Urology reports (St. - Petersburg)

BACKGROUND: Renal cell cancer is complicated with bone metastases quite often, which are determined in a third of patients at the time of diagnosis of the primary tumor. The development of skeletal complications causes the complexity of managing such patients, which requires optimizing treatment tactics using combined methods and improving the quality of life after treatment.

AIM: The aim of this study is to assess the quality of life of renal cell cancer patients with single metastases in the bones before and after surgical treatment in combination with targeted therapy and without it.

MATERIALS AND METHODS: The study included 62 patients with single bone metastases of renal cell cancer with the presence of skeletal related events. 20 patients (group 1) underwent surgical treatment of metastases after surgery on the primary focus in combination with targeted therapy, 42 patients (group 2) underwent only surgical treatment of metastases. The quality of life was assessed using the EORTC QLQ-C30 questionnaire before and after surgery within and between groups.

RESULTS: Comparison of the survey influence on life quality in group 1 before and after treatment revealed that 8 out of 30 indicators of the EORTC QLQ-C30 questionnaire did not show a statistically significant change. These include: any restrictions in daily activities, as well as doing what you like, decreased appetite, nausea, shortness of breath, diarrhea, fatigue, financial difficulties. The remaining 22 indicators of the scale showed a statistically significant improvement. Comparison of quality of life indicators in group 2 before and after treatment showed that for 3 out of 30 indicators of the EORTC QLQ-C30 questionnaire, no statistically significant changes were registered, among them: the severity of pain syndrome, the presence of financial difficulties and health status over the past week. Statistically significant improvement was revealed for the remaining 27 indicators of the scale. Prior to treatment, difficulties in taking a short walk, doing daily chores, doing favorite things are more pronounced in group 1, and the need for rest in group 2 patients. After surgery, the indicators associated with daily activity were worse in group 1 patients, while the severity of the pain syndrome, its effect on daily activity, the need for rest, a sense of tension, and the effect on the emotional background were more noticeable in group 2 patients. Both before and after surgery, group 1 patients had a better assessment of both their health and quality of life over the past week.

CONCLUSIONS: The comparative analysis of the treatment confirmed our hypothesis that the most rational and effective combination is an active surgical tactic in combination with targeted therapy for bone oligometastases of renal cell cancer.

BACKGROUND: The number of older patients with kidney tumors is steadily increasing. Surgical methods are the main ones in the treatment of patients with localized forms of renal cell carcinoma, including the elderly.

AIM: to conduct a comparative analysis of perioperative data and functional results of surgical interventions for renal cell carcinoma in patients of different age groups.

MATERIALS AND METHODS: The study included 256 patients with kidney tumors (mean age 65.2 ± 8.6 years). 146 (57.0%) patients aged 56 to 64 years made up group I, and 110 (43.0%) patients aged 65 to 75 years — group II. In 210 (82.0%) patients, the tumor diameter did not exceed 4 cm (T1a), in 46 (18.0%) patients it ranged from 4 to 6.2 cm (T1b). Radical nephrectomy and partial nephrectomy were performed respectively in 44 (30.1%) and 102 (69.9%) patients of group I and 58 (52.7%) and 52 (47.3%) patients of group II. All operations were performed laparoscopically.

RESULTS: In patients of group I, the duration of radical nephrectomy was 115.0 ± 18.0 min, and partial nephrectomy — 135.5 ± 25.0 min (p < 0.0001), in patients of group II, 120.0 ± 20.5 and 138.0 ± 25.5 min (p < 0.0001), respectively. Warm ischemia time during partial nephrectomy was 17.6 ± 1.2 min in patients of group I and 18.2 ± 1.5 min in patients of group II (p = 0.25). The volume of blood loss in patients of both groups I and II was significantly higher during partial nephrectomy. The average volume of blood loss in patients of group I was 130.0 ± 20.0 ml when performing radical nephrectomy and 236.5 ± 20.0 ml when performing partial nephrectomy (p < 0.0001), and in group II — 125.0 ± 18.5 ml for radical nephrectomy and 246.0 ± 22.0 ml for partial nephrectomy (p < 0.0001). The frequency of significant complications did not differ in patients of groups I and II. Grade IIIa complications according to the Clavien–Dindo classification of surgical complications were observed in 5 (3.4%) patients of group I and 4 (3.9%) patients of group II (p > 0.05), and grade IIIb in 3 (2.1%) and 2 (1.8%) patients (p > 0.05). Intraoperative bleeding developed in 19 (7.4%) patients: in 13 (8.4%) of 154 patients with partial nephrectomy, and in 6 (5.9%) of 102 patients with radical nephrectomy. In the early postoperative period in patients of group I after radical nephrectomy and partial nephrectomy, normal glomerular filtration rates was observed in 34.0% and 54.0% of patients, respectively, and in group II — in 31.0% and 52.0% of patients, respectively. Renal function significantly decreased in patients of both groups after radical nephrectomy compared with partial nephrectomy (p < 0.05). The results of GFR 3 months after surgery improved in patients after partial nephrectomy, and did not change significantly in the radical nephrectomy group.

