Saratov JOURNAL of Medical and Scientific Research

Urology

Basic principles of prenatal counseling by a pediatric urologist: challenges and opportunities

Year: 2019, volume 15 Issue: №4 Pages: 884-887
Heading: Urology Article type: Author's opinion
Authors: Deryugina L.A.
Organization: Saratov State Medical University
Summary:

This publication is based on the results of the accumulated experience of a practicing pediatric urologist during prenatal counseling in the framework of the regional prenatal consultation and is the result of long-term research work in the field of pediatric urology, fetal urology, prenatal ultrasound diagnosis of urinary system defects. The system of prenatal diagnosis of urinary system pathology proposed in the article will significantly increase the reliability of antenatal diagnosis and prognosis, plan the timing, scope and tactics of treatment activities carried out as early as possible after birth at the stage of preclinical manifestations. To do this, it is assumed, firstly, the creation of a group of perinatal observation of patients; secondly, the use of evaluation and interpretation of ultrasound data that determine the level and nature of urodynamic lesions of the fetal urinary system, the severity of urinary tract dilatation, the preservation of renal parenchyma, which is the basis for prenatal diagnosis, evaluation of prospective kidney function. The signs of prognostically unfavorable malformations of the urinary system, in which the question of termination of pregnancy is discussed, are highlighted.

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Possibilities of radiological methods in the diagnosis of bilateral uroepithelial cancer (clinical case)

Year: 2019, volume 15 Issue: №3 Pages: 666-668
Heading: Urology Article type: Case report
Authors: Chekhonatskaya M.L., Rossolovsky A.N., Kryuchkov I.A., Kondratyeva O.A., Bobylev D.A., Klimashin D.F., Kondratyeva D.A., Zuev V.V., Gladkov V.A.
Organization: Saratov State Medical University
Summary:

The article presents data on the development of urothelial cancer and methods of its diagnosis. A clinical case of diagnosis of bilateral uroepithelial cancer in a patient by magnetic resonance imaging is described.

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Magnetic resonance imaging in the diagnosis of bladder cancer (review)

Year: 2019, volume 15 Issue: №3 Pages: 662-666
Heading: Urology Article type: Review
Authors: Bobylev D.A., Chekhonatskaya M.L., Rossolovsky A.N., Ponukalin A.N., Kryuchkov I.A., Kondratieva O.A., Zakharova N.B., Abramova A.P., Popkov V.M.
Organization: Saratov State Medical University
Summary:

The current review represents possibilities of magnetic-resonance imaging in bladder cancer diagnostics. The most important indicator that determines the bladder cancer prognosis and surgical treatment tactics is the muscle wall invasion. Dynamic-contrast-enhanced magnetic resonance imaging and diffusion-weighted magnetic resonance imaging can determine the depth of invasion, although although both are susceptible to over-staging. Magnetic resonance imaging and computed tomography have approximately the same accuracy in determining perivesical invasion as well as in relation to metastatic lymph nodes less than 8 mm in diameter. A promising new technique is the ultra-small paramagnetic iron oxide particles-enhanced magnetic resonance imaging.

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Principles of the program of enhanced recovery of patients after radical prostatectomy

Year: 2019, volume 15 Issue: №2 Pages: 324-327
Heading: Urology Article type: Review
Authors: Pavlov V.N., Tarasenko A.I., Korelov Yu.A., Maksimova S.Yu., Khotko D.N., Khotko A.I.
Organization: Bashkir State Medical University of the Russian Health Care, I.M. Sechenov First Moscow State Medical University, Saratov State Medical University
Summary:

Analysis of statistical data on cancer incidence shows a high prevalence of such diseases as prostate cancer. The existing methods of treatment of this pathology are efective, but the question of reducing the surgical stress of patients who underwent surgery, reducing the number of complications, early mobilization and early recovery remains relevant. The presented literary review reveals the provisions proposed in the XX century, multimodal strategy «Fast track sur-gery», revealing the tactics of surgical patients throughout the perioperative period. The application of this protocol shows its efectiveness in reducing the duration of hospitalization and early rehabilitation of the considered group of patients.

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Principles of the program of enhanced recovery of patients after radical prostatectomy

Year: 2019, volume 15 Issue: №2 Pages: 324-327
Heading: Urology Article type: Review
Authors: Pavlov V.N., Tarasenko A.I., Korelov Yu.A., Maksimova S.Yu., Khotko D.N., Khotko A.I.
Organization: Bashkir State Medical University of the Russian Health Care, I.M. Sechenov First Moscow State Medical University, Saratov State Medical University
Summary:

Analysis of statistical data on cancer incidence shows a high prevalence of such diseases as prostate cancer. The existing methods of treatment of this pathology are efective, but the question of reducing the surgical stress of patients who underwent surgery, reducing the number of complications, early mobilization and early recovery remains relevant. The presented literary review reveals the provisions proposed in the XX century, multimodal strategy «Fast track sur-gery», revealing the tactics of surgical patients throughout the perioperative period. The application of this protocol shows its efectiveness in reducing the duration of hospitalization and early rehabilitation of the considered group of patients.

