The prognostic value of the expression Ki-67, ММР-9 and collagen IV were estimated in urotelial bladder tumors. The biopsy and surgery samples from 43 patients (27 males and 16 females ) aged 42 to 87 years (mean age 66 ± 1.5 years) who received combination treatment for urotelial tumors. It has been found that Ki-67, ММР-9 and collagen IV are important prognostic markers of urotelial invasive bladder carcinoma.

Background. The advantage of our proposed therapy technique is to transit from the photodynamic diagnosis stage to effective therapeutic exposure (photodynamic therapy (PDT)) during one intervention.

Objective: to evaluate the efficiency and safety of the novel treatment option for superficial bladder carcinoma (BC).

Subjects and methods. The study enrolled 18 patients aged 66 ± 5 years (range 60−75 years) with superficial BC. A photosensitizer (photoditazine, Veta-Grand, Russia) was intravesically injected in a dose of 10 mg in 20 ml of saline solution 2 hours before intervention. Endoscopy was carried out on Storz PDT equipment with a monochrome light source at a wavelength of 402 nm, which corresponded to the maximum absorption spectrum for the molecule of photoditazine. The procedure was started with the PDT stage during which damaged bladder mucosal areas were found. Then there was transurethral resection of detected papillary masses and fluorescent areas with well-defined outlines. The fluorescent areas with ill-defined outlines underwent targeted light exposure at a wavelength of 402 nm for 5–10 min. The total light exposure of the bladder mucosa during the entire procedure was at least 30 min. The above procedure was performed in the patients at their inclusion into the study, then 1, 4, 7, 10, and 13 months later. The rates of complete tumor regression and adverse events were estimated during the study.

Results. Multifocal bladder mucosa lesion with invasion grades Ta, T1, Tis was detectable in all the patients at their inclusion into the study. Complete tumor regression was noted in 13 (72 %), 15 (83 %), and 17 (94 %) patients 1, 4, and 7 months after initiation of treatment, respectively. Following 10 and 13 months, no tumor tissue was found in the biopsy specimens from any patients. There were no evident local and systemic toxic reactions, including skin photosensitization.

Conclusions. The proposed technique versus the traditional treatments for superficial BC is advantageous in its high antitumor selectivity and the absence of obvious local and systemic toxic reactions (so in the possibility of multiple repetitions of a treatment procedure), and a complementary combination of photodynamic diagnosis and therapeutic exposure (PDT) during one procedure. Our proposed technique is a promising treatment for superficial BC, including carcinoma in situ.

Radical cystectomy (RCE) is associated with a considerable number of early postoperative complications as before. Based on 10 years’ experience, this paper demonstrates the frequency (33.9 %) and types of early complications following RCE, as well as postoperative mortality (5.5 %) and its resulting causes. Although postoperative mortality is relatively low today, the frequency of early postoperative complications remains high as before.

The paper considers treatment regimens for metastatic bladder cancer (MBC) and gives the data of trials of the efficiency of using different chemotherapy schemes and regimens in patients with MBC.

The results of research in 130 patients with space-occupying lesions of kidneys treated in MCH n.a. S.R. Mirotvorcev were analysed. The diagnostic significance of metabolic tumor marker TuM2Pk, matrix metalloproteinases ММР-9, ММP-3, vascular endothelial growth factor (VEGF) and angiogenic cytokines (TNF-α, IL-8, IL-12) was evaluated. It was determined that VEGF detection in blood serum has the most important diagnostic value in differential diagnosis between renal tumor and renal cyst and in TNM staging.

The experimental modeling of a kidney resection and nephrectomy in a series on 100 laboratory rats in comparison with group of the control animals has revealed essential authentic (p < 0,05) the disorder of kathecholamine metabolism not only in operating kidney, but also in opposite, and also in heart and Central nerve System. As a result of 30-day's supervision over animals is revealed, that the specified the disorder of kathecholamine metabolism in the early postoperative period after nephrectomy are expressed much in the greater degree and up to the end of experiment is saved in comparison with group of a kidney resection, in which by 30 day of experience all investigated parameters were normalized. The given study is an experimental substantiation the greater pathophysiological safety of a kidney resection in comparison with nephrectomy.

