[Experimental foundation of the use of prolene implant while performing kidney resection].

AIM: To study the method of performing a kidney resection using a prolene mesh implant of medium rigidity and to substantiate the possibility of further application of this method of kidney resection in clinical practice in an experiment. Materials and research methods. The study is experimental. The study was carried out using pig models. In total 50 laboratory animals were included in the study. The operation of kidney resection was simulated using laboratory animals. In 25 cases, the kidney resection was performed according to the classical method, in other 25 cases, the kidney resection was performed according to the authors method of kidney resection using a prolene mesh implant. We studied the average time of surgery, the average weight of the postoperative scar, the pathological presentation of the area of kidney resection at various term after the operation. RESULTS: The average operation time was on average 3.1 minutes (5.7%) longer in the group of laboratory animals operated on with the use of a prolene mesh implant. The average weight of the postoperative scar zone is 1.7 grams (27%) higher in the group of laboratory animals operated on according to the classical hemostasis method of the renal resection area. Interpretation of the results of a histopathological study of the kidney resection area indicates the development of a taft connective tissue structure around the prolene implant of the "patch" type in the shape of strands of dense granulation tissue surrounded by foreign body granulomas. CONCLUSION: The use of a prolene implant when performing a kidney resection is a reliable method of hemostasis of the postoperative defect area, that gives a possibility to minimize cicatricial changes in the renal parenchyma without significant prolongation of the operation time.

[Morphologic structure and immunohistochemical analysis of vaginal wall in women with pelvic organ prolapse].

AIM: to study a correlation between clinical stage of pelvic organ prolapse (POP), a histological structure and results of immunohistochemical study of the vaginal wall were evaluated. MATERIALS AND METHODS: A total of 60 peri- and postmenopausal women (average age 61.9+/-8.4 years) with POP of stage II-IV, according to the POP-Q classification, or with stress urinary incontinence and cystocele of stage I-II, who undergone to surgical treatment, were included in the study. During a procedure, a biopsy from the anterior vaginal wall was taken. Depending on the stage of POP, patients was divided into two groups. In the group 1, 30 patients with stage I and II of POP were included, while group 2 included 30 women with POP of stage III and more. The control group (group 3) consisted of 20 patients without POP (mean age 63.4+/-11.0 years) who underwent a hysterectomy due to to other indications. A histological and immunohistochemical studies of vaginal wall tissue was performed in order to determine the tissue content of collagen type I and III; matrix metalloproteinases 1 and 2 (MMP-1 and MMP-2), a tissue inhibitor of metalloproteinases 1 (TIMP-1), vimentin and smooth muscle actin. RESULTS: In contrast to two other groups, in group 2 there were significant changes in the connective tissue. Collagen has a form of fibrous mass with areas of reduced content. In addition, scarring areas with an increase in the content of type III collagen, a decrease in the amount of type I collagen and elastic fibers with significant fragmentation, were seen. Moreover, in patients with severe POP (III-IV), degradation of collagen fibers with a decrease in connective tissue strength and elasticity was detected. Women with POP had a low ratio of type I:III collagen. Analysis of the collagen content in the vaginal wall in patients with mild POP (I-II) revealed a significant increase in the level of collagen type I (p=0.0003) and a decrease in the content of type III (p=0.045), compared to patients with more severe POP (III-IV). The level of MMP-1 and MMP-2 in women with POP was higher, than in control group by 1.7 times (p<0.05). The content of TIMP-1 in the group 1 was significantly lower by 1.5 and 2.2 times, compared to group 2 and 3, respectively. An analysis of MMP-1 and MMP-2 concentration in patients of groups 1 and 2 revealed a significant (p=0.04) decrease in their activity in severe POP (III-IV). In women of the group 2, biopsy of the vaginal wall showed that expression of vimentin and smooth muscle actin in the connective tissue was significantly higher, than in group 1 and 3 (p<0.05). Vimentin expression in the group 2 was 1.4 and 2.6 times higher than in the group 1 and 3, respectively. In the control group, the expression of these markers in the vaginal wall was minimal and focal. CONCLUSION: Our data indicate that fibrosis and degradation of the connective tissue in the vaginal wall predominate in POP, and these changes are a consequence, but not a cause of PG. The aggravation of degenerative changes in the connective tissue leads to the progression of POP.

