[Dissolution of uric acid stones in the ureter].

INTRODUCTION: Uric acid stones (UA), consisting of uric acid/uric acid dihydrate, occur in 6.1-15.1% of all cases of urolithiasis in industrialized countries. At the same time, the frequency of these stones is directly dependent on age. Thus, the incidence of UA reaches 40% in men over 80 years of age and 27.3% in women over 90 years of age. UA are the only stones that are amenable to dissolution therapy with the use of citrate salts that alkalinize urine pH. A number of authors and European Association of Urology guidelines consider stone dissolution as a first-line therapy in the treatment of patients with UA, both as monotherapy and in combination with surgical procedures. MATERIALS AND METHODS: The results of conservative treatment of 86 patients aged 28 to 78 years with radiolucent ureteral stones ranging in size from 3 to 25 mm and a density of 133 to 728 HU, who underwent 89 courses of stone dissolution therapy from 2011 to 2018, are presented in the article. They had no obstruction or were prestented. There were 52 men (n=55 courses) and 34 women (n=34 courses). RESULTS: In 78 out of 89 clinical cases (87.6%), stone-free status was obtained within 14 to 181 days. Most often the duration of therapy was 30 days. In 11 (12.4%) cases the treatment was considered ineffective. However, only in 4 (4.5%) patients the stone size did not change, while in 7 (7.9%) cases it decreased. The results of the study suggest the high efficiency of citrate therapy in patients with ureteral stones in case of unobstructed urine outflow (including those with stents), which is comparable to surgical treatment.

[Use of intelligent analysis in urology].

The main methods of intellectual analysis (IA) used in modern medicine are described in the review. The main areas for IA application in the healthcare are diagnostics, treatment, prognosis of the course and efficiency of treatment in various diseases. The IA is based on mathematical methods and algorithms. The basic concepts of IA along with examples of its use in urological practice are presented in the review.

[Retrograde intrarenal surgery using a 1.94 m superpulsed thulium fiber laser].

INTRODUCTION: surgical treatment of urinary stone disease plays an important role in urological practice. Stone fragmentation can be performed using various lithotripters, from which Holmium fiber laser (Ho: YAG) has currently taken the main place. According to the current literature, a superpulsed thulium fiber laser with a wavelength of 1.94 m and a maximum power output of 40 W showed in vitro higher efficiency compared to Ho: YAG, while having the same safety profile. The use of a thulium fiber laser with a pulse energy of 0.025-6 J and a high repetition rate (up to 1600 Hz) allows to most effectively perform stone dusting during retrograde intrarenal surgery (RIRS). AIM: to improve the performance of RIRS using the 1.94m superpulsed thulium fiber laser. MATERIALS AND METHODS: a total of 152 patients with renal stones who were treated during the period from February 2018 to July 2019 were included in the study. The analysis of the laser settings, their effect on retropulsion and visibility when performing RIRS using a superpulsed thulium fiber laser with a wavelength of 1.94 m and a maximum power output of 40 W, a peak power of 500 W, as well as an assessment of the stone-free rate the first postoperative day and 3 months after the procedure was done. RESULTS: The most frequently used settings were as following: 0.5 J, 30 Hz, 15 W (No. 1), 0.15 J, 200 Hz, 30 W (No. 2), 0.8 J, 31.25 Hz, 25 W (No. 3), 0.8 J, 37.5 Hz, 30 W (No. 4). The statistical analysis of the influence of the settings on the quality of endoscopic imaging and retropulsion was carried out. In addition, the features of each settings were analyzed. The stone-free rate on the first postoperative day was evaluated using low-dose CT. CONCLUSION: A superpulsed thulium fiber laser with a wavelength of 1.94 m and a maximum power of 500 W has shown high efficiency in clinical practice when performing RIRS, since it allows to have good endoscopic imaging, minimal retropulsion, and to perform stone dusting, which had a positive effect on the stone-free rate. Optimization of the settings of thulium fiber lithotripsy may improve the results of surgical treatment of urinary stone disease.