The study estimated overall and adjusted survival rates and analyzed the role of clinical, morphological, and laboratory parameters in predicting the results of surgical treatment in patients with Stage I renal cell carcinoma (RCC). The patients with RCC were found to have high overall and adjusted survival rates. An independent prognostic factor, such as erythrocyte sedimentation rate, that was statistically significantly related to the risk of death from the underlying disease was identified.

The incidence of kidney cancer is 2–3 % of all malignancies and tends to rise. If the problems of treatment in patients with a renal tumor and a normally functioning contralateral kidney have mainly been solved, how to treat patients with bilateral tumors and a tumor in a solitary functioning kidney continues to be discussed. In particular, the limited decrease in renal function of the remaining kidney in a patient after nephrectomy, whose achievement does not require renal replacement therapy, has not been conclusively defined; what part of a solitary kidney with tumors will be able to maintain a good quality of life in the patient, without doing hemodyalisis, has not been elucidated either.

Objective: to estimate the rate, predictive and prognostic value of VHL gene alterations in the population of patients with sporadic metastatic renal cell carcinoma (mRCC).

Subjects and methods. Paraffin embedded tumor tissue blocks were available from 88 patients with mRCC who had undergone antitumor therapy in 1994- 2010. Of them, 53 patients received only immunotherapy regimens with interferon (IFN)-α and 35 patients had targeted therapy with VEGFR inhibitors. VHL mutations were detected by polymerase chain reaction (PCR) for exons of 1-3, single-strand conformation polymorphism analysis of PCR products, and further sequencing. VHL gene methylation was determined by methyl-sensitive PCR.

Results. Somatic mutations and/or promoter hypermethylation of the VHL gene were found in 23 (26%) patients; Of them, VHL gene mutations and promoter hypermethylation were found in 15 patients and 7 patients respectively. Mutation and promoter methylation VHL were simultaneously observed in one case. VHL gene mutations were detected only in patients with clear cell RCC while aberrant promoter methylation was seen in both clear cell and papillary RCC. With a median follow-up of 34 months (range, 2-127 months), the median time to progression (TTP) and median overall survival (OS) for the entire group of patients were 5.8 and 26.7 months, respectively. In patients with and without VHL gene alterations, the median TTP was 5.5 and 6.9 months, respectively (p = 0.15) and the median overall survival time was 22.0 and 34.5 months, respectively (p = 0.98). Moreover, the subgroup analysis revealed that VHL gene inactivation events had no impact on the objective response rate (ORR), TTP and OS in the subgroup of patients who received immunotherapy (n = 53) or antiangiogenic targeted therapy (n = 35) (p > 0.05).

Conclusion. VHL gene mutations and/or promotor hypermethylation observed in 26% of patients with mRCC. These VHL gene alterations were neither prognostic nor predictive factors in mRCC patients during immunotherapy with IFN or antiangiogenic therapy with VEGFR inhibitors.

The paper describes a clinical case of a local recurrence of tubulocystic carcinoma (TCC) in a 46-year-old man, a relatively good course (the relapse occurred after 4 years), who has been successfully operated on and is being followed up. This disease is a rare renal malignancy and, until recently, it has been referred to as collecting tubular carcinoma. However, this disease has come to be regarded as an independent nosological entity, by taking into account its certain morphological, immunohistohemical, and cytogenetic characteristics, as well as the nature of its course. About 80 TCC cases have been described to date. Further study of this disease and other rare renal malignancies will allow the more accurate elaboration of management tactics for such patients in terms of certain prognostic factors, which calls for a larger number of cases of this disease.

Plasma proteome from patients with renal cell carcinoma (RCC) and controls underwent mass spectrometric mapping. A total of 247 proteins were identified; the expression of 12 proteins of them increased on transition from the controls to patients with Stages I–II and III–IV RCC. There was decreased expression of 14 proteins in this series. Out of the 26 proteins showing a change in their expressions, 7 proteins belong to acute-phase ones, 3 proteins are associated with the intercellular matrix. These proteins can be potential markers for RCC.

Due to the introduction of angiogenesis inhibitors into clinical practice to treat metastatic renal cell carcinoma, the trials dealing with the use of this class of medications are urgent. The paper gives the results of studies of the efficacy of bevacizumab in combination with low-dose interferon-α2a.

