[Simultaneous laparoscopic bilateral nephrectomy as a preparation for kidney transplantation in patients with autosomal dominant polycystic kidney disease].

AIM: to study the possibility and safety of performing simultaneous bilateral laparoscopic nephrectomy in symptomatic patients with autosomal dominant polycystic kidney disease (ADPKD) as a preparation for kidney transplantation. MATERIALS AND METHODS: From May 2018 to September 2019, six symptomatic patients with end-stage renal disease caused by ADPKD, who had hemodialysis, underwent simultaneous bilateral laparoscopic nephrectomy. The mean vertical kidney size according to CT data was 211.67+/-37.15 mm, the mean horizontal size was 145.36+/-19.53 mm. In 5 cases, the hand-assisted procedure was performed. RESULTS: The average duration of the procedure was 225.1+/-40.37 minutes. Postoperative complications were recorded in 2 (33.2%) patients. The average length of stay was 8.83+/-2.13 days. There were no clinical manifestations of adrenal insufficiency. All patients are alive. In two patients, cadaveric kidney transplantation was performed after laparoscopic bilateral nephrectomy. CONCLUSION: Laparoscopic bilateral nephrectomy in patients with chronic renal failure associated with ADPKD is feasible, safe and is associated with a short length of stay. This procedure improves the quality of life of patients and facilitates subsequent kidney transplantation.

[Assessments of long-term results of different types of sling procedures for stress urinary incontinence in women].

AIM: To evaluate long-term results of surgery for stress urinary incontinence in women using different types of sling procedures. The study included 698 patients aged 42 to 68 years (median 54 years) with stress urinary incontinence. TVT was used in 167 (23.9%) cases, TVT-O Gynecare system in 359 (51.4%), TVT-O Monarch system in 105 (15.0%), and TVT Secur mini-sling system - in 67 (9.6%). Follow-up ranged from 12 to 108 months (median 55 months). Patients' status was assessed using UDI-6 and IIQ-7 questionnaires, an improvised treatment satisfaction questionnaire, voiding diary, cough test and 1-hour Pad-test. The effectiveness of the treatment, according to objective criteria was 92.2%, 93.3%, 91.4% and 92.5% after surgery with TVT, TVT-O Gynecare, TVT-O Monarch and TVT Secur, respectively, and according to subjective criteria - 90.4%, 91.1%, 89.5% and 91.0%. No differences in the effectiveness of techniques were found. The data obtained in long-term observations of a large sample of patients treated with a variety of techniques in a single center showed the effectiveness and safety of modern sling procedures for correcting urinary incontinence in women.

[Quality of life in women after anterior pelvic exenteration].

60 women, who underwent anterior pelvic exenteration with different types of urine derivation since 2004 till 2014 years in urology department, RMAPO, S.P. Botkin city hospital, were included in retrospective investigation. Middle age of patients was 53,2+/-3 (32-68). 38 women with bladder cancer and 22 women with urinary injuries after radiation therapy underwent anterior pelvic exenteration. Aim of this work is to perform quality of life comparison of patients after anterior pelvic exenteration with different types of urine derivation. Patients were divided in 3 groups: 1-st group 39 (65%) women, who underwent Brickers operation, 2-nd group 19 (31,66% ) women, who had Studers operation and 3-rd group - 2 (3,34%), patients who underwent continent urine derivation with formation of catheterizing urinary reservoir. Questionnaire (SF-36) was used to evaluate quality of life. Observation period was from 2 to 10 years. Postsurgical lethality was 3%, 5-years survival rate was 60,9+/-15,8% and 5-years recurrence-free survival rate was 55,4+/-12,6%. We established that quality of life in women who underwent orthotopic urine derivation was higher than in patients who underwent incontinent ileoconduit formation. Better quality of life was demonstrated by women, who had catheterizing urinary reservoir, but it is difficult to compare this group with the others, because of small number of patients with heterotopic catheterizing reservoir. Regarding the results of our investigation we made next conclusions: In spite of difficult technique, high risk of postoperative complications and lethality, anterior pelvic exenteration provide 5-years survival rate for 70% of patients In locally advanced tumors of pelvic organs anterior pelvic exenteration is salvational operation and keep satisfactory quality of life Orthotopic intestinal urine derivation is better to provide satisfactory quality of life for patients with invasive bladder cancer. For women with urinary injuries after radiation therapy Brikers operation is better type of urine derivation, in special cases heterotopic catheterizing reservoirs can be made.

[MICROBIAL COMMUNITIES ON KIDNEY STONES].

The clinical material obtained surgically in patients with kidney stone disease (KSD) was tested for content of the stone microflora using PCR and standard microbiological methods. It was demonstrated that about 50% of stones in patients with KSD were infected with various infection agents as observed using standard microbiological and molecular genetic methods. The percentage of detection of the Mycoplasma hominis using cultural method is lower than the percentage detected using PCR, which is due to difficult isolation and cultivation, as well as DNA fragments of mycoplasma observed after antibiotic therapy. Studies based on modern microscopy methods showed that microorganisms on the surface of the kidney stone formed multispecies biofilms.

