Vol 13, No 3 (2023)

BACKGROUND: Bladder cancer is a serious problem of oncourology. The gold standard of treatment for muscle-invasive bladder cancer is radical cystectomy with previous neoadjuvant chemotherapy. Unfortunately, the effectiveness of radical treatments is severely limited in the long term. For this reason, research in the field of predicting survival can significantly improve long-term oncological results. The determination of the levels of macrophages associated with the tumor appears promising.

AIM: to determine the effect of the expression levels of macrophages associated with a tumor on survival rates in patients diagnosed with muscle-invasive bladder cancer after radical cystectomy.

MATERIALS AND METHODS: the study was conducted on the basis of the Clinic of the Bashkir State Medical University in the period from 01.05.2021 to 01.07.2023. The study involved 66 patients with an established diagnosis of muscle-invasive bladder cancer. After surgical treatment, histological and immunohistochemical studies were performed to determine CD68 and CD163 levels. After 24 months, a survival analysis was performed to determine the levels of general, tumor-specific and relapse-free survival and the construction of Kaplan–Mayer graphs.

RESULTS: According to the results of the analysis, there was a significant decrease in survival in groups with high CD68 and CD163 expression rates (p < 0.05). In the study groups, there was a significantly significant correlation between high levels of CD68 and CD163 (p < 0.05).

CONCLUSIONS: CD68 and CD163 can act as independent markers of predicted survival in patients with muscle-invasive bladder cancer after radical cystectomy.

BACKGROUND: The ureteral plastic surgery with their extended constrictions and obliterations remains one of the most difficult problems of reconstructive urology. This is especially true in cases where it is impossible to repair the patency of the ureter due to unchanged urinary tract sections. In such cases, various segments of the gastrointestinal tract and, above all, the ileum proved to be the best plastic material. However, the number of such operations in the world is not enough, which requires further accumulation of experience and study of long-term results of ileoureteroplasty.

AIM: The aim of the research is to present the technical features and results of intestinal plastic surgery of ureters.

MATERIALS AND METHODS: From 2001 to 2023 ileoureteroplasty was performed in 193 patients of the Clinic of the North-Western State Medical University named after I.I. Mechnikov on the basis of the urological department of City Multidisciplinary Hospital No. 2. The panel consisted of 71 men (36.8%), 122 women (63.2%). The average age was 51 ± 3.2 years. Indications for these operations were extensive defects of the ureters as a result of complications of surgical intervention on the upper urinary tract in 69 (35.8%) of patients, radiation therapy — in 54 (28.0%) and the consequences of iatrogenic damage to the ureters — in 40 (20.7%). Megaureter (6.2%), Ormond’s disease (7.3%) and neoplasms of the ureters (2.0%) were observed less frequently.

RESULTS: Unilateral ileoureteroplasty was performed 153 (79.3%), bilateral — 40 (20.7%). The total number of ureteralsurgeries is 235. Since 2013 ileureteroplasty has also been performed with laparoscopic method, and the share of such operations for this period was 35.9%. The early postoperative complications occurred in 18 (9.3%) patients. There were no fatal outcomes. Late complications developed in 16 (11.2%) of 143 examined patients.

CONCLUSIONS: This surgical tactics may be recommended in the clinical practice of large urological hospital due to our 22-year experience in using small intestine segments to replace extended ureteral constrictions with a minimum number of postoperative complications, no deaths and good long-term results allows us to recommend.

BACKGROUND: Cytoreductive nephrectomy and metastasectomy are recommended for patients with solitary renal cell carcinoma metastases.

AIM: To determine the impact of cytoreductive surgery on overall survival (OS) in patients with solitary renal cell carcinoma metastases.

MATERIALS AND METHODS: A retrospective analysis of the data of 90 patients with solitary metastases of renal cell carcinoma, who underwent systemic therapy and various types of cytoreductive surgery operations at the City Oncological Hospital No. 62 in Moscow and the City Clinical Oncological Dispensary in St. Petersburg from 2006 to 2022, was carried out. In the majority of patients with solitary metastases, G1 and G2 tumors according to Fuhrman were detected (37 patients each, 41.1%). Cytoreductive nephrectomy was performed in 16 (17.8%) patients, metastasectomy was performed in 35 (38.9%) patients, in combination with metastasectomy — in 4 (4.4%) patients, in combination with retroperitoneal lymphadenectomy — in 19 (21.1%) patients. In addition to cytoreductive surgical treatment of the primary tumor and metastases all patients received systemic therapy.