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Prognostic significance of the assessment of the expression of immunohistochemical markers and the degree of pathomorphism before and after treatment of patients with prostate cancer at high risk of progression

Year: 2019, volume 15 Issue: №2 Pages: 318-324
Heading: Urology Article type: Original article
Authors: Voronina E.S. , Fomkin R.N. , Bucharskaya A.B. , Palatova T.V. , Popkov V.M., Maslyakova G.N.
Organization: Saratov State Medical University
Summary:

Purpose: to analyze the expression of immunohistochemical markers in patients with prostate adenocarcinoma at high risk of progression before and after combined and combined treatment of patients with prostate specific antigen (PSA) level of blood below discriminatory. Material and methods. Examined patients (n = 80) with a diagnosis of “High-risk progression prostate cancer,” with clinical stage T3a, total score for Gleason scale from 8 to 10, the level of total PSA more than 20 ng / ml. Patients of the 1st group (n = 42) only combined surgical treatment in the scope of TUR and HIFU ablation the prostate; The 2nd group of patients (n = 38) additionally applied androgen deprivation in adjuvant mode. Results. Blood PSA, determined in patients after various methods of treatment is not always an objective indicator of its effectiveness. Immunohistochemical studies of tumor tissue for proliferative activity tumor cells, the activation of apoptosis in them, as well as the assessment of specific tumor markers and tumor suppressor genes showed that a decrease in the expression of these markers in patients with PSA values ​​of blood lower than discriminatory observed in all patients independently on the type of treatment. However, after treatment in the 1st group of patients, despite the achievement PSA level of nadir, there is a decrease in the expression of an intercellular adhesion marker E-cadherin, which indicates an increased risk of tumor metastasis, as well as increased expression of markers of the apoptosis inhibitor Bcl-2 and androgens, which indicates about the possibility of progression of tumor growth. Conclusion For a more accurate assessment therapeutic pathomorphism in patients with prostate cancer at high risk of progression, which HIFU ablation monotherapy was carried out, along with the determination of blood PSA level, it is necessary during the control biopsy of the prostate immunohistochemical studies of tumor tissue to determine the prognosis and risk of relapse.

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The value of tumor markers in prognos-ing the outcomes of treatment of patients with bladder cancer

Year: 2018, volume 14 Issue: №4 Pages: 661-666
Heading: Urology Article type: Review
Authors: Ponukalin A.N., Zakharova N.B., Skriptsova S.A., Fomkin R.N., Chekhonatskaya M.L.
Organization: Saratov State Medical University n.a. V I. Razumovsky, Scientific Research Institute of Fundamental and Clinical Uronephrology, Saratov State Medical University
Summary:

The review analyzes the recent publications of the results of the use of molecular genetic markers of bladder cancer (RMP) in clinical practice. The prospects of application of a series of molecules determined in tumor tissue, serum, urine in the diagnosis of RMP are presented. One ofthe most promising areas of finding a marker forthe diagnosis and control of treatment of RMP in recent years are the study ofthe proteomic composition of urine.

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Biomarkers of renal damage and immunohistochemical detection of oncogenesis in the surgical treatment of renal cell carcinoma

Year: 2018, volume 14 Issue: №3 Pages: 420-426
Heading: Urology Article type: Original article
Authors: Tarasenko A.l., Rossolovsky A.N., Berezinets O.L., Ponukalin A.N., Medvedeva A.M., Zakharova N.B., Popkov V.M., Maslyakova G.N.
Organization: Saratov State Medical University, I.M. Sechenov First Moscow State Medical University
Summary:

Objective: to assess the possibility of using markers of renal injury and carcinogenesis as additional criteria for the choice of the method of surgical treatment of RCC and to minimize the risk of development and progression of kidney injury. Material and Methods. 60 patients with morphologically confirmed RCC T1-3M0N0 operated on in the volume of open nephrectomy or laparoscopic nephrectomy or laparoscopic resection and the kidney were examined. Patients were divided into 3 groups: group 1: patients after nephrectomy performed for kidney cancer using traditional surgical technique, group 2: patients after laparoscopic nephrectomy and group 3: after laparoscopic resection of kidney tumor. Before surgical operation, on the 5-7 day and after 1 month, all patients were examined by concentrations of urinary excreted lipocalin 2 (NGAL), and serum concentrations of IL-18, MMP-9 and IGF-1. Renal function was estimated using the calculated GFR equation (CKD-EPI 2009) based on serum creatinine level. Immunohistochemical study of histological preparations of distant tumors on proliferation antibodies (Ki-67, PCNA), apoptosis (BAX, Bcl-2) was performed. Differences in clinical data and clinical variables were compared using Spearman rank correlations and t-test. Results. The studied indices of renal damage of IL-18, NGAL, MMP-9 and IGF-1 both in the early (5-7 days) and later (1 month) postoperative period showed a correlation between the surgical intervention method and the degree of tumor cell differentiation. Conclusion. The levels of biomolecular markers of renal damage (IL-18, NGAL, MMP-9 and IGF-1) correlate with the degree of differentiation in thetumoral cells and functional activity of the remaining renal parenchyma in the postoperative period, but also depend on the individual characteristics of the patient's body. A certain level of expression of MMP-9 and IL-18 with a small tumor size can be a guide to determine the indications for the choice of organ-preserving surgery in patients.

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Complications after different surgical methods of setting polypropylene suburethral meshes in women with stress urinary incontinence

Year: 2018, volume 14 Issue: №2 Pages: 277-280
Heading: Urology Article type: Original article
Authors: Eisenakh I.A., Korotkevich O.S., Mozes V.G., Vlasova V.V.
Organization: Kemerovo State Medical University, Novokuznetsk State Clinical Hospital № 1
Summary:

The aim: to determine the complication's rate, based on a seven-year experience, after the stress urinary incontinence correction in women with different methods of setting suburethral polypropylene meshes. Material and Methods. The analysis of seven years of experience of surgical correction with different methods of setting suburethral meshes in 1260 women with stress urinary incontinence; obturator fixation the mesh inside-outside and outside-inside: supra-pubic fixation the mesh; non-trocar fixation the mesh type mini-sling was carried out. Results. The greatest frequency of complications were identified in the first two years of implementation the setting of suburethral meshes, after that the complication's rate decreased progressively and it was in the range 7-8% the last three years. The frequency of early operative complications at a different setting of suburethral meshes had no statistically significant differences, but there were more the statistically significant intraoperative and mesh-associated complications at suprapubic fixation. Conclusion. The study confirms that the installation of suburethral meshes by the method of suprapubic fixation of mesh is associated with a higher incidence of complications and should be performed only in the target group of patients who are not suitable for surgical correction in safer ways.

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Endoscopic correction of obstructive complications after HIFU-ablation of the prostate with holmium laser

Year: 2018, volume 14 Issue: №2 Pages: 272-277
Heading: Urology Article type: Original article
Authors: Popkov V.M., Fomkin R.N., Shatylko T.V.
Organization: Saratov State Medical University
Summary:

Purpose: to improve the results of treatment of the obstructive complications (an urethra stenosis, a bladder neck sclerosis) caused by application of the high-intensity focused ultrasonic ablation (HIFU) concerning treatment of the localized prostate cancer. Material and Methods. An object of the research included 41 patients, with the infravesical obstruction (IVO) which has arisen in the postoperative period to which elimination the holmium laser is used. Results. The bladder neck was the most frequent place of obstruction. Average time before emergence of the first episode of IVO: 8.2±1.3 months. Distinctions on time before development of an episode of IVO depending on the fact of carrying out TURP before HIFU not confirmed (p=0.440). More advanced age for a moment HIFU-ablation has been associated with much higher frequency of IVO (p=0.021). Considerably smaller frequency repeated was observed by IVO at a larger ratio transurethral resection to the initial volume of a prostate (p=0.031). Duration of a laser endoscopic ure-throtomy was 27 [10-70] minutes, serious perioperative or postoperative complications were not determined. Average term before removal of a catheter of Foley: 3 [1-5] days, hospitalization duration included 4 [3-6] days. After treatment considerable improvement on indicators of the maximum speed of a stream of urine (Qmax) and volume of residual urine was observed. The total score according to the questionnaires of IPSS and QoL has considerably improved, significant changes on symptoms of accumulation are noted. After the first holmium laser urethrotomy of 80.4% of patients have noted satisfactory results without recurrence of IVO; 19.6% of patients were required a repeated laser endoscopic urethrotomy. Recurrence term after the first laser urethrotomy is on average equal to 2.5 months. Conclusion. The endoscopic urethrotomy by means of the holmium laser is safe, effective and minimum invasive type of treatment of a stenosis of a neck of the bladder / urethra after ablative cancer therapy of prostate. The advantages are the minimum of traumas of surrounding tissues and preservation of the mechanism of deduction of urine.

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