[Medical and economic analysis of the effectiveness of the structural units of a medical organization].

Medico-economic analysis in a medical organization is a set of techniques and methods for assessing the indicators of medical, industrial and financial activities, the purpose of which is to choose ways to rationally use internal resources. The main objectives of medical and economic analysis is to determine the reserves for the use of the organization's resources; introduction of effective technologies of the treatment process; assessment of the effectiveness of medical care, assessment of the effectiveness of management decisions. The combination of types of analysis, their subordination to management goals can improve the efficiency of the medical organization and its structural divisions. In the context of increasing competition in the medical services market, the importance of medical and economic analysis in medical organizations of various forms of ownership is growing. State medical institutions are no exception. Modern autonomous and budgetary healthcare institutions operate in the status of independent economic entities, while the role of the chief physician as the organizer of the medical and economic process, as well as the role of the head of the structural unit, who must analyze the results and costs, calculate the need for material and financial resources, determine efficiency of medical activity. The subject of the analysis of this article is to determine the optimal algorithm for conducting a medical and economic analysis in the context of the functioning of the structural units of a medical organization.

[Radical prostatectomy in patients with incident prostate cancer].

The problem of detecting localized prostate cancer following transurethral resection of the prostate (TURP) for benign prostatic hyperplasia is fairly common. Historically, radical prostatectomy (RP) after previously performed TURP was associated with poor surgical and functional outcomes. It is believed that the periprostatic fibrosis, scar tissue and inflammation after previous TURP may interfere with the optimal RP results. The present retrospective study evaluates intraoperative characteristics, postoperative oncological and functional outcomes of RP in patients with a history of TURP.

[Morphology of collagen matrices for tissue engineering (biocompatibility, biodegradation, tissue response)].

OBJECTIVE: to perform a comparative morphological study of biocompatibility, biodegradation, and tissue response to implantation of collagen matrices (scaffolds) for tissue engineering in urology and other areas of medicine. MATERIAL AND METHODS: Nine matrix types, such as porous materials reconstructed from collagen solution; a collagen sponge-vicryl mesh composite; decellularized and freeze-dried bovine, equine, and fish dermis; small intestinal submucosa, decellularized bovine dura mater; and decellularized human femoral artery, were implanted subcutaneously in 225 rats. The tissues at the implantation site were investigated for a period of 5 to 90 days. Classical histology and nonlinear optical microscopy (NLOM) were applied. RESULTS: The investigations showed no rejection of all the collagen materials. The period of matrix bioresorption varied from 10 days for collagen sponges to 2 months for decellularized and freeze-dried vessels and vicryl meshes. Collagen was prone to macrophage resorption and enzymatic lysis, being replaced by granulation tissue and then fibrous tissue, followed by its involution. NLOM allowed the investigators to study the number, density, interposition, and spatial organization of collagen structures in the matrices and adjacent tissues, and their change over time during implantation. CONCLUSION: The performed investigation could recommend three matrices: hybrid collagen/vicryl composite; decellularized bovine dermis; and decellularized porcine small intestinal submucosa, which are most adequate for tissue engineering in urology. These and other collagen matrices may be used in different areas of regenerative medicine.

[ASSESSMENT OF THE RISK OF INCIDENTAL PROSTATE CANCER PROGRESSION].

At present, methodology based on the stage T1a or T1b is used to determine the risk of incidental prostate cancer (IPC) progression. This approach was developed before the introduction of prostate-specific antigen (PSA) into the practice of the urologist, and does not account of the degree of IPC. For the prediction of IPC progression, multifactorial prognostic model was created. This model is based on the analysis of two parameters--the total PSA level before the surgery and the Gleason score according to the results of morphological examination after transurethral resection of the prostate hyperplasia. This model has a high predictive value (AUC 86.6%) and can be easily used in practice. For the interpretation of the calculated results special table is formed that allows to assess the risk of progression over the next 3.5 years.

[PLGA mesh-collagen hybrid scaffold and tissue-engineered product in substitution urethroplasty: experimental validation].

Urethral strictures are a pressing issue in modern medicine. Substitution urethroplasty is considered one of the most effective treatment methods. However, despite the surgery showing good results, many problems remain unresolved, one being substitute material deficiency in extensive or recurrent strictures, as well as in cases requiring multistage surgeries, including those used to treat hypospadias. Graft removal also leaves the donor area prone to diseases and increases the length of surgery leading to a higher risk of intra- and postoperative complications. Tissue engineering (namely tissue-engineered products comprised of scaffolds and cells) may be a useful tool in dealing with these issues. The authors assessed the characteristics of a novel hybrid scaffold created from "reconstructed" collagen and a poly(lactic-co-glycolic acid) mesh. The resulting composite product showed good mechanical properties and functional performance. The hybrid scaffold was non-cytotoxic and provided an adequate base for cell adhesion and proliferation. Biodegradation resulted in the scaffold being replaced by urothelium and urethral mucosa. The newly formed tissues possessed adequate structural and functional properties. Only one rabbit out of 12 developed urethral stricture at the site of scaffold implantation. The above-mentioned facts suggest that the novel hybrid scaffold is a promising tissue-engineered product with potential implication in substitution urethroplasty.

[Diagnosis and treatment of incidental prostate cancer].

Incidental prostate cancer (IPC)--cancer, identified by morphological evaluation of prostate tissue removed during transurethral resection (TUR) or open prostatectomy, in cases where the results of preoperative prostate biopsy revealed no prostate cancer. Literature review presents the data on the incidence of IPC, features of its diagnosis, prediction of tumor progression, and choice of treatment approaches. Many questions remain unresolved and require additional research.