RESULTS: Cytoreductive nephrectomy and metastasectomy had a statistically significant effect on overall survival in renal cell carcinoma patients with solitary metastases. 3- and 5-year survival in patients who underwent CNE was 78.2 ± 1.7% and 40.3 ± 1.6%, while in patients without Cytoreductive nephrectomy it was only 29.2 ± 1.4% and 0%, respectively. The median overall survival was 55 months for patients who underwent cytoreductive nephrectomy and 30 months for those who did not. A similar trend was noted for the outcomes of metastasectomy. In patients after metastasectomy, 3 and 5-year overall survival was 86.3 ± 1.8% and 59.6 ± 1.6%, in patients without metastasectomy — 61.3 ± 1.6% and 19.8 ± 1.3%, respectively, median — 59 and 38 months for patients with and without metastasectomy, respectively. Statistically significant differences in the overall survival of patients with solitary metastases were revealed depending on the degree of tumor differentiation according to Fuhrman. 3- and 5-year OS of patients was 84.2 ± 1.8% and 59.9 ± 1.7%, 80.3 ± 1.8% and 46.7 ± 1.6%, 52.2 ± 1.8% and 22.2 ± 1.6% for tumors G1, G2 and G3, respectively (p = 0.009), median — 63, 56, and 31 months for G1, G2, and G3 tumors, respectively. Depending on the prognosis according to the International Metastatic Renal Cancer Database Consortium (IMDC) classification, the 3- and 5-year overall survival of patients was 83.7 ± 1.8% and 69.4 ± 1.7%, 68.8 ± 1.6% and 37.2 ± 1.5%, 23.7 ± 1.4% and 11.7 ± 1.3% for the group of good prognosis, intermediate prognosis and poor prognosis, respectively (p = 0.0001). Median overall survival was 64, 41, and 25 months for the three prognosis groups, respectively.

CONCLUSIONS: Cytoreductive nephrectomy and metastasectomy had a significant impact on overall survival in patients with solitary renal cell carcinoma metastases. The degree of tumor differentiation according to Fuhrman and prognosis according to IMDC also influenced survival rates.

The article provides an overview of modern approaches to pharmacotherapy of overactive bladder. It has been shown that the choice of drug therapy for overactive bladder should be made taking into account the pathophysiological mechanisms of the development of the disease, the characteristics of its clinical course, as well as the potential risks of developing side effects of treatment. A pathogenetic rationale for the choice of treatment tactics for different categories of patients is presented, including those with a hypersensitive bladder, bladder outlet obstruction, neurological and geriatric patients. The pharmacological properties of the β3-adrenergic receptor agonist mirabegron are described, which provide high efficacy and a favorable safety profile in the treatment of patients with overactive bladder. The practical issues of prescribing mirabegron in various clinical situations are considered.

The review article discusses modern methods for diagnosing and treating patients with non-muscle-invasive bladder cancer. The search and analysis of information was carried out in the databases PubMed, Google Scholar, eLibrary. Information about photodynamic diagnostics, narrow-band imaging, mono- and bipolar transurethral resection, transurethral thulium and holmium laser resection, en-bloc resection of neoplasms, Nd:YAG laser ablation of the tumor bed is presented. The features, advantages and disadvantages of each of these methods, as well as their combinations and modifications are described in detail. Particular attention is paid to the use of laser technologies in the surgical treatment of patients with non-muscle-invasive bladder cancer. An analysis of the results of studies of the efficacy and safety of various methods of surgical treatment of non-muscle-invasive bladder cancer was carried out. The significance of the problem of increasing the efficiency of treatment of such patients, which is one of the priority areas of modern oncourology, is indicated.

Arteriovenous conflicts of the ileocecal segment are a frequent cause of recurrent and bilateral varicocele. Insufficient and untimely diagnosis of varicocele causes in this group of patients leads to multiple repeated surgical interventions due to recurrence. This paper presents a clinical case of successful fertility of a 30-year-old patient with bilateral varicocele and testicular hypotrophy on the background of Mey–Thurner syndrome by two-stage surgical treatment including transsclerotal ligation of testicular veins, angioplasty and stenting of the left common iliac vein.