Due to the better diagnostic feasibilities of health care facilities, the proportion of patients with small renal tumors (T1a) has substantiallyincreased in recent years. In accordance with the international standards, these patients should undergo nephron-sparing surgery: neoplas-tic kidney resection. At Russian hospitals, organ-preserving treatment is not in adequate use for the technical difficulties associated withresection and for the likelihood of postoperative complications. The performed study has yielded a simple highly effective procedure ofnephrectomy in neoplasms, by using vasoselective parenchymatous sutures enhanced with polymer stripe-implants. 

The performed study compared the toxic effects caused by the administration of sorafenib with the manifestations that immediately accompanied extensive renal-cell carcinoma. There is evidence that Sorafenib that is a safe and well tolerable agent increases progression-freesurvival.

Objective: to study the results of sparing cystectomy in patients with urinary bladder cancer (UBC).

Subjects and methods. The study has covered 82 patients with transitional-cell UBC (T1-4aN0M0) who received radiotherapy (RT) and thenunderwent radical cystectomy at the N.N. Blokhin Russian Cancer Research Center, Russian Academy of Medical Sciences, in 1980 to2007. Among them there were 76 (92.7%) males and 6 (7.3%) females. The median age was 55.2±10.8 years. Superficial (T1) and inva-sive (Т2—4а) carcinomas were detected in 33 (40.2%) and 49 (59.8%) patients, respectively. Category N+ was identified in 3 (3.7%) patients.All the patients received RT to the bladder area (median total focal dose (TFD) 56±12.3 Gy) and regional metastatic zones (median TFD40.0±0.0 Gy). A full effect of irradiation was achieved in 44 (53.7%) patients, of whom 41 (93.2%) developed local relapses. All the 82patients underwent radical cystectomy: that with ureterostomy in 28 (34.1%) cases, Bricker’s operation in 45 (54.4%), Studer’s operationin 4 (4.9%), and rectal urinary bladder in 5 (6.1%). The median follow-up was 32.7±31.9 months.

Results. The median interval between RT and cystectomy was 12.5±5.1 months; the median time of surgery was 360 (60—480) min; themedian blood loss was 1515.2±1227.8 ml. Intraoperative and postoperative complications developed in 10 (12.2%) and 40 (48.6%)patients, respectively. Repeated operations were performed in 7 (8.4%) cases. Mortality was 4.9%. A urinary derivation technique failed toaffect the incidence of complications and the rates of mortality (p > 0.05). Histological studies revealed transitional-cell carcinoma in thedistant specimens in 80 (97.6%) cases. Recurrences developed in 40 (48.8%) of the 82 patients following an average of 32.9 (1—150)months of cystectomy: local relapses in 5 (6.1%) cases; distant metastases in 29 (35.4%); a local relapse and distant metastases in 5 (6.1%);urethral recurrence in 1 (1.2%) patient. Five-year overall, specific, and relapse-free survivals were 43.9 (median 48.4±10.5 months), 48.5(59.9±9.3 months), and 42.8% (47.4±9.6 months), respectively.

 Conclusion. Sparing cystectomy with any urinary derivation technique is associated with the acceptable frequency of complications and pro-vides fair long-term results in patients who show no complete effect or who have a local UBC relapse after RT. 

The authors describe their first experience in using bipolar transurethral resection for a urinary bladder tumor. The obvious advantage of thistechnique over others suggests that in the immediate future the bipolar technology will serve as the gold standard instead of monopolar one.

Background: Both bacillus Calmette-Gue’rin (BCG) and interferon-alpha (IFN-α) are active against urinary bladder cancer. In this studywe evaluate the therapeutic efficacy and toxicity of combined intravesical BCG plus IFN-α for treating non-invasive bladder cancer.

Subjects and methods: A total of 149 patients (mean age 63.2 years) were enrolled for the study. The inclusion criteria were histologically verifiednon-invasive transitional cell carcinoma with intermediate and high risks of recurrence and progression. After transurethral tumor resection, all thepatients were randomized in three groups. Group 1 (n=60) was treated with a 6-week course of BCG, 125 mg, starting 14 to 21 days after TUR, Group2 (n=60) patients received 6-week instillations of BCG, 125 mg, plus IFN-α, 6 million units, Group 3 patients (n = 29) had 4-month courses ofintravesical IFN-α, 6 million units, twice daily during 3 consecutive days. A response was assessed by cystoscopy every 3 months after treatment.