Intravesical chemo/immunotherapy is a constituent of combination treatment for bladder cancer and widely used after transurethral resection of the tumor. The goal of intravesical therapy is to reduce the risk of a recurrence and progression of the disease, by exerting a direct cytotoxic effect on malignancy. The unique properties of the bladder make it possible to constantly improve the existing local therapy options and to develop novel ones, such as intravesical electrophoresis, local hyperthermia, gene therapy, and the use of penetrants and magnetic particles. The given review combines the physicochemical and pharmacokinetic properties of drugs, the histoarchitectonic features of the bladder, the present and future of intravesical therapy.

Erectile dysfunction is a frequent complication of radical prostatectomy despite numerous modifications in surgical technique. The term «penile rehabilitation» refers usually to treatments intended to restore functional penile erection after radical prostatectomy. Selective phosphodiesterase type 5 inhibitors are the mainstay of this rehabilitation at present. Tadalafil seems a logical choice for recovering of erectile function
after radical prostatectomy given its prolonged duration of action. The once-daily dose of tadalafil has the theoretical benefit in terms of safety and separation of medication from sexual activity. In this paper we review the published clinical and basic science research studies on the role of tadalafil in patients with postprostatectomy erectile dysfunction.

A bacteriological study of prostate biopsy specimens was conducted in patients with prostate benign hyperplasia (PBH) and in those with prostate cancer (PC). It revealed a wide range of aerobic (Corynebacterium sp., Enterococcus sp., E. coli, S. haemolyticus, S. hominis) and nonclostridial anaerobic (Bacteroides sp., Bifidobacterium sp., Eubacterium sp., Propionibacterium sp., Рeptococcus niger, Peptostreptococcus sp., Prevotella sp., Veilonella sp., Fusobacterium sp., Capnocytophaga ochracea, Streptococcus parvulus) bacteria. Differences were seen in the detection rate of these microorganisms and in the level of tissue infectivity in PBH and PC. The average seeding of the prostate biopsy specimens and the detection rate of different types of bacteria in PBH were greater than those in PC; moreover, some bacteria were undetectable in PC at all.

Radical prostatectomy is a «gold standard» for treatment of the patients with a localized prostate cancer. Urinary incontinence is one of the two most common complications of this operation. In this article we report a study aimed to compare the efficacy parameters linked to postoperative continence in 39 patients with new technique for reconstruction of the bladder neck during the radical prostatectomy using a deep suture of the bladder wall dorsally to the neck aperture with 45 patients in control group with a standard type of reconstruction in the form of tennis racket. According to the results, application of the new technique leads to a significant improvement in continence during the first 6 months after the operation with no difference among groups during follow-up later on. Given the results of the anatomical study, the efficacy of the new method of reconstruction is linked to passive closure mechanism created in the area of the bladder neck.

The frequency and degree of complications and adverse events following radical prostatectomy (RPE) depend on many factors; a major factor of them includes a surgeon’s experience. In this connection, the results of an operation were analyzed in relation to surgical experience. The results of 215 RPE cases were examined. The median postoperative follow-up was 53 months (range 3–132 months). The analysis was made in 3 steps: 1) 2000−2006 (n = 60), 2) 2007−2009 (n = 74), 3) 2010−2011 (n = 81). It was found that perioperative, functional, and oncological results improved, quality of life in patients increased, and treatment costs decreased as surgical experience was higher. Thus, the analysis has confirmed that a surgeon’s experience is a major factor that influences all the results of RPE.

Background. Retropubic radical prostatectomy (RPE) is now the gold standard of treatment for locally advanced prostate cancer (PC). However, robot-assisted RPE procedures using the da Vinci system are finding increasing acceptance.

Materials and methods. The authors conducted a prospective study of 60 robot-assisted prostatectomies made at the Clinic of Urology, N.I. Pirogov National Medical Surgical Center, in the period January 2009 to December 2010.

Results. The duration of an operation averaged 230 min; the average amount of blood loss was 200 ml. The mean duration of postoperative analgesia was 2,7 days. That of urinary catheterization was 8.5 days. A normal postoperative course was noted in most cases (88,4 %). Seven patients were found to have 8 (13,3 %) mild and moderate complications. A pathohistological study revealed a positive surgical margin of resection in 21,7 % of the patients, extracapsular tumor growth in 21,7 %, and seminal vesicle invasion in 23,3 %. Tumor-affected regional lymph nodes were detected in 1 (1,7 %) patient. In our observed series, 82 and 93 % of the subjects completely retained urine after 6 and 12 moths, respectively. Throughout the follow-up, erectile function recovered in 7 of the 15 patients undergoing a nerve-sparing surgical procedure.

Conclusion. Postoperative results in our series of interventions are comparable to those obtained in the studies by Russian and foreign colleagues at the early stage of mastering this procedure. By considering a few observations, it is today difficult to say that our study is valid in the context of evidence-based medicine. Estimation of the benefits of robot-assisted laparoscopic prostatectomy calls for long-term multicenter randomized trials.

The main radical treatments for patients with prostate cancer (PC) are radical prostatectomy (RPE) and radiotherapy. At the same time pelvic lymphadenectomy (PLAE) in patients with PC is an important diagnostic step during both surgical and radiation treatments. The main goal of PLAE is to evaluate the pelvic lymph nodes. The paper gives the data of a number of trials of the efficiency of RPE with extended PLAE and adjuvant hormonal therapy.

Objective. The developing and introduction the quality of life (QL) automatized assessment in oncourological patients in clinical practice.

Subjects and methods. General questionnaire EORTC QLQ-C30 and modules (QLQ-PR25 and QLQ-BLM30) were selected for QL assessment. The software tools of hospital information system were used for development. There were surveyed 236 oncourological patients.

Results. Forms of unitary and dynamic researches were developed for result visualization, interactive modules were developed for data complex analysis. The first results of QL assessment were received. The highest values were in role and social functions (medians were equal 100 points). Fatigue, pain and sleeplessness were disturbed patients most of all (medians — 33,3, 16,7 and 33,3 points respectively). The median of Global health status was not high, only 50 points. There were analyzed three nosological groups of patients: urinary bladder cancer, renal cancer, prostate cancer. And the lowest values of functioning scales were in patients with urinary bladder cancer; also these patients complained of dyspnea reliably more often.

Conclusions. The developed technology of quality of life study can be used as a good methodological base for assessment of cure efficiency not only in early postoperational period, but during treatment, and in late time after termination of course of treatment.

The paper describes a clinical case of a local recurrence of tubulocystic carcinoma (TCC) in a 46-year-old man, a relatively good course (the relapse occurred after 4 years), who has been successfully operated on and is being followed up. This disease is a rare renal malignancy and, until recently, it has been referred to as collecting tubular carcinoma. However, this disease has come to be regarded as an independent nosological entity, by taking into account its certain morphological, immunohistohemical, and cytogenetic characteristics, as well as the nature of its course. About 80 TCC cases have been described to date. Further study of this disease and other rare renal malignancies will allow the more accurate elaboration of management tactics for such patients in terms of certain prognostic factors, which calls for a larger number of cases of this disease.

The paper describes clinical examples of tuberous sclerosis and angiomyolipomas, their manifestations, and methods for their diagnosis and treatment.

Bladder cancer (BC) is the second most common urinary tract malignancy. Early diagnosis of BC generally increases the probability of successful treatment in a patient. The paper considers noninvasive diagnosis methods for BC and gives a database of the known molecular markers of this disease.

Bladder cancer (BC) is one of the most common malignancies. More than 90 % of the notified cases are morphologically diagnosed as transitional cell carcinoma; moreover, over 70 % of them are the early stages (Ta, Tis, and T1) of the disease. Patients with diagnosed T1 tumor are deemed to be the most difficult group of patients with early-stage BC. Despite the generally good prognosis of the course of this stage of BC after performed therapy, the tumor recurs in most patients and progresses to a more disseminated stage in 15–20 %. In this connection, there is a continuous search for the prognostic markers associated with the poor prognosis of the disease. A number of morphological, immunohistochemical, and molecular signs that, according to the investigators’ data, correlate with the risk for BC recurrence and progression have been identified. Nonetheless, a diagnostic testing algorithm that permits the prediction of the course of the disease from primary histological data remains to be elaborated. There should be further investigations that enable one to develop an informative panel of diagnostic and prognostic markers that allow a pathologist to correctly define the stage and prognosis of the disease and a clinician to choose an optimal treatment policy for each patient.