[Morphological results of repeated transurethral resection of the bladder for muscle-non-invasive cancer].

Operating material taken from 101 patients aged 32 to 88 years with verified bladder cancer was investigated. Repeated morphological analysis of biopsy material obtained after repeated transurethral resection (TUR) has revealed 35.6% of residual tumors, and the same stage cancer was diagnosed in 23% of cases, lower stage Ta cancer--in 5% of cases. Underestimating the stage took place in 7.9% of cases. Residual tumors according to histological examination were revealed in 24.7% of patients. In tumor size larger than 3 cm, the frequency of detection of residual tumors and muscular invasion was 44.8 and 12.1%, and in tumor size less than 3 cm--23.2 and 2.3%, respectively. Residual tumor was found in 45.7% of cases with rT1G3 and in 27.2% of cases with rT1G2. The muscle invasion was observed only in low-grade tumors--13.5% of cases. In the presence of muscular tissue, invasion was diagnosed in 1.4% of cases, and in the absence of muscular tissue--in 20.5%. Repeated TUR of bladder for muscles-non-invasive cancer allows achieving optimal local control, obtaining additional histological material for morphological examination to confirm the stage of the disease, there from, choose the appropriate treatment and remove residual tumor.

[Use of isolated intestinal segments in surgical treatment of radiation-induced lesions of the urinary tract].

Fifteen females with various radiation-induced lesions of the urinary tract (urinary fistulas alone or in combination with uni- or bilateral ureteral strictures) received surgical treatment using isolated intestinal segments. The above surgical intervention reestablished natural urination in 9 patients. They were relieved from continuous urine leakage into the vagina and/or from nephrostomas. Heterotopic urine derivation was performed in 6 patients. Thus, restoration of natural urination in most patients with postradiation lesions can be performed only in usage of isolated intestinal segments. In some cases heterotopic urine derivation is indicated.

[Complications of mesh-vaginopexy: results of a multicenter trial].

A retrospective multicenter trial with participation of 7 large clinics of Moscow and Moscow Region has been performed to characterize complications after correction of genital prolapse with application of the PROLIFT system. The trial enrolled women with uterine and vaginal prolapse of stage II-IV by POP-Q classification. The women also had anatomic and functional defects of the adjacent organs. From January 2005 to March 2008 all the patients have undergone vaginal extraperitoneal colpopexy using Prolift system. The results of the trial showed that extraperitoneal colpopexy with application of the Prolift system should not be considered as a low-invasive intervention and therefore it is not valid to use this technique as a routine method of genital prolapse treatment as in 29.5% cases the operation is accompanied with complications of different severity.

[Antegrade endopyelotomy in the treatment of patients with pelvicoureteral segment stricture in combination with urolithiasis].

A total of 17 urolithiasis patients (12 males, 5 females aged 29-65 years, mean 47 +/- 8.2 years) with pelvicoureteral segment stricture (PUS) received percutaneous surgical treatment in the clinic of urology and surgical andrology from 2005 to 2009. The treatment consisted in endopyelotomy combined with nephrolithotomy and/or contact lithotripsy. Bilateral concrements were detected in 4 (23.5%) patients. Of them, 1 (5.9%) had PUS strictures in both kidneys. Good short-term results were achieved in 14 (82.4%) patients, satisfactory results - in 2 (11.8%) patients, unsatisfactory - in 1 (5.9%) patient. After long-term follow-up examination (mean follow-up 14 months after the operation) of all 17 patients it was found that 14 (82.4%) patients improved PUS condition (by the data of excretory urography and multislice computed tomography). Urological complaints were absent in 16 (94.1%) patients.

[Hyperbaric oxygenation in the treatment of patients with interstitial cystitis: clinical and morphological rationale].

We studied efficacy of hyperbaric oxygenation (HBO) in 8 patients with interstitial cystitis/painful bladder syndrome (IC/PBS). Mean age of the patients was 53 years (35-72 years), mean duration of the disease 7.5 years (6-17 years). Ulcerative IC/PBS was diagnosed in 7 of 8 patients. The patients received combined treatment: surgical (hydrobouginage of the bladder, electrocoagulation of bladder ulcer) and a HBO course in the postoperative period. The efficacy was assessed by clinical and morphological criteria (estimation of histamine level in urethral smears, proliferative activity of bladder mucosa epithelial cells). A HBO course consisted of 10 sessions (40 min, 2 atm). The treatment reduced the number of voidings for 24 hours, increased mean effective bladder volume, lowered a total score by L. Parsons scale, histamine content in urethral smears, stimulated proliferative activity of bladder mucosa epithelium. Thus, HBO proved its safety and effectiveness in combined treatment of IC/PBS.

[Renal tumor size. Clinicomorphological correlations].

