PCa. However, while excellent long-term oncologic results can be achieved, these methods are often associated with significant complication rate, which negatively affects the quality of life of patients. Technological advancement and their implementation in medicine have increased treatment opportunities in oncourology. The purpose of this literature review is to study alternative treatment methods of localized PCa and compare their efficiency with conventional therapy.

[Erectile dysfunction associated with radical prostatectomy: appropriateness and methods to preserve potency].

RELEVANCE: Erectile dysfunction (ED) associated with radical prostatectomy (RP) affects 25-75% of patients and has a significant negative impact on their quality of life AIM: To analyze the maintenance of erectile function after RP depending on the type of endoscopic access and nerve-sparing. MATERIALS AND METHODS: This retrospective study comprised 231 patients with localized prostate cancer, who underwent surgery between February 2015 and February 2016. Surgery was performed using one of three approaches: laparoscopic, extraperitoneoscopic or robot-assisted. Nerve-sparing surgery was chosen were based on the Briganti nomogram (low risk of extraprostatic extension), Partins table, and taking into account the patients desire to maintain EF. EF and the quality of life were evaluated using the International Index of Erectile Function (IIEF-5) questionnaire and the QoL (Quality of Life) scale. RESULTS: Nerve-sparing RP was performed in 153 patients. Nerve-sparing RP did not differ significantly from non-nerve sparing RP with regard to operative time (p=0.064) and blood loss (p=0.073). According to the pathomorphological study, the prostatic capsule was intact, and surgical margins were negative in all cases. The incidence of significant ED and complete loss of erectile function was greater in patients after non-nerve sparing RP compared with nerve sparing RP [(5.0 (0-10.0) vs. 6.5 (0.8-19,0) points according to the IIEF-5 scale, p=0.271)]; 96.2% versus 72.2% (p<0.001). Nerve-sparing RP had a statistically significant better effect on the quality of life: 1.63+/-1.16 points against 1.88+/-1.02 points (p=0.035). CONCLUSION: The best outcomes were observed in patients undergoing robot-assisted RP. Nerve-sparing RP resulted in a lower rate of ED. This advantage without compromising the completeness of resection allows us to consider nerve-sparing RP as an appropriate and validated modality of preventing erectile dysfunction in properly selected patients.