[Analysis of the learning curve in laparoscopic partial nephrectomy in patients with localized renal parenchymal lesions depending on the nephrometric score].

AIM: to analyze the learning curve of surgeons while performing laparoscopic partial nephrectomy in patients with localized renal parenchymal lesions by calculating the MIC (negative surgical margin, ischemia, and complications) index depending on tumor complexity according to the R.E.N.A.L. and PADUA nephrometric scores. MATERIALS AND METHODS: the retrospective study included the results of laparoscopic partial nephrectomies in 320 patients with localized renal parenchymal lesions. The procedures were carried out by four surgeons from the Institute of Urology and Human Reproductive Health of FGAOU VO I.M. Sechenov First Moscow State Medical University, Moscow, Russia (EC-1; ESH-4; EB-7; ME-13) from January 2014 to June 2019. At baseline, all operators had experience of performing at least 30 laparoscopic interventions. In addition to the standard preoperative examination, a 3D virtual planning was carried out using the Amira 3D modeling program. In all cases, the nephrometric assessment of complexity was performed according to the R.E.N.A.L. and PADUA scores. The learning curve was assessed based on the results of operations based on the MIC index. All surgical interventions were divided into eras. In the era, 40 consecutive procedures for each operator were evaluated. Acquired skills were assessed over two eras. RESULTS: The average age of patients, of which 191 (59.7%) were men, was 54.4+/-11.37 years. The average body mass index was 28.55+/-3.85 kg/m2, the absolute volume of kidney lesions was 26.72+/-43.72 cm3, the average Charlson comorbidity index was 1.46+/-1.29, the average R.E.N.A.L. and PADUA scores were 6.38+/-1.75 and 7.92+/-1.51, respectively, the average duration of procedure was 150.36+/-50.18 min, the average blood loss was 227.94+/-280.22 ml, the average time thermal ischemia was 13.28+/-7.82 min. Postoperative complications were seen in 36 (11.2%) cases, of which grade III and more according to Clavien-Dindo developed in 8 patients (2.5%). A positive surgical margin was found in 4 (1.2%) patients. The overall MIC index was achieved in 243 (75.9%) cases; in era 1 it was seen in 71.9% cases in comparison with 80% in era 2. With the 1st degree of complexity (152 (47.5%) patients), MIC was achieved in 80.9% of cases, compared to 76.6% and 56.8% in patients with 2nd degree of complexity (n=124, 38.8%) and 3rd degree of complexity (n=44, 13.8%), respectively. Rate of MIC achievement in eras 1 and 2 for different surgeons were as following: 65% and 72.5%, 75 and 80%, 87.5 and 85% and 60 and 82.5%, for operator 1, 4, 7 and 13, respectively. Age, tumor complexity, R.E.N.A.L. score and PADUA score were the most significant parameters for determining MIC, identified on the basis of the criterion of equality of group means of discrete analysis. CONCLUSION: In all surgeons, the MIC index increased with the accumulation of experience in performing laparoscopic partial nephrectomy, but was lower with an increased degree of complexity of procedures. The minimum number of laparoscopic partial nephrectomies required to achieve an MIC more or equal 70% should be at least 40.

[Adherent Perinephric Fat: a prognosis and influence of perioperative results of organ-sparing procedures in localized kidney parenchyma tumors].

The results of recently published articles on the etiology and pathogenesis of "Adherent Perinephric Fat" (APF) are presented in the review. The current possibilities for predicting the presence of APF based on clinical data and imaging methods are highlighted, as well as the to an influence of ARF on perioperative results of organ-sparing procedures using various surgical approaches in patients with localized kidney parenchyma tumors.

[Flexible ureteroscopy for lower pole renal stones: novel superpulse thulium (TM) fiber laser lithotripsy].

