During orthotopic ileocystoplasty, the short mesentery causes an increase in the risk of incompetence of anastomosis of the reservoir with the urethra. Inverting orthotopic ileocystoplasty ensures a free reservoir pull-through into the small pelvis and eliminates tissue tension in the anastomosis. The proposed procedure differs from the Studer operation in that the reservoir is sutured lengthwise, after which it is inverted between the mesenteric leaves. The posterior reservoir wall is anteverted and freely brought out into the small pelvis. This reduces the distance to the urethral stump by 3-4 cm. This procedure was used in 19 patients to be operated on. There were no cases of reservoir or reservoir-urethral anastomotic incompetence. The mean neocystic capacity was 110, 350, and 490 ml 0, 3, and 12 months, respectively, after urethral catheter removal. The maximum reservoir pressure does not exceed 40 (mean 30) cm H2O. Daytime urinary retention was 94.7%; nocturnal urinary retention during forced nocturnal miction was 79%. The obtained functional results compare well with those achieved during the similar procedures.

Among 1430 patients with renal tumors, followed up at the Urology Clinic, I. M. Sechenov Moscow Medical Academy, in 1973 to 2007, 117 (8.2%) patients were found to have bilateral neoplasms, 81 (5.7%) patients being diagnosed as having bilateral renal cell carcinoma (RCC), out of them 51 (3.6%) and 30 (2.1%) patients had synchronous and asynchronous RCC, respectively. Asynchronous tumor was identified in 19 (63.3%) and 8 (26.7%) patients in the period of under 5 and >10 years (including 22 years in 1 case), respectively, after initial tumor removal. Among 30 patients with asynchronous RCC, 27 had previously undergone nephrectomy and 3 had resection of a kidney with tumor. When asynchronous RCC was detected, its treatment policy consisted of organ-preserving surgery. Analysis of the morphological pattern of a tumor in patients with bilateral asynchronous RCC revealed its similar type in 85.2% of cases and the identical degree of tumor cell differentiation in 48.1%; the patients with a varying degree of differentiation were ascertained to have high-grade asynchronous malignancy in 92.9% of cases. Molecular genetic studies showed that all the patients had mutations of VHL and FHIT genes located on the third pair of chromosomes. Our findings indicate that bilateral RCC is a genetically determined primarily bilateral tumor process that can manifest itself at once (synchronously) or after a (frequently considerable) time (asynchronously). In asynchronous carcinoma, overall and adjusted 5-year survival rates were 53.3 and 60%, respectively. The fact that an asynchronous tumor may occur in the contralateral kidney a considerable time after the first surgery necessitates to make a regular purposeful follow-up of patients operated on for unilateral RCC. The minimum control examination should include chest X-ray study, ultrasonography of the remaining kidney, removed tumor bed, and great vessels, which should be performed every 6 months within the first 5 years, then once every year. If a disease relapse is suspected, multispiral computed tomography of the abdomen and retroperitoneal space is to be made.

Objective: to study the efficiency and tolerance of autologous vaccine therapy based on dendritic cells (DC) in patients with renal cell carcinoma (RCC) and to examine changes in immunological parameters and their association with the efficiency of the therapy. Subjects and methods. Twenty-nine patients with RCC received autologous vaccine therapy based on DC in 2002 to 2008. Therapy was performed in the induction mode in 16 patients before disease progression and in the adjuvant mode (8 vaccinations) in 13 patients after radical nephrectomy (grade III) or radical metastasectomy. Peripheral blood monocyte-derived DCs treated with autologous tumor lysate were used to prepare the vaccine. Results. In a group of 16 patients with distant metastases, partial regressions were recorded in 2 (12.5%) patients and long (> 6-month) stabilizations of a tumor process were observed in other 2 (12.5%) patients. The median time prior to progression was 3 (range 1.5-12) months. Thirteen patients on adjuvant treatment did not achieve the median time to progression: 4 patients showed no signs of disease progression ?12 to ?25 months after metastasectomy. Patients with a clinical effect (disease regression or long stabilization) showed a significant increase in the populations of CD3+CD8+ and CD3-CD16+ T lymphocytes (natural killers (NK) cells) after 3 vaccinations from 23.3 to 27.2% (p = 0.018) and from 15.17 to 20.3%, respectively (p = 0.03). Prior to vaccine therapy, the count of CD3+CD16+-NK cells was thrice greater in patients with the progressive disease than that in the donor group - 11.2 and 3.5%, respectively. The baseline count of CD4+CD25+ Т lymphocytes in patients with progressive disease was also significantly higher than that in patients with the clinical effect - 12.01 and 5.6%, respectively. Conclusion. In patients with RCC, DC-based vaccine therapy is able to induce a specific anti-tumor immune response that is transformed into the clinical effect in some cases. The baseline count of suppressor T lymphocyte (NKT and T-reg) populations may be a factor that predicts the efficiency of autologous DC-based vaccine therapy in patients with RCC. This immunotherapeutic approach merits further study, by defining the indications for its application in patients with RCC.

Renal carcinoma (RC) is one of ten most common malignancies in adults and an urgent problem of modern oncology. The purpose of the study was to make a molecular genetic analysis of a number of suppressor genes in RC, which was aimed at searching for and characterizing the potential markers of the disease. Two hundred and nine RC samples were examined, of them there were 192 clear-cell carcinomas. VHL gene mutations were detected by single-strand conformation polymorphism and sequence analyses while the methylation of suppressor genes was by the methylation-sensitive polymerase chain reaction. Somatic VHL mutations were determined in 35.4% of cases of clear-cell RC (CCRC). VHL gene disorders were found in 53.7% of patients with Stage 1, which counts in favor of VHL inactivation in early-stage CCRC. The methylation of the VHL, RASSF1, FHIT, and CDH1 genes was identified in 12, 56, 58.4, and 46.4% of primary tumors, respectively; that of at least one gene was in 84.1% of the samples. The hypermethylation of the RASSF1 gene was associated with late stages (p = 0.015) and the presence of metastases (p = 0.036); that of the CDH1 gene was related to the progression, invasion, and dissemination of primary tumors (p = 0.009, 0.039, and 0.002, respectively). The findings show it possible to use an analysis of abnormalities in the VHL gene and the methylation of the RASSF1 and CDH1 genes to develop a system of molecular genetic markers of RC.

Objective: to define predictors that influence longevity in patients with recurrent non-seminomatous germinal testicular tumors (NGTT) on standard second-line chemotherapy (CT) including cisplatin and iphosphamide. Statistical analysis was performed using the statistical packages Graph Pad Prism 4.00 for Windows and SPSS 15.0 for Windows. Subjects and methods. Case history data were analyzed in 693 patients with disseminated NGTT who had received current CT and followed up at the Department of Clinical Pharmacology and CT, N.N. Blokhin Russian Cancer Research Center, Russian Academy of Medical Sciences. The median follow-up was 32 (range 3-215) months. The disease progressed in 181 (26%) patients. Detailed information was available on the nature of second-line CT in only 138 patients. Half (71 (51.7%) of the 138 patients had second-line CT including iphosphamide. Uni- and multivariate analyses were made to identify predictors that influence longevity in patients with recurrent NGTT on standard secondline CT including cisplatin and iphosphamide. Results. Five-year overall survival (OS) was 32% (95% confidence interval 25-41%). The multivariate analysis showed the morphological pattern of a primary tumor (a yolk sac tumor component), a pre-induction CT lactate dehydrogenase (LDH) level of ?d1.5 units of the upper normal range, progression during induction CT, and a pre-second-line CT LDH level of ?d 1000 U/l to be negative predictors. According to the number of negative factors, the patients were classified into 3 groups: 1) good prognosis [n = 10 (14%) of the 71 patients], 100% 3-year OS; 2) intermediate prognosis (one negative factor) [n = 33 (46.5%) of the 71 patients], 50.2% 3-year OS; 3) poor prognosis (?d 2 negative factors), 6.7% 3-year OS. Conclusion. Standard iphosphamide-containing therapy enables all patients to be treated in the good prognosis group of those with recurrent NGTT. That fails to achieve such striking results in the intermediate and poor prognosis groups of patients with recurrent NGTT, which necessiates to search for new treatment regimens and approaches for these patient groups.

