Urology reports (St. - Petersburg)

BACKGROUND: Currently there are practically no works in the literature to assess the outcomes of systemic therapy in patients with solitary, single and multiple metastases of renal cell carcinoma.

AIM: The aim of the study was to analyze the outcomes of systemic drug therapy of the first line in patients with solitary, single and multiple metastases of renal cell carcinoma.

MATERIALS AND METHODS: The data of 981 patients with metastatic renal cell carcinoma who underwent systemic therapy of the first line at the City Oncological Hospital No. 62 in Moscow and the City Oncological Dispensary in St. Petersburg from 2006 to 2022 were retrospectively analyzed. All patients underwent clinical, laboratory and pathomorphological examination. 90 (9.2%) patients had solitary metastases, 252 (25.7%) single metastases and 639 (65.1%) multiple metastases. An analysis was made of the outcomes of 1st line therapy, which were conditionally divided into favorable, including all cases of complete response, partial response and stabilization, and unfavorable — progression during treatment, death or deregistration. Subsequently patients who had previously received chemotherapy or cytokine treatment were excluded from the analysis.

RESULTS: Complete response (3.3%) and deregistration (5.56%) were more often observed in patients with solitary metastases, stabilization more often occurred in patients with single metastases (51.1%), partial response (9.4%) and death (6.2%) — in patients with multiple metastases. In patients with multiple metastases treated with immune checkpoint inhibitors a partial response was observed in almost half of the cases. Stabilization and progression were observed in almost the same percentage of cases (about a quarter of cases), and only two patients had a fatal outcome, which is slightly lower than in patients receiving tyrosine kinase inhibitors. Frequent outcomes when using tyrosine kinase inhibitors were stabilization of the process (40.72% of cases) or progression (38.72%), a complete and partial response was rarely recorded. Significant differences in the occurrence of favorable and unfavorable outcomes were revealed in patients with multiple metastases, depending on the number of affected organs and the prescribed drug. When comparing the results of systemic therapy of the first line, a higher efficiency of tyrosine kinase inhibitors was observed in solitary metastases of tumors with a high and moderate degree of differentiation. Systemic therapy of G3 tumors with solitary metastases had low efficacy in the appointment of tyrosine kinase inhibitors in 27.27% of patients. Higher efficiency was noted in single and multiple metastases. The effectiveness of immune checkpoint inhibitors was revealed in 70.6% of patients with single and multiple metastases.

CONCLUSIONS: When choosing systemic therapy for metastatic renal cell carcinoma in clinical practice, it is necessary to take into account such prognostic factors as histological variants, the degree of differentiation of the tumor and the number of affected organs.

BACKGROUND: One of the leading links in the pathogenesis of urolithiasis is oxidative stress, which occurs as a result of the intensification of free radical oxidation with insufficient activity of the antioxidant defense system of the body.

AIM: The aim of the study was to study the effect of a complex of natural terpenes and vitamin E Renotineх® on the state of oxidative stress in patients with urolithiasis in the postoperative period after percutaneous nephrolithotripsy.

MATERIALS AND METHODS: The study included 42 patients. Of the 35 people who underwent percutaneous nephrolithotripsy, 2 groups were formed. Patients of the main group (n = 20), in contrast to the control group (n = 15), received Renotinex® (Polaris LLC, Russia) before and after surgery, 2 capsules (1 capsule 300 mg) twice a day. To determine the main indicators of the activity of free-radical processes in the body, all patients underwent a blood test on the 3^rd day after surgery. The total activity of the pro- and antioxidant systems in blood plasma was determined by the method of induced chemiluminescence. The activity of lipid peroxidation was assessed by determining the concentration of active products of thiobarbituric acid — secondary products of lipid peroxidation in blood erythrocytes. The activity of antioxidant enzymes was studied by spectrophotometric method. To determine the ability of blood plasma to crystallize in some of the same patients with urolithiasis while taking Renotinex®, the method of wedge dehydration was used. For a comparative analysis of the crystal structure of dried blood plasma samples (facies), 7 healthy volunteers were included in the study, which made up the third group (comparison group).

RESULTS: The results of the study reliably demonstrate that the composition of the complex of natural terpenes and vitamin E Renotinex® has a positive effect on free-radical processes in patients with urolithiasis, biochemical parameters of blood plasma (indicators of induced chemiluminescence, catalase activity, malondialdehyde level), as well as on crystallization processes blood plasma, which is confirmed by the method of wedge dehydration of blood plasma. Any change in the body caused by excessive activity of free-radical oxidation processes is reflected in the composition of the blood, and specifically in the indicators of the “mechanical” characteristics of blood plasma (viscosity, structure, surface tension), which determine the shape of the resulting structures of the drying drop of biological fluid.

