[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).

[Complications after PCNL: diagnosis and management].

Percutaneous nephrolithotomy (PCNL) is the gold standard treatment of large and staghorn kidney stones. Despite technological progress and improvement of PCNL technique, this procedure is associated with complications and in some cases remain a challenge for endourologists. According to the time, complications can be divided into intra- and postoperative. Intraoperative complications include bleeding, injury of the renal collecting system, visceral organs, pulmonary complications, thromboembolic disorders, extrarenal migration of the stone fragments and incorrect nephrostomy tube placement. Postoperative complications include infection and sepsis, bleeding, persistent urinary fistula, infundibular stenosis and death of the patient. The different recommendations that might be useful for the timely diagnosis of various complications in patients undergoing PCNL are provided in the review. Additionally, information on treatment algorithms is included.

[Transurethral electroresection of prostatic adenoma under transrectal ultrasonic control].

The aim of the study was to improve the results of transurethral prostatic resection (TUPR) by introduction of intraoperative transrectal ultrasonic investigation (TRUSI) and to determine topographic-anatomic features of the prostate, intraorgan relations of adenomatous nodes and surgical prostatic capsule on-line in TUPR. A total of 64 patients with prostatic adenoma (PA) of the second degree aged 52-79 participated in the study. All of them have undergone TUPR. The patients were divided into two study groups (15 patients with volume of the prostate 36.5-78.6 cm3 and 17 patients with prostate size 80-4-141.2 cm3) in which TRUSI was performed and two control groups (n = 14, size 34.9 to 79.2 cm3 and n = 18, size 81.7-130.8 cm3, respectively) who have not undergone intraoperative TRUSI. PA clinical symptoms were similar in all the groups. Intraoperative TRUSI was conducted in 3 stages (in the beginning, middle and end of surgery) in two planes--transverse and sagittal. Postoperative complications required repeated endoscopic interventions in 2 and 4 patients of groups 2, 3 and 4, respectively. Control TRUSI on day 7 after TUPR registered mean volume of the prostate to be 19.3 +/- 1.4 cm3 in group 1, 39.8 +/- 2.1 cm3 in group 2, 28.1 +/- 1.6 cm3 in group 3, 47.7 +/- 3.2 cm3 in group 4. Maximal flow rate 1 month after TUPR was, on the average, 21.4 +/- 1.4 ml/s, 18.8 +/- 1.1 ml/s, 18.3 +/- 1.6 ml/s and 15.5 +/- 1.2 ml/s in groups 1, 2, 3 and 4, respectively. Thus, intraoperative TRUSI provides information which helps the surgeon to orient in the course of surgery and minimize the threat of perforation of the prostatic capsule; minimizes intraoperative complications and enhances efficacy of radical transurethral electroresection of prostatic hyperplasia improving long-term outcomes of the operation.