To reveal correlations between a renal tumor size and its clinical and morphological characteristics, we retrospectively analysed 263 case histories of patients with renal cell cancer. At a univariate analysis a maximal renal tumor size as a continuous variable significantly correlated with tumor differentiation, histological involvement of regional lymph nodes, presence of tumor necrosis, venous thrombosis, invasion into the collecting system, severity of clinical symptoms, 3- and 5-year cancer-specific survival. An increase of a tumor size, either as a continuous variable or a categorical one is accompanied with enhancement of tumor properties determining the outcome. The inclusion of a tumor size as a continuous parameter in the staging systems may have in the future a significant impact on accuracy of prediction of a renal cell cancer course and outcome, on specification of indications for various treatments.

[Comparative evaluation of the quality of life in patients with kidney cancer after organ-preserving operations and radical nephrectomy]. / Sravnitel'naia otsenka kachestva zhizni bol'nykh rakom pochki posle organosokhraniaiushchikh operatsii i radikal'noi nefréktomii.

The study included 26 patients with renal carcinoma (RC) stage T1 which have undergone elective conservative surgery and 33 patients with the same disease after radical nephrectomy. To compare their postoperative quality of life, the patients filled in questionnaire EORTC QLQ-C30 (version 3) for cancer patients. The results of the questionnaire survey show a higher quality of life in RC patients after organ-saving operations, i.e. their physical condition is better, social adaptation faster. High quality of life and good 5-year survival suggest that conservative elective surgery in renal carcinoma stage T1 is an alternative to radical nephrectomy.

[A multicentric variant of renal carcinoma growth]. / Mul'titsentrichnyi variant rosta raka pochki.

78 kidneys removed for cancer in 1999-2002 were studied for multifocal growth of the tumor. The results demonstrated a direct correlation between multicenter growth of renal cell carcinoma (RCC), size of the primary tumor and stage of the disease. Most of the additional foci were detected at the distance of more than 2.0 cm from the primary tumor, i.e. outside the safety zones in conduction of organ-saving operations. Frequent coincidence of a morphological type of the primary and additional tumors (70%), degree of cell differentiation (80%) and higher incidence of multifocality in infiltrative growth of the primary tumor support the existing hypophysis about the role of intra-organ metastasizing as the underlying cause of multifocal lesions. Also, the study confirmed low preoperative detection of multifocality: 1.8% preoperatively and 19.2% under investigation.

[Change in anatomo-functional state of the parenchyma in early unilateral renal cell carcinoma before and after surgical treatment]. / Izmenenie anatomo-funktsional'nogo sostoianiia parenkhimy pri odnostoronnem rannem pochechno-kletochnom rake do i posle operativnogo lecheniia.

The aim of the trial was to study compensatory potential of renal parenchyma in the presence of renal cell carcinoma (RCC) and after organ-saving and radical surgical treatment as shown by one-photon emission computed tomography (OPECT). OPECT before the treatment and 6 and 12 months after it evidences that in unilateral RCC, irrespective of the focus location, both kidneys as a single organ respond to tumor growth with compensatory hypertrophy. Compensatory reserve is limited. In tumor size more than 6 cm the affected kidney starts losing the volume of the functional tissue while infiltrative growth is most likely. Assessment of the compensatory potential of the kidneys provides additional information. If the volumes of the kidneys differ by more than 30%, RCC growth is infiltrative. In this case only radical nephrectomy is recommended. If the size of the kidneys is by 60% more than normal one and parenchymas of the affected and contralateral kidney reach their compensatory limit but are equal, indications to organ-saving surgery extend as greater hypertrophy of the remaining kidney is excluded. After organ-saving surgery, a compensatory increase was observed in the contralateral kidney. This is explained by effective distribution of protein material and separate processes of proliferation (healing) and hypertrophy (compensation). Assessment of anatomo-functional condition of renal parenchyma helps better selection of patients for organ-saving surgery.

[The intraoperative ultrasonic control of the radicalness of transurethral resection in bladder cancer]. / Intraoperatsionnyi ul'trazvukovoi kontrol' radikal'nosti transuretral'noi rezektsii pri rake mochevogo puzyria.

72 patients with bladder cancer stage T1, T2 underwent transurethral resection of the bladder wall affected with tumor under ultrasound control of the removal radicality. The evidence obtained at transurethral ultrasound scanning was compared to the findings of histological examination of the tissue removed. The accuracy of the control made up 87.3%. This made it possible to follow tumor invasion from the tumor margins along the periphery in accordance with blastomatosis stage. The authors have developed a technique of transurethral resection of bladder wall under transurethral ultrasonic scanning as control of the removal radicality.

[The treatment of patients with benign prostatic hyperplasia with Proscar MSD (finasteride)]. / Lechenie bol'nykh s dobrokachestvennoi giperplaziei predstatel'noi zhelezy proskarom MSD (finasterid).

53 patients have undergone 1-year conservative treatment of benign prostatic hyperplasia with the drug proskar MSD. All the patients had the disease stage I-II, maximal urination rate at least 5 ml/s, residual urine to a maximum 150 ml. Benign nature of the disease was confirmed by the test with prostate-specific antigen. Selection of patients, follow-up and assessment of treatment results were conducted according to the scale of the International System of Overall Assessment of Prostatic Lesions. Proskar MSD was found active in benign prostatic hyperplasia basing on the shifts in the main three indices (symptom status, maximal urination rate, prostate size).