INTRODUCTION: The SuperPulse Thulium (Tm) fiber laser (wavelength of 1.94 m) has been recently introduced as a directed-energy source for urology. Preclinical studies have shown a significant potential of the SuperPulse Tm fiber laser (SP TFL) for lithotripsy. However, clinical reports of using SP TFL to treat urolithiasis are still few and limited. Of special interest are challenging cases, e.g., lower pole stones, when extreme deflection of the instrument is required. OBJECTIVE: To evaluate the effectiveness of the SuperPulse Tm fiber laser in the management of lower pole small calyceal stones during flexible ureteroscopy (F-URS). METHOD: s. The SuperPulse Tm fiber laser device (Urolase 2, IRE Polus, Fryazino, Russia) has been cleared for clinical use by the Ministry of Health of Russian Federation. Study protocol has been approved by the Ethical Review Committee. Between January 2018 and February 2019, 130 patients with kidney stones have undergone Thulium fiber laser lithotripsy during F-URS. We retrospectively analyzed 15 of this patients with a single radiopaque lower pole calculus that were included in the present study. Stone size, stone density, lithotripsy time (from the first to last footswitch press) and "lasering" (laser emission) time were measured. The SP TFL was used for stone disintegration with different settings in dusting and fragmentation modes (0.1 - 4J, 7-300Hz, 6-40W) via a fiber with a 200-m core diameter. Low dose CT scanning was performed on POD 90 to assess SFR. RESULTS: Stone size ranged from 4 to 17 mm and stone density varied from 350 to 1459 HU. The average lithotripsy time was 12 min (3-30 min). The average "lasering" time was 1.3 min (0.4-2.5 min) and the mean hospital stay was 1.1+/-0.3 days. In all cases we reached the lower pole stone containing calyx with a laser fiber. The complication rates were evaluated by using the Clavien-Dindo grading system and did not exceed GII (6.6%). SFR on POD 90 was achieved in 86.6% of cases. CONCLUSIONS: F-URS with SuperPulse Tm fiber laser is safe and effective option in the management of lower pole small calyceal stones. The possibility of using small laser fibers gives better instrument deflection which make possible to reach lower pole calyceal stones even with acute lower pole infundibulopelvic angle (IPA).

[Novel approaches for transurethral en-bloc resection of large bladder tumors].

OBJECTIVE: to develop optimal techniques of en-bloc resection of large non-muscle invasive bladder tumors, determine the proper method of specimen extraction and assess the quality of specimens obtained by different techniques. MATERIALS AND METHODS: A total of 12 patients with primary cT1 bladder cancer underwent transurethral en-bloc resection between January 2018 and March 2019 were enrolled into the study. Tumor size ranged from 3.5 cm to 6.2 cm. For removal and extraction of large bladder tumors using thulium fiber en-bloc laser three different techniques were developed: "swiss cheese technique", "crown and root technique" and "three steps technique" technique". The main pathologic criteria used for assessment of removal technique were tumor grade (G), depth of invasion (T), presence of carcinoma in situ (CIS), variant histology (VH), lymphovascular invasion (LVI), presence of detrusor muscle. Additional criteria were horizontal and vertical resection margin, subclassification of T1-stage and presence of focal necrosis in tumor. RESULTS: Among the techniques developed and tested, the best quality of specimens for morphological evaluation was obtained using the combined "crown and root technique". First step is electroresection of the exophytic part of the tumor into pieces, and the next step is en-bloc laser resection (using thulium fiber or holmium laser) of the tumor base. Overall, the quality of all specimens obtained using three techniques met the current requirements of pathologic study. SUMMARY: En-bloc resection techniques of large bladder tumors allow obtaining specimen suitable for proper morphological evaluation and correct tumor staging. Further studies are required to evaluate the impact of these techniques on long-term results of treatment options.

[Methods for training of robot-assisted radical prostatectomy]. / Metody obucheniia robot-assistirovannoi radikal'noi prostatéktomii.