Results: A median follow-up of 30.9 months revealed recurrences in 26 (43.3%) patients in the BCG group, 8 (13.3%) patients in the BCG + IFN-αgroup and 18 (62.1%) patients in the IFN-α group. Progression to muscle invasion occurred in 12% and 7% in Groups 1 and 3, respectively, withno progression in Group 2 patients. Three-year relapse-free survival was higher in the BCG+IFN group (78.5% versus 62.6 and 40.2% in theBCG and IFN-α groups, respectively). There was no significant difference between the BCG groups in relapse-free survival. Monotherapy withIFN-α showed a significantly lower response rate than did BCG therapies (p = 0.007). Adverse reactions were observed in 25, 116, and 6.9% ofpatients from Groups 1, 2 and 3, respectively. Toxicity-related withdrawal and treatment delay were similar in both BCG groups. Comparison ofthe rate of adverse reactions revealed a significant difference between the BCG + IFN-α and BCG groups (p = 0.025). The respective rates ofmoderate-to-severe adverse reactions caused by treatment were 6.7 and 21.7% in the BCG+IFN-α and BCG groups, respectively (p = 0.013).

Conclusions: Full-dose intravesical BCG plus IFN-α appears to be much effective than BCG and IFN-α monotherapies despite that there isno significant difference in this study. IFN-α monotherapy showed the lowest complication rate but a lower response rate than those withBCG therapies (p = 0.007). The co-administration of BCG and IFN-α displayed a significantly less complication rate and severe adversereactions (p = 0.025 and p = 0.013, respectively). Longer follow-up is required to validate these findings.

Whether it is expedient and possible to effectively affect the tumors of the urinary bladder by ionizing irradiation remains urgent not onlydue to a rise in the rate of primary carcinoma at this site, but also to the late diagnosis and high incidence of recurrences after surgical andmultimodality treatment. The paper describes the causes of radiation cystitis in patients after radiotherapy for small pelvic neoplasms andconsiders the currently available methods and technologies for eliminating these causes. 

The volume of an operation on the urinary bladder (UB) in case of its extensive involvement due to locally advanced colorectal can-cer varies from partial cystectomy to cystectomy. The results of a morphological examination of 18 patients after pelvic exenterationdemonstrated true invasion into the urinary bladder wall only in 7 (38.9%) cases. This created preconditions for organ-preservingtreatment. Combined operations with partial cystectomy were performed in 37 patients. Pathology showed true tumor invasion intothe urinary bladder wall in 13 (35.1%) cases. The bladder volume was 55.2±17.1 ml after surgery and 175 to 360 (230±31.2) mlfollowing autohydrotraining with pharmacological support made 3 months after surgery. No patient had recurrent urinary bladderdisease. The surgical results suggest that organ-preserving treatment does not violate the oncological radicalism principles and is aserious alternative to cystectomy: Firstly, there is no need for the technically complex stage of an operation - to create a urinaryreservoir. Secondly, urination is preserved by its natural way; there are no signs of urinary incontinence, which ensures the betterquality of life. 

The development of prostate cancer is inseparably linked with the effect of androgens on the fundamental prostatic intracellular processes,such as proliferation, apoptosis, which is realized through a number of second messengers. Major of them are the AR gene encoding androgenreceptors and the SRD5A2 gene encoding 5α-reductase enzyme. This paper deals with the study of the role of these genes in prostate cancer. 

According to the data obtained by Russian and foreign investigators, the major complication after radical prostatectomy (RPE) is urinaryincontinence that is recorded in 20-30% of cases.

Objective. To improve the results of surgical treatment in patients with prostate cancer, by developing and introducing a well-rounded post-operative rehabilitation program.

Subjects and methods. Seventy-four patients who were treated at the urology clinic, Bashkir State Medical University, and underwent RPEin 2005 to 2007 have been examined; 27 of them were diagnosed as having urinary incontinence (UI). After discharge from the clinic, acontrol group received rehabilitative treatment at the sanatorium “Krasnousolsk” of the Republic of Bashkortostan.

 Results and discussion. Therapeutic exercises and pelvic floor electrostimulation halve the number of day urinations and paddings used inpatients with UI, by increasing the bladder capacity from 138.2±12.7 to 196±11.2 ml and improving the trophism of the bladder neck andurethra in the sphincteral area.

Objective: to study the likelihood of tumor extracapsular invasion (EI) and lymphogenous metastasis (N+) in patients with prostate cancer(PC) after radical prostatectomy (RPE) on the basis of prognostic factors.

Subjects and methods. Fifty hundred patients who had undergone RPE in 1999-2008 were enrolled in the study. The patients' age was63.2±6.2 (range 46-78) years; median prostate-specific antigen (PSA) was 11.0 ng/ml (interquartile range 7.4-19.5 ng/ml). According topreoperative findings, 418 (78.9%) and 112 (21.1%) patients were diagnosed as having advanced and locally advanced PC, respectively.According to Gleason tumor grades, the patients were distributed as follows: 2-4 scores in 94 (17.7%) patients; 5-6 scores in 266 (50.2%);7 scores in 103 (19.4%); 8-10 scores in 26 (4.9%). Planned histological studies revealed no tumor in 1.5% of cases; advanced and locallyadvanced PC was diagnosed in 54.5 and 45.5% of cases, respectively; of them N+ was in 32.9%.

Results. A correlation of prognostic factors and expected outcomes was analyzed, the results of which were used to select the most importantpredictors of the extension of a tumor process (percent of positive biopsy specimens, sum of Gleason scores, PSA level, clinical process stage,presence of EI from preoperative data). Regression models were created considering the results of the logistic regression analysis. To evalu-ate efficiency, the area under the AUC-ROC curve was calculated for each model. For evaluation of the comparative effectiveness, the AUC-ROC curve was also estimated for each outcome, by applying the Partin tables.

Conclusions. The developed models of predicting the presence of tumor EI and metastatic spread to the lymph nodes make it possible to havea good agreement of the predicted likelihood of an outcome and the results of a histological study. These models show a higher prognosticeffectiveness than do the Partin tables. 

Lucrin depot used to treat patients with prostate cancer has been investigated. The agent has been found to be highly effective, to causeadverse effects rarely, and to be well tolerated. The administration of leuproreline acetate yields the results comparable with those in the useof other luteining hormone-releasing hormone agonists and antagonists, bilateral orchiectomy, and estrogens. 

Objective: to evaluate the pharmacodynamic equivalence of 3-month and 28-day formulations of tryptoreline, a sustained-release luteininghormone (LH)-releasing hormone analogue.

Subjects and methods. The patients who had a verified diagnosis of locally advanced or metastatic prostate cancer were randomized intogroups to have either one injection of a 3-month dosage form (n = 63) or 3 injections of a 28-day formulation at 28-day intervals (n = 68).The onset rate of drug-induced castration, which was defined as a percentage of the patients achieving a plasma testosterone level of ≤0.5ng/ml, was compared on day 84 (i.e. thrice every 28 days). The plasma profiles of testosterone, LH, and tryptoreline, as well as the changesin the plasma concentration of prostate-specific antigen (PCA) from the baseline values were estimated within 3 months (from the initiationof therapy to day 91).

Results. In the 3-month and 28-day groups, the onset rate of drug-induced castration was 98 and 96%, respectively (at confidenceintervals (94.2% bilaterally) in [-8.1%; 9.6%]. The median time for drug-induced castration was 18.8 and 18.5 days, respective-ly (p = 0.86; log-rank test). The ratios of the mean peak plasma concentrations to AUC91 of the two formulations for testosteroneand LH were within 0.80; 1.25 equivalence interval. By day 91, the mean PSA level was decreased by 91.0 and 91.7%, respec-tively (p = 0.73).

Conclusion. The use of the two formulations during 3 months is pharmacologically equal. 

A major focus of this paper is on the organization of specialized urological treatment, by taking into account the Governor's program “Male urological health” in the Sverdlovsk Region. It also shows the great importance of financial support for early diagnosis, timely effective treatment, clinical examination, and better quality of life in the male population of the Sverdlovsk Region.

The indices of primary and repeated disability were analyzed from the materials of examining 1198 patients with oncourological diseases at the Medicosocial Examination Bureau of the Samara Region. The age-gender index and the severity of disability greatly differed in the group of persons whose disability was repeatedly established.