CONCLUSIONS: The results of the study showed no differences in perioperative parameters (volume of intraoperative blood loss, warm ischemia time) during radical nephrectomy and partial nephrectomy in patients aged 56–64 and 65–75 years. The functional results of partial nephrectomy in patients of both groups were better compared to patients after radical nephrectomy. Thus, our data indicate the justification for performing organ-preserving operations, including in elderly patients.

Amyand’s hernia, an inguinal hernia that contains the appendix within the hernia sac, is a rare condition in surgical, and even more so in urological practice. It is difficult to diagnose due to its low frequency, anatomical atypicality and urgency. There are no review publications on this issue, and those that are available are mainly descriptions of individual cases. In this article an attempt was made to highlight the largest possible number of clinical observations that reflect the urological aspects of the problem and present them in a systematic manner. Aim — to analyze the available publications covering the urological aspects of Amyand’s hernia.

The literature review was carried out on the basis of publications covering the urological aspects of Amyand’s hernia in adults and children, published in PubMed databases and Scientific Electronic Library eLibrary.ru. The search was carried out by the following keywords: “Amyand’s hernia”, “acute scrotum”, “inflammatory diseases of the scrotum”, “Fournier’s phlegmon”, “scrotal fistula” (in Russian and English). Taking into account the rarity of the analyzed problem, the analysis includes publications for the last 15 years. 189 publications related to the topic of the review were identified. 38 publications of the greatest scientific and practical interest were selected directly for citation in the review. The maximum number of available publications reflecting the “urological aspects” of Amyand’s hernia has been analyzed, and an attempt has been made to systematize them clinically. The variety of clinical manifestations caused by Amyand’s hernia is commonly referred to in the English literature as “Amyand’s hernia syndrome”. We have identified the following variants of the clinical course: scrotal fistula — a casuistic variant described in detail only by C. Amyand; picture of the “acute scrotum” syndrome — the most frequent variant of the clinical course of Amyand’s hernia with scrotal manifestations is noted mainly in childhood, however, it can also occur in adults in all age groups; phlegmon of the scrotum, phlegmon of Fournier — an extremely rare variant of the clinical course with scrotal manifestations, publications on this subject are rare.

Amyand’s hernia being a rare surgical problem in both children and adults, has a number of urological “masks”, causing diagnostic difficulties and is of some interest to the urologists.

The article describes the clinical manifestations of a solitary kidney cyst, methods for diagnosing this disease, as well as possible complications and videoendoscopic methods of surgical treatment.

The presented nosology is a fairly common lesion of the kidneys with clinically significant symptoms that manifest at any age. In most cases, simple kidney cysts are an accidental finding on ultrasound examination and, with small sizes, do not require active observation and treatment. In a small percentage of cases, cysts can be complicated by bleeding, infection or rupture, after which there is a need for active surgical treatment. As a clinical example illustrating the options for endoscopic treatment of a complicated course of solitary kidney cyst, the data of 2 patients with a new coronavirus infection, in whom a hemorrhage into the cavity of a large cyst was diagnosed in the postcovid period against the background of continued anticoagulant therapy, are presented. The article describes in detail the clinical manifestations of the disease, options and stages of surgical treatment from laparoscopic and retroperitoneal approaches in a multidisciplinary hospital.