Robotic surgery is a future method of minimal invasive surgery. Robot-assisted radical prostatectomy (RARP) is a common method of surgical treatment of prostate cancer. Due to significant differences of the surgical technique of RARP compared to open or laparoscopic radical prostatectomy (LRP) new methods of training are needed. At the moment there are many opinions how to train physicians best. Which model is the most effective one remains nowadays controversial. OBJECTIVE: Analyze currently available data of training methods of RARP. Determine the most effective training model and evaluate its advantages and disadvantages. Establish a standardized plan and criteria for proper training and certification of the entire surgical team. MATERIAL AND METHODS: Literature review based on PubMed database, Web of Science and Scopus by keywords: robot-assisted radical prostatectomy, training of robot-assisted prostatectomy, training in robot-assisted operations, a learning curve of robot-assisted prostatectomy, virtual reality simulators (VR-simulators) in surgery. RESULTS: According to the literature in average 18 to 45 procedures are required for a surgeon to achieve the plateau of the learning curve of the RARP. Parallel training, pre-operative warm-up and the use of virtual reality simulators (VR-simulators) can significantly increase the learning curve. There are many described models of RARP training. CONCLUSIONS: The absence of accepted criteria of evaluation of the learning curve does not allow to use this parameter as a guide for the surgeon's experience. Proper training of robotic surgeons is necessary and requires new methods of training. There are different types of training programs. In our opinion the most effective training program is when a surgeon observes the performance of tasks or any steps of operation on the VR-simulator, then he performs them and analyzes mistakes by video recording. Then the surgeon observes real operations and performs some steps of the operation which are already leant on the simulator under supervision of the mentor and analyzes mistakes by video recording. Thus, mastering first the simple stages under supervision of a mentor, the surgeon effectively adopts the surgical experience from him. It is necessary to train not only the surgeons but also the entire surgical team.

[Aberrant expression of arrestin-1 and recoverin in kidney tumors].

INTRODUCTION: Early diagnosis of renal cell carcinoma (RCC) is extremely difficult, due to the late development of clinical manifestations. The study of the aberrant expression of tumor-associated antigens and a production of autoantibodies to these proteins seems promising and novel method for RCC diagnosis. AIM: To evaluate the possibility of using arrestin-1 (Arr-1), recoverin (Rec) and autoantibodies against arrestin-1 (AAA1) and recoverin (AAR) as a kidney tumor biomarker. MATERIALS AND METHODS: Primary kidney tumors and metastases of 62 patients were investigated. For immunohistochemical studies, tissues were incubated with polyclonal antibodies against Rec and Arr1 as the main antibodies. Detection of AAR and AAA-1 in the serum of patients was performed using Western Blot analysis according to a standard protocol. RESULTS: Among 62 tumors, renal cell carcinoma (RCC) constitutes 50 cases (86.4%), and oncocytoma was diagnosed in 12 patients (19.4%). In 11 (22%) cases of RCC, distant metastases were detected. Positive expression of Rec was observed in almost 71% of all types of kidney tumors. In 61.3% of patients with RCC, Arr-1 expression was seen. In the serum, AAR was found only in 1 patient (1.6%) with RCC. However, unlike AAR, AAA-1 in the serum of patients was observed much more often (75.8%). CONCLUSION: According to our data, the presence of AAA1 in the serum, unlike AAR, can be considered as an early kidney tumor biomarker. The high expression of recoverin and arrestin-1 in kidney tumors suggests the use of these proteins in future as a marker for the diagnosis or even as a potential target for immunotherapy.

[Experimental verification of thulium lithotripsy].

