Objective: to compare immediate, oncological, and functional results, as well as quality of life in patients undergoing open and laparoscopic transperitoneal radical nephrectomy (RNE) for clinically localized kidney cancer (KC).

Subjects and methods. Data from 426 cT1-2N0M0 KC patients after radical nephrectomy in 1991 to 2011 were retrospectively selected. Their median age was 57 years. The male/female ratio was 1.1:1. The median highest tumor diameter was 5.0±2.2 cm. RNE was carried out in all 426 patients: in 211 (49.5 %) patients through open access and in 215 (50.5 %) through transperitoneal laparoscopic one. The patient groups operated on via different accesses were matched for major signs; however, the laparoscopy group displayed a preponderance of cT1a tumors. The median follow-up was 50.0±12.3 months.

Results. There were no significant differences in the frequency of intraoperative and postoperative complications of laparoscopic and open nephrectomies. The five-year overall, specific, and relapse-free survival rates in the patients who had undergone open nephrectomy were 95.4, 98.4, and 92.2 %, respectively; those in the patients who had laparoscopic nephrectomy were 94.5, 100.0, and 93.6 %, respectively (p > 0.05 for all). The incidence of acute renal dysfunction and its distribution according to the RIFLE classes, the rate of acute dialysis and that of a decrease and a continued reduction in glomerular filtration rate, as well as the distribution of patients according to the stages of chronic kidney disease after RNE did not depend on the surgical access (p > 0.05 for all). The QLQ-30 survey data show that the laparoscopic access versus the laparotomic one improves quality of life within 1 month after RNE.

The paper gives an overview of peri-operative chemotherapy in patients with muscle-invasive bladder cancer (MIBC) as insufficient option, demonstrates a clinical need for the development of more efficacious and safe treatment and introduces a MAGNOLIA study proposed by the European Association of Urology Research Fund in a concept of MIBC immunotherapy. The MAGNOLIA trial conducted in 56 research centers of 10 countries assesses whether adjuvant immunotherapy with recMAGE-A3+AS15 vaccine is safe and effective and improves outcome of patients with MAGE-A3 positive MIBC after cystectomy. 60 of 273 patients have been enrolled. The trial has to be continued to elaborate a general peri-operative treatment strategy for MIBC.

This paper analyzes the experience in treating 20 patients with nonseminomatous germ cell tumors metastasizing to the brain. It presents brain metastasis-associated factors: multiple lung metastases; IGCCCG poor prognosis; and a baseline human chorionic gonadotropin level of > 50000 mIU/ml. The authors have identified a group to be screened for brain metastasis, which includes patients with intermediate/poor prognosis and multiple lung metastases. Long-term survival was achieved in 45 % of patients with baseline brain damage and in 22 % of those with metastases revealed after first-line chemotherapy. The positive prognostic factors associated with long-term survival were a single brain lesion, no neurological symptoms, and achievement of clinical complete personse in the brain.

The paper gives the comparative results of chemoprevention against prostate cancer (PC) in 189 patients with benign prostate hyperplasia with a prostate-specific antigen (PSA) level of 2.5 to 10.0 ng/ml during 4‑year combined (avodart + omnic) or monotherapy with either drug. Biopsy revealed PC in 14.3 % of the patients treated with avodart and in 29.0 % of those who received omnic monotherapy (p < 0.05). In the avodart groups, the incidence rate of aggressive PC was almost twice the rate in the omnic monotherapy group. The long-term avodart therapy was safe with a stable reduction in the baseline levels of PCA and dihydrotestosterone, and conversely, any PSA rise and even an episodic fall in free PSA ratio are indications for transrectal multifocal prostate biopsy.

The efficiency of prostate cancer (PC) diagnosis using multipatametric magnetic resonance imaging (MRI) was evaluated. Unlike most of investigations of the similar problem, this trial provides an objective assessment applying the method of statistical analysis - binary logistic regression. It used data on 166 patients, including primary patients (with suspected PC), as well as patients with the established diagnosis of PC, those with a history of negative biopsy, and those with suspected recurrent PC. Some patients underwent target biopsy, the results of which were then employed for statistical processing. The data of the analysis showed that the sensitivity, specificity, and total accuracy of the method using the created model of binary logistic regression at the separation value of 0.625 were 75.0, 85.2, and 79.7%, respectively. The efficiency of diffusion-weighted images (DWI) with varying weighing degree by water molecule diffusion (b factor) on MRI systems with different magnetic field strength (1.5 and 3 Tesla) was also evaluated. There were no statistically significant differences in normalized absolute signal intensity as to the contralateral gland portion) in DWI with b factors of 1000 and 2000 between the MRI systems with a magnetic field strength of 1.5 and 3.0 Tesla.

Objective: to evaluate transobturator retrobulbar sling (TRS) implantation midterm results for stress urinary incontinence (UI) after radical prostatectomy.

Subjects and methods. From April 2008 to December 2012 thirteen TRS implantations were performed in Department of Urology and Surgical Andrology of Russian Medical Academy Postgraduate Education in men with mild to severe stress UI. Preoperative assessment, including urethrocystoscopy, was performed. The use of only one safety pad per day was considered to be recovery. The application of no more than 2 pads or a more than 50 % urine leakage reduction was regarded as improvement.

Results. An average follow-up of 33±19 months indicated recovery in 11 of the 13 patients, 1 patient had improvement, and 1 patient showed no positive result. In addition to urine loss reduction, there was significant quality of life improvement. No complications requiring sling removal were seen.

Conclusion. TRS implantation is an effective and safe treatment option for selected patients with stress UI after radical prostatectomy, leading to significantly quality of life improvement.