[Female genital prolapse surgery using ultra lightweight polypropylene mesh].

AIM: To compare the results of female genital prolapse (FGP) surgery via vaginal access using lightweight and ultra-lightweight polypropylene mesh. MATERIALS AND METHODS: From 2007 to 2011, 93 women aged from 46 to 71 years with II-IV stage FGP (POP-Q classification) were examined and underwent the vaginal extra-peritoneal colpopexy using polypropylene implants in the Department of Urology. Patients were divided into 2 groups. In patients of group 1 (n=50) the surgery was performed according to a newly developed technique using perforated ultra-lightweight (surface density 19 g/m2) domestically manufactured polypropylene implant. In group 2, a standard trocar set with light (surface density of 42.7 g/m2) foreign-made polypropylene implants was used. RESULTS AND DISCUSSION: Long-term follow-up was from 1 to 5 years. General surgical complications (urinary bladder injury, blood loss over 300 ml, perineal and vaginal hematomas) were detected in 2 (4%) patients of group 1 and in 7 (16.3%) patients of group 2. The most common specific mesh-related complication was the vaginal wall erosion, which was observed in 4 (9.3%) patients of group 2 and in 1 (2%) patient of group 1. FGP recurrence was diagnosed in 5 (10%) patients of group 1 in the non-treated part and in 8 (18.6%) patients of group 2. Three patients (7%) in group 2 developed recurrent cystocele due to the shrinkage of the mesh implant which was not observed in group 1. At 12 month follow-up, the results of FGP surgical treatment were estimated as good (full functional recovery and no FGP recurrence) in 41 (82%) and 32 (74.4%) patients of groups 1 and 2, respectively. CONCLUSION: We have developed a method of vaginal extra-peritoneal colpopexy using a perforated ultra-lightweight polypropylene implant. This technique has resulted in the absence of recurrence in the treated part of FGP, and 4.1, 4.2 and 4.7 fold reductions in the incidence of general surgical complications, vaginal wall erosions and perineal and vaginal hematomas, respectively, compared with FGP patients undergoing the placement of the lightweight polypropylene implant using the standard trocar set.

[Radical nephrectomy in a left pelvic dystopic kidney in a patient with renal cell carcinoma].

The incidence of the renal cell carcinoma in Russia and worldwide remains high. Current literature reports isolated cases of patients who were diagnosed and treated for malignant neoplasms of dystopic kidneys. In addition, the absence of patient complaints and the paucity of non-specific symptoms of pelvic dystopic kidneys lead to late diagnosis of this anomaly and the kidney diseases. This article presents a case study of a radical nephrectomy in a patient with renal cell carcinoma of the left pelvic dystopic kidney.

[Surgical treatment of renal carcinoma today: laparoscopic radical nephrectomy and resection of the kidney].

The authors have rich experience in laparoscopic operations on retroperitoneal organs and give detailed description of the technique of laparoscopic radical nephrectomy and renal resection in cancer. Seventy two nephrectomies at stage pT1b-pT3a and twelve renal resections at stage pT1a have been made since September 2003. Good immediate results were achieved. Lymphodissection in renal carcinoma is considered and the technique of laparoscopic regional and extended lymphadenectomy is described.

[Laparoscopic nephropexy with polypropilen graft implantation: a clinico-experimental study].

The article presents experimental data on interaction of the polypropilen implant with the kidney and adjacent tissues, on comparative evaluation of reliability of mechanical methods of polypropilen net fixation to different human tissues (the kidney, muscles and costal periosteum). A novel technique of laparoscopic nephropexy with usage of prolen implant has been developed. It was tested in 49 patients with nephroptosis in 2003-2006. Good short- and long-term results were obtained.