AIM: Experimental evaluation of the efficacy and safety of lithotripsy using a new pulsed thulium fiber laser operating at a wavelength of 1.94 microns, peak power of 500 watts (maximum average power of 50 watts) by comparing it with a holmium laser operating at a wavelength of 2.1 microns (average maximum power 100 W and 120 W). RELEVANCE: The proportion of minimally invasive surgery in the management of urolithiasis, including retrograde intrarenal surgery, is steadily growing. The most appropriate tool for stone destruction is a laser. To date, the gold standard of minimally invasive surgical treatment of nephrolithiasis is holmium laser lithotripsy, which uses a laser on yttrium-aluminum-garnet activated by holmium ions (Ho: YAG) operating at a wavelength of 2.1 m. However, in recent years, lasers on a Tm-activated fiber with a wavelength of 1.94 m have become increasingly popular since the water absorption coefficient for the Tm radiation of a fiber laser is 5.5 times higher than for a Ho: YAG laser and in 2.2 times higher than for the Tm: YAG laser. This difference may translate into greater effectiveness and speed of stone crushing, which in turn leads to shorter operating time. MATERIALS AND METHODS: This article describes physical foundations of holmium and thulium laser radiation, the mechanisms of stone fragmentation, data from a series of experiments comparing the efficiency and safety of ex-vivo lithotripsy using a holmium solid-state laser with a wavelength of 2.1 m and a thulium fiber laser with a wavelength of 1.94 m. RESULTS: The study findings suggest that the STA IRE-Polyus thulium fiber laser operating at a wavelength of 1.94 microns and a maximum power of 500 watts has several advantages over the holmium laser in the stone fragmentation in urological practice. CONCLUSION: The results of the experimental work allow us to conclude that the use of a thulium fiber laser operating at a wavelength of 1.94 m and a maximum peak power of 500 W enables highly effective and safe lithotripsy.

[Urate urolithiasis: pathogenesis and possibilities of conservative therapy].

Urolithiasis is a widespread chronic disease; its prevalence has been steadily increasing over the past 50 years. Urolithiasis accounts for a large proportion urologic diseases, exceeded only by urinary tract infections and diseases of the prostate. Urate urolithiasis refers to a type of urolithiasis, characterized by the formation of kidney stones consisting of uric acid or its salts. In populations of industrialized countries, uric acid is the second or third most frequently occurring stone-forming substance. The article summarizes the data on the global prevalence of both urolithiasis as a whole and urate urolithiasis in particular. The authors provide a detailed overview of the formation of the current concept of the urate urolithiasis pathogenesis and the management of the disease. The main focus is placed on the possibilities and the role of litholytic (stone-dissolving) therapy for urate urolithiasis and the mechanisms of the action of citrate preparations.

[Current trends in bladder cancer diagnosis].

In the Russian Federation, a proportion of bladder cancer in the overall structure of malignant tumors is about 2.8% and among oncological diseases of genitourinary system its incidence is second only to prostate cancer. Bladder cancer ranks as ninth most prevalent in males and as eighteens in females. The most important issue is to determine a recurrence rate of non-muscle invasive bladder cancer, which can reach 80%. In this regard, currently, all over the world much more attention is paid to studying and creation of early detection, including non-invasive, which will be reliable in the early stages. It can possibly lead to a reduction the number of cystoscopy and become as "golden" standard of non-invasive diagnosis bladder cancer.

[Issues of spectrum and local sensitivity of E. coli in female patients with acute uncomplicated lower urinary tract infection a review of M. Seitz study and own observations].

RELEVANCE: Acute uncomplicated lower urinary tract infections (AULUTI) are one of the most common diseases in urological practice. The management of cystitis is commonly based on antibacterial therapy. Despite the high efficiency, inadequate prescription of antibiotics leads to an increase in microorganisms resistance. In light of these matters, the selection of antibacterial agents to which the sensitivity of bacteria is the highest is becoming increasingly challenging. AIM: To estimate the spectrum and local sensitivity of E. coli in patients with AULUTI. MATERIALS AND METHODS: The present study analyzed the results of bacterial culture sampled from 45 patients with AULUTI. The mean age of the patients was 44+/-17 years. All bacterial cultures were obtained in out-patient settings in the framework of a multicenter initiative study on the prevention of recurrent AULUTI with d-mannose. RESULTS: Microbiological studies of the urine of patients with AULUTI revealed the growth of E. coli in concentrations ranging from 104 to 107 CFU/ml. Assessment of sensitivity demonstrated 100% sensitivity of Escherichia coli to fosfomycin trometamol. CONCLUSION: According to the findings of microbiological studies, the patients with the AULUTI retain the highest sensitivity level of E.coli to phosphomycin trometamol, which allows it to be used as a first-line drug.

[Complications of the holmium laser enucleation of prostate for benign prostatic hyperplasia].

INTRODUCTION: With growing experience in the HoLEP, it can replace TURP as the "gold standard" for the surgical management of BPH, and therefore this technique is the most studied surgical modality. Despite the proven effectiveness of HoLEP in the treatment of patients with BPH, its widespread use has been associated with both intra- and postoperative complications. AIM: To improve the results of surgical management of patients with BPH. MATERIAL AND METHODS: The study comprised 310 patients who underwent HoLEP for BPH. HoLEP was performed using the Gillings technique. INCLUSION CRITERIA: presence of LUTS (Qmax<15 ml/s, Qav<10 ml/s, presence of residual urine, I-PSS score> 5, QoL score> 2), absence of an active inflammatory process of the urogenital organs. RESULTS: Intraoperative complications included severe hemorrhage in 16 (5.2%), the bladder wall injury in 17 (5.5%) and the ureteral orifice injury in 2 (0.6%) patients. 275 (88.7%) had no intraoperative complications. Early postoperative complications included fever in 4 (1.3%), the bladder tamponade that required cystoscopy and evacuation of blood clots in 7 (2.3%) and acute urinary retention in 36 (11.8%) patients. 263 (84.6%) patients had no postoperative complications. Long-term postoperative complications comprised urinary incontinence in 39 (12.6%) patients and urethral strictures requiring surgical treatment in 9 (2.9%) patients. There were no long-term complications in 262 (84.5%) patients. CONCLUSION: HoLEP is an effective and safe surgical modality for treating patients with BPH with minimal complications, suitable for any size of the prostate.

[Current view on the pathogenesis of varicocele and the problem of its recurrence].

The clinical signs of varicocele typically emerge during the puberty. Varicocele is found in 15% of men in the general population and 25-35% and 50-80% of males presenting with primary and secondary infertility, respectively. Factors contributing to the development and recurrence of varicocele include the abnormalities of the testicular venous drainage and outflow (varicose veins are more common on the left than on the right), the anatomical features of the veins of the testicular and prostatic venous plexus, the patients constitution, predisposition to constipation or diarrhea, physical activity. At present, the genetic defects, including the undifferentiated connective tissue dysplasia (UCTD) with hereditary insufficiency of venous valves and the weakness of the testicular vein walls, are thought to play a key role in the formation of a varicocele. Considering the importance of varicocele in the development of male infertility, the role of the UCTD in varicocele formation warrants a detailed investigation to provide an individual approach to patients and predict the disease recurrence.

[Laparoscopic pyelolithotomy and its role in modern surgery of nephrolithiasis].

AIM: To determine the place of laparoscopic pyelolithotomy in surgical management of nephrolithiasis. MATERIALS AND METHODS: We analyzed 16 laparoscopic pyelolithotomies performed in our clinic over the last few years for large and stag-horn stones of anomalous kidneys (n=8), the "giant" (>30-40 cc) monolithic stones of the large extrarenal pelvis (n=3), multiple stones of PCS with the stone burden of more or equal 40 cm (n=2) and large recurrent (after PCNL) kidney stones in patients at risk of bacteriotoxic complications of percutaneous nephroscopy (n=3). The age of the patients ranged from 39 to 72 years (mean age 51+/-8 years). The average density of stones was 1012 (160-1483) HU. RESULTS: There were no conversions to open surgery. The mean operating time of laparoscopic pyelolithotomy was 137 (96-255) minutes, flexible transabdominal pyelocalycoscopy 31.2 (12-110) min. The stone-free rate was 87%. Residual clinically insignificant stones were found in two (13%) patients with staghorn horseshoe kidney calculi and complex PCS. The preoperative hospital stay was 1 day, postoperative-from 2 to 18 (mean 6) days. DISCUSSION: We believe that laparoscopic pyelolithotomy supplemented by transabdominal flexible pyelocalycoscopy may be recommended for surgical management of patients with "giant", multiple and infected kidney stones, because the length of their percutaneous removal is beyond the recommended time intervals and it is accompanied by an increased risk of septic complications.

[Ultrasound-guided percutaneous cryoablation of renal tumors].

INTRODUCTION: Surgery remains the gold-standard curative treatment for localized (T1) renal carcinoma. However, recent medical-technological advances have led to the development of new minimally invasive treatment options, one of which is percutaneous cryoablation. AIM: To assess the effectiveness and safety of ultrasound-guided percutaneous cryoablation of renal tumors. MATERIALS AND METHODS: The study comprised 12 patients aged 52 to 76 years who underwent ultrasound-guided percutaneous cryoablation of renal tumors from 2015 to 2017. In 11 patients, the size of the renal mass was 3.0 cm (T1a), in 1 patient 4.5 cm (T1b). A Doppler ultrasound, contrast-enhanced MSCT and computer 3D modeling were performed in all patients pre-operatively and 6 months after surgery to assess the tumors size and extent and the spatial location of the tumor internal surface to the pelvicalyceal system. In all patients, the tumors were located along the posterior or lateral surface of the kidney, in the lower or middle segment and without sinus invasion. We used a 3rd generation Galil Medicals SeedNet Gold Cryotherapy System and IceSeed and IceRod cryoprobes. Intraoperatively, immediately before cryoablation, the tumor was biopsied. In all patients the diagnosis of renal cell carcinoma was confirmed morphologically. RESULTS: Mean duration of cryoablation was 60 minutes. Endotracheal, spinal, local and intravenous anesthesia was used in 1, 6, 5 and 1 patients, respectively. Doppler ultrasound at 6 months after surgery showed that in 11 patients (T1a) the tumor size decreased on average by 8 mm, with no blood flow in the tumors. MSCT with 3D modeling also revealed a decrease in tumor size and total absence of contrast agent accumulation, or accumulation gradient not exceeding 10 HU (initially it was about 200 HU). In the patient with T1b stage renal carcinoma, MSCT showed a decrease in tumor size from 4.5 to 3.7 cm, however, there was a mass up to 1.5 cm with a high gradient of contrast agent accumulation. The patient underwent kidney resection. No intra- and postoperative complications were observed. CONCLUSION: The accumulated experience allows to confirm the effectiveness and safety of ultrasound-guided percutaneous cryoablation and to consider it a method of choice for patients with stage T1a renal carcinoma located along the posterior or lateral surface of the kidney in the lower or middle segment, without sinus invasion.

[The role of waterjet dissection in improving erectile function and continence after nerve-sparing prostatectomy].

INTRODUCTION: Erectile dysfunction (ED) and urinary incontinence (UI) following radical prostatectomy (RP) adversely impact patients psycho-emotional status reducing the quality of life and treatment satisfaction. AIM: To investigate the rates of regaining continence and erectile function (EF) after nerve-sparing radical retropubic prostatectomy (NS-RRP) and nerve-sparing laparoscopic radical prostatectomy (NS-LRP) in the early postoperative period. MATERIALS AND METHODS: The study comprised 116 patients who preserved sexual activity and the ability to have sex. 64 patients underwent standard resection of NVB (34 RRP and 30 LRP) and in 52 patients the NVB resection was performed using a waterjet dissector (WD) (30 RRP and 22 LRP). All operations were performed by one surgeon with the experience of over 350 RRP and 150 LRP. The study patients had low and moderate risk prostate cancer, according to DAmico risk classification. RESULTS: Our study findings showed that patients who underwent the WD of NVB had significantly greater IIEF-5 scores (by 2.8 scores) at 8 weeks than after the standard NS-RP. After 6 month follow-up the scores increased by 3.5 points. Patients who underwent NS-RP + WD achieved a successful sexual intercourse 3 months after surgery (regardless of the use of PDE5 inhibitors). In the group of patients who underwent standard NS-RP, it took a longer time to achieve a successful sexual intercourse. Sixty-seven percent of patients who underwent NS-RP + WD were fully continent at one month follow-up after removal of urethral catheter, while most patients treated with standard NS-RP (41%) had mild stress UI. After 3 months follow-up, among patients who underwent NS-RP + WD only one patient had mild stress UI and the vast majority (95%) of patients were fully continent. At 6 months after removal of the urethral catheter there were no significant differences between the groups in regaining urinary continence. CONCLUSIONS: Waterjet dissection of NVB significantly improves patients postoperative quality of life due to early recovery of urinary continence and EF.

[Holmium laser enucleation of the prostate (HOLEP) for small, large and giant prostatic hyperplasia. Practice guidelines. Experience of more than 450 surgeries].

INTRODUCTION: and objectives. Most of modern endoscopic procedures (e.g., TURP) are only confined to small and medium-sized glands (up to 80 cm3), but not HoLEP, which allows to enucleate large and extremely large prostates (200 cm3). The aim of the study was to compare the efficiency of HoLEP for prostates of different sizes. METHOD: s. A total of 459 patients were divided into three groups: Group 1 included 278 patients (prostate volume <100 cm3); mean prostate volume, 70.8+/-16.1 cm3; IPSS, 18.7+/-5.5; QoL, 4.1+/-0.5; Qmax, 6.2+/-1.5 mL/s; post-voided residual volume, 64.2+/-30.5 mL. Group 2 included 169 patients (prostate volume 100-200 cm3); mean prostate volume, 148.1+/-25.2 cm3; IPSS, 19.7+/-3.3; QoL, 4.2+/-0.7; Qmax, 5.9+/-0.7 mL/s; post-voided residual volume, 70.9+/-20.1 mL. Group 3 included 12 patients (prostate volume >200 cm3); mean prostate volume, 230.1+/-18.1 cm3; IPSS, 19.5+/-4.5; QoL, 4.1+/-0.3; Qmax, 4.7+/-0.9 mL/s; post-voided residual volume, 72.3+/-10.9 mL. All the patients underwent HoLEP from 2013 to 2015. For the prostate to be enucleated, a 100-W laser system, 550-micron end-fire fiber, and a morcellator for tissue evacuation were used. RESULTS: The average duration of surgery in Group 1 was 56.5+/-10.7 min; in group 2, 96.4+/-24.9 min; in Group 3, 120.9+/-35 min. The average duration of morcellation in Group 1 was 37.5+/-7.3 min; in Group 2, 63.3+/-11.2 min; in Group 3, 84.0+/-25.6 min. The efficiency of enucleation in Group 3 (1.70 g/min) was significantly higher (p < 0.05) than in Group 1 (1.05 g/min) and Group 2 (1.23 g/min). Similar results were obtained for the efficiency of morcellation. It was lower in Group 1 and Group 2 (1.58 and 1.87 g/min, respectively) than in Group 3 (2.45 g/min) (p<0.05). In order to compare the long-term results of HoLEP for prostates of different sizes, all the 459 patients were followed up for 18 months. IPSS, Qmax, QoL, and post-voided residual volumes were measured. There were no significant differences (p>0.05) in the postoperative outcomes for 1, 3, 6, 12, and 18 months after surgery. CONCLUSIONS: It follows from our two years experience that HoLEP is a safe, highly efficacious and a size-independent procedure, which is why it has become a new gold standard for treatment of extremely large prostatic hyperplasia in our clinic.