CONCLUSIONS: The complex of natural terpenes and vitamin E Renotinex® has a positive effect on free-radical processes, biochemical parameters of blood plasma, as well as on the systemic structural organization of blood plasma in patients operated on for urolithiasis. The inclusion of the combined product Renotinex® in the treatment regimen for patients with urolithiasis is pathogenetically justified.

BACKGROUND: Transurethral incision of the bladder neck is one of the main methods of correction of bladder neck stenosis that occurred after treatment of patients with benign prostatic hyperplasia. This technique involves endoscopic dissection in the area of the stenosed area without removing scar tissue. Taking into account the emergence of new reconstructive methods of surgical intervention in patients with recurrent bladder neck stenosis the expediency of using transurethral incision of the bladder neck in recurrent cases remains a subject of discussion.

AIM: The aim of the study is to evaluate the effectiveness of the use of transurethral incision of the bladder neck in patients with recurrent bladder neck stenosis.

MATERIALS AND METHODS: The study included 30 patients with a diagnosis of recurrent bladder neck stenosis who were treated in the period from 2012 to 2022. in Clinical Hospital of St. Luke and was performed transurethral incision of the bladder neck using bipolar electrosurgical energy. The diagnosis of bladder neck stenosis was established on the basis of complaints, anamnesis, uroflowmetry with determination of the volume of residual urine, ureteroscopy, retrograde urethrography. Recurrence was recorded when the maximum urination rate below 12 ml/s, there was an episode of acute urinary retention, or the need for additional surgical intervention for bladder outlet obstruction.

RESULTS: All 30 patients underwent transurethral incision of the bladder neck using bipolar electrosurgical energy. The average duration of surgery was 22.9 minutes. The degree of postoperative complications did not exceed grade II according to the Clavien scale. The frequency of de novo stress urinary incontinence was detected only in one patient, which resolved spontaneously within 6 weeks. The maximum urination rate after 3 months was 14.73 ± 3.61 ml/s, while after 6 months there was a significant decrease to 10.91 ± 6.92 ml/s, and after 12 months — to 9.4 ± 7, 65 ml/s. The absence of recurrence in patients after TUI BN during the observation period was noted in 17 (56.67%) patients.

CONCLUSIONS: Transurethral incision of the bladder neck using a bipolar electrode is a safe method for correcting bladder neck stenosis, but in recurrent cases it has limited efficacy. In this regard, in patients with a large number of endoscopic interventions in history, other methods of bladder neck reconstruction should be chosen.

BACKGROUND: Renal cell cancer is accompanied by the development of a disorder of renal function. The parameters of homeostasis after nephrectomy in renal cell cancer are not well understood.

AIM: The aim of the study is to compare the kidney functional status and parameters of homeostasis in patients with RCC after nephrectomy performed by open and laparoscopic surgery.

MATERIALS AND METHODS: Eighty patients with renal cell cancer Т3N0M0 were randomized according to the surgery into the comparison group with open nephrectomy (n = 40; 50,1 ± 3,4 years old; 18 males, 22 females) and the main group with laparoscopic nephrectomy (n = 40; 52,4 ± 5,1 years old; 16 males, 24 females). The control group was comprises from twenty subjects without urological pathology, 22–58 years old, 10 males, 10 females. Laboratory parameters of endotoxicosis, lipid peroxidation, kidney functional status, partial kidney functions, and urinary syndrome were assessed on the 1^st, 3^rd, 6^th and 10^th days after the surgery.

RESULTS: The early postoperative period of nephrectomy in renal cell cancer is accompanied by the development of endotoxicosis, activation of lipid peroxidation, deterioration of the functional state of the remaining kidney, and the formation of chronic kidney disease. At the same time, both systemic indicators (toxicity index, as well as concentrations of medium-weight molecules, diene conjugates, malondialdehyde), and renal parameters (glomerular filtration rate, albumin-creatinine ratio) are associated with the method of surgery: with a laparoscopic approach, changes in these indicators are reversible and less pronounced than with open nephrectomy.

CONCLUSIONS: The present study demonstrates the advantage of laparoscopic nephrectomy compared to open nephrectomy in patients with renal cell cancer.

Renal cysts can be both an independent nosological entity, and a clinical manifestation, or a complication of a severe diseases. Understanding the epidemiology, pathogenesis and diversity of causes of cystic kidney disease contributes to the timely diagnosis and selection of reasonable treatment and prevention tactics. The presented literature review describes the most common processes that contribute to the development of this pathology, as well as genetic diseases and rare causes, the clinical manifestation of which is the formation of cystic cavities. The article presents the main diagnostic algorithms and modern classifications of the disease for practical assistance to the doctor. The review contains up-to-date information on the modern staging of cystic kidney disease according to the Bosniak classification, and also presents the risk of malignancy, according to the statistical data presented in the literature.