Radiotherapy (RT) alone or in combination with other treatment modalities is widely used in the treatment of urological and gynecological cancers. Despite the fact that there is continuous technical improvement of equipment and RT procedures, the frequency of complications due to this treatment option remains high in the early and late periods and generally requires complex and long-term care. One of the leading pathogenetic mechanisms responsible for the development of these complications is vascular endothelial damage and hence decreased blood and oxygen supply to the tissues of pelvic organs. Postradiation cystitis is one of the commonest complications of RT. Among various treatment modalities for postradiation hemorrhagic cystitis, hyperbaric oxygenation yielded good results particularly in cases of ineffective standard treatments.

The paper analyzes procedures for internal drainage of the upper urinary tract in ureteral tumor obstructions. It details indications for and contraindications to ureteral stenting or endoprostethic replacement, subcutaneous nephrovesical bypass. Postoperative complications and procedures for their prevention and treatment are considered. The data available in the literature on rare drainage procedures for the upper urinary tract, such as ureteral endoprosthetic replacement and nephrovesical bypass, are summarized.

TNephroureterectomy is by right considered to be the gold standard for treatment in patients with urothelial cancer of the upper urinary tract. Nevertheless, various surgical treatments are now being intensively developed and introduced into clinical practice and a possibility of using adjuvant and neoadjuvant chemotherapy is also being studied. The review summarizes data on various methods of treatment, its efficiency, long-term results and prognosis.

Clinical staging of cancer is the important element of a diagnostic process that determines the nature and scope of therapeutic measures required for a patient. Objective: to assess the role of clinical, clinical laboratory, and morphological findings in the diagnosis of prostate cancer (PC) and to analyze the pattern of its clinical stages in patients having different levels of serum prostate-specific antigen (PSA) and the results of digital rectal examination (DRE) and ultrasound study (USS) of the gland. Subjects and methods. The examination and follow-up records were analyzed in 2579 males aged 38-88 years who had indications for primary puncture biopsy of the prostate. Results. PC was detected in 997 (38.66%) patients. Clinically localized adenocarcinoma was diagnosed in 50.85% of cases, locally advanced one being in 49.15%, including that with its invasion into the seminal vesicles in 8.73%. The findings of DRE and transrectal USS and serum PSA values allow one to substantially define the likely extent of cancer.

The incidence of polyneoplasia was studied among the urban and rural populations of the Omsk Region. Urinary tract neoplasms constitute 10% of the total structure of cancer morbidity, these occurring twice more frequently in the urban population than in the rural one. Polyneoplasias involving the urinary tract are metachronous in 62.8%, synchronous in 35.2%, metachronous-and-synchronous in 1.2%, and synchronous-and-metachronous in 0.8%. Out of 253 patients with polyneoplasia involving the urinary tract, 176 (69.6%) died and 77 (30.4%) survived during 8 years.

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Rhabdomyosarcoma is the most common soft tissue tumor in children aged less than 19 years. In the represented case report, polychemotherapy at Stage 1 of treatment resulted in a complete regression of metastases in the lung and pleura, normalization of the patients health status within 18 months. Consolidation radiotherapy directed to the prostate and femoral bones could achieve a local control over these foci. The emerged recurrence was located in the lung and pleura. The effect of second-line chemotherapy did not exceed 3 months. Despite primary disease dissemination and poor prognosis, disease stabilization and better quality of life (improved general condition, recovery of spontaneous urination, relief and complete disappearance of pain) could be achieved at therapy month 27.

The nested variant of urothelial cell carcinoma is a relatively rare neoplasm of the urinary bladder, which has in turn an aggressive behavior and a poor prognosis. This report discusses the clinical pathological characteristics of this disease and its possible treatment options.

At present Sunitinib is the drug of choice in the treatment of metastatic renal cell carcinoma. In some cases complications due to the use of the drug make it to be unreasonably discontinued, which potentially affects the results of therapy. The paper proposes practical recommendations for the prevention