Background. Many investigators point out the importance of detecting the neuroendocrine differentiation of prostate adenocarcinoma (PA) and consider its relationship to the clinical picture of the disease and total Gleason scores (Gleason index).

Objective: to study relations between the presence of markers indicative of neuroendocrine differentiation in PA tissue, Gleason index, and disease characteristics.

Materials and methods. The fragments of the postoperative histological specimens obtained from 30 patients after radical prostatectomy in 2008 were stained by an immunohistochemical assay to identify specific markers of neuroendocrine differentiation: chromogranin A (CgA) and synaptophysin. The expression of the markers of neuroendocrine differentiation was compared to the clinical stage of the disease and Gleason index that was used to allocate the patients to 3 groups: low-, moderate-, and high-grade tumors.

Results. The patients» mean age was 67 ± 9.2 years. Groups 1, 2, and 3 included 5, 19, and 6 patients, respectively. The expression of CgA was found in 10 % of Group 1 patients, in 33 % in Group 2, and in 40% in Group 3. CgA expression considerably increased with a higher Gleason score (p = 0.024).

Conclusion. The expression of CgA is more than that of other used markers and correlates with the clinically determined stage of the disease. The expression of CgA increases with a higher grade, which can be potentially used to predict the course of the disease. The limitations of this investigation are associated with its retrospective pattern and a small sample size. The findings need to be clarified in a large cohort study.

In Russia, there is presently a growing interest in low-dose intratissue radiotherapy (brachytherapy) for locally advanced prostate cancer (PC). Since its inception, current brachytherapy has undergone a number of significant changes in terms of improved visualization and better treatment planning and monitoring, which is sure to have affected the higher quality of their performance and better long-term results. The main purpose of the given paper is to generalize the data of foreign investigators who have the greatest experience with brachytherapy for its further use in the treatment of patients with locally advanced PC under the conditions of Russian clinics.

In the metastatic patterns of the cancer, the tumor foci are located more frequently in the tubular bones and vertebral column, just less frequently in the bones of the pelvis, and even more rarely in those of the shoulder and skull. Bone pain is usually related to the involvement of the periosteum that has an extensive network of nociceptors. Auxiliary exposures that directly affect the intensity of pain syndrome and the strength of bone structures are used in addition to basic therapy options for cancer of the prostate. Among these agents there are bisphosphonates. Once ingested, bisphosphonates are transported by blood to the areas of active bone tissue rearrangement where they are tightly bound to the mineral matrix. Their administration causes a considerable reduction in pain syndrome, a decrease in the frequency of complications of bone metastases, and an increase in time before a first bone complication. Antiresorptive therapy including particularly zoledronic acid (resorba) or denosumab is a necessary treatment option in the above category of patients with bone metastases.

The possible benefits of radical surgical treatment for prostate cancer in elderly patients are controversial. The data of 1367 patients who had undergone radical prostatectomy (RPE) in the Clinics of Urology, S. P. Kirov Military Medical Academy, in 1997 to 2003 and in the Clinic of Urology, Russian Medical Academy of Postgraduate Education, in 2001 to 2010 were retrospectively analyzed. In the patient age group of ≥70 years, the five- and ten-year relapse-free survival rates were 76.4 and 70 %, respectively. In that of < 70 years, those were 79.1 and 75.4 % (p = 0.76). The five- and ten-year overall survival rates were 88.5 and 75.4 % in the patients aged ≥ 70 years and 95.2 and 87.7 % in those aged with < 70 years (p = 0.02). The ten-year cancer-specific survival rate was 99.1 and 95.6 % in the groups of ≥ 70 and < 70 years, respectively. The cause of death was cardiovascular diseases in more than half of the patients over 70 years of age (52.9 % of all deaths; 7.4 % of the entire cohort). In the patients aged above 70 years, indications for surgical treatment should be individually determined via aggregate assessment of cancer potential, surgical and anesthetic risks, and life expectancy.

Background. Radiotherapy is a basic treatment for patients with locally advanced cancer of the cervix uteri (CCU). However, in 20–30 % of patients, postradiation injuries result from different causes, which may give rise to fistulas.

Objective: to define an optimal surgical rehabilitation method for patients with postradiation vesicovaginal fistulas in CCU.

Subjects and methods. Forty-eight patients with CCU and postradiation vesicovaginal fistulas were operated on in 1996 to 2010. Patients with primary fistulas underwent 46 radical operations and 2 palliative ones; those with recurrent fistulas had 17 radical operations and 1 palliative one.

Results. Recurrences after radical surgery for primary fistulas occurred in 39.1 % of the patients; the efficiency was 80.0 % for transvaginal plasty, 61.5 % for bladder resection, 61.5 % for bladder resection with ureteral reimplantation, and 0 for subtotal bladder resection. In recurrent fistulas, the efficiency was 0 for bladder resection with ureteral reimplantation, 50 % for subtotal bladder resection, and 100 % for cystectomy, Bricker surgery. Surgical rehabilitation could be achieved in a total of 40 (83.3 %) of the 48 women.

Conclusion. The correct choice of surgical scope allows the satisfactory results of treatment for postradiation fistulas to be achieved in patients with CCU.

In 2003 malignant neoplasms (MN) of the urinary system and male genital organs affected more than 43,000 people in Russia, amounting to 9.4% in the structure of total cancer morbidity. In 2012, the incidence of urologic cancers at only three sites (prostate, kidney, and bladder) was 12.1%. In the same year, Moscow showed the proportion of patients with new-onset urologic cancer, which accounted for one sixth (16.5%) of the total MN morbidity and almost one fifth (18.5%) of the total number of registered cancer patients.