Vol 9, No 4 (2019)

The results of surgical treatment of 59 women (average age 31.9 ± 1.3 years) who underwent laser ablation of paraurethral cysts using the Lakhta-Milon laser apparatus (Russia) (diode laser with a wavelength of 0.97 μm) are presented. The postoperative period in all patients proceeded without serious complications. The average hospital stay was 1.7 ± 1.5 days. 4 weeks after surgery, all 59 patients noted improvement such as lack of dysuria, only 10 (16.9%) had minor discharge from the genital tract. 6 weeks after surgery all 59 operated patients had wound epithelization. Conclusion: The treatment of paraurethral cysts should be surgical and as radical as possible. The operation of choice is laser ablation of paraurethral formations.

To present own initial experience of Retzius-sparing robot-assisted radical prostatectomy (RS-RARP) and surgical technique. In October–November 2019 on the basis of the Urological Department and the Center for Robotic Surgery of City Mariinsky Hospital (Saint Petersburg, Russia) five patients with localized prostate cancer were treated with RS-RARP. The operation time was from 140 to 205 min. The blood loss volume was from 50 to 250 ml. No conversions and intraoperative complications were recorded. Nervous-saving RS-RARP was performed in three patients. No blood transfusions were performed. Two patients faced Clavien Grade I postoperative complications. Immediate continence after removal of the urethral catheter was noted in 3 out of 5 patients. All the patients became continent for 2 weeks. One extraprostatic positive surgical margin was recorded. RS-RARPis an accessible technique for treating patients with localized prostate cancer, which allows achieving high early results. It is necessary to accumulate more experience of such surgeries to assess the distant outcomes and compare them with the data of the robot-assisted radical prostatectomies performed by other approaches.

Relevance. The study of alternative non-drug methods of rehabilitation therapy is an important task in the preventive direction of rehabilitation medicine. An important role in rehabilitation measures to prevent relapse of nephrolithiasis is therapy with the use of balneological therapeutic factors. The purpose of the study is to increase the effectiveness of rehabilitation therapy in patients with chronic pyelonephritis with the use of “Serebryaniy klyuch” mineral water.

Materials and research methods. The basis of the work is the analysis of data from examination and treatment of 48 patients with chronic pyelonephritis in the phase of latent inflammation. All patients included in the study were divided into 2 groups. Patients of the 1^st group (n = 23) were prescribed antibacterial, antispasmodic, herbal medicine and drinking fresh water. In addition to standard therapy, patients of the 2^nd main group (n = 25) were prescribed 300–350 ml of “Serebryaniy klyuch” mineral water 30–40 minutes before meals up to 2 liters per day at a temperature of 39–40 °C.

Results. In patients of the 2^nd group in 91.4% of cases, curation of the clinical signs of the disease was noted, pathogens were eliminated in 100% of patients. At the same time, normalization of cytokine homeostasis and humoral immunity was observed, which contributed to a decrease in interstitial edema and normalization of renal vascular tone.

Conclusion. The internal intake of “Serebryaniy klyuch” mineral water in the rehabilitation therapy of patients with chronic pyelonephritis has a positive effect on the elimination of the clinical manifestations of the disease, increases the percentage of sterile urine culture, improves the basal blood flow in the kidneys, the immune status of patients, the cytokine profile of blood serum and there by increases the duration of the full clinical and laboratory remission in this category of patients.

The main screening test for prostate cancer is the determination of prostate-specific antigen (PSA) in the blood. Increasing of the PSA level above 4 ng/ml is an indication for a detailed clinical examination of the patient. At the same time only in a quarter of cases with a PSA level of 4 to 10 ng/ml prostate cancer is diagnosed, and in 70–80% of cases prostatic hyperplasia and prostatitis are diagnosed.

Objective: to determine the need for anti-inflammatory treatment in the initial detection of elevated PSA blood levels within the “gray area” in men over 50 years of age to minimize the number of puncture biopsies of the prostate.

Materials and methods. The study was divided into 2 parts. Part 1 – a retrospective study, in which results of the histological examinations of the prostate gland of 297 men after a puncture biopsy about an increase in the PSA level of more than 4 ng/ml were analyzed. Part 2 – a prospective study in which 118 men over 50 years of age with a primary increase in the PSA level from 4 to 9 ng/ml received anti-inflammatory treatment to monitor the dynamics of the PSA level.

Results: the appointment of anti-inflammatory treatment allows in 69% cases to avoid puncture biopsy of the prostate, increase the predictive value of PSA, reduce the frequency of post-puncture complications of inflammatory genesis.

Conclusion: the appointment of anti-inflammatory treatment is advisable when the primary increase in blood PSA levels to 9 ng/ml.

The article deals with the main problems concerning the optimization of treatment of patients with renal cell carcinoma. Variants of the course of the disease after pseudoprogression are considered. The strategies of differential diagnosis and correction of treatment based on modern ideas about the pathogenesis of renal cell carcinoma are considered in detail. Data of own researches in which the assessment of possibility of treatment without change of preparations in the first and second lines after primary progression is carried out are resulted.

The article presents a successful trial of constructing neourethra with the use of a free graft of the mucous tissue of the cheek in a patient with a post-trauma total urethral loss.

The article is dedicated to the 70^th anniversary of the death of Academician Richard Mikhailovich Fronshtein who was an outstanding clinician, scientist and teacher. The main stages of scientific, pedagogical activity and practical activity are presented. R.M. Fronshtein published more 140 scientific papers, including manuals on operative urology. In 1922 together with prof. S.P. Fedorov he founded the journal “Urologiia” and for 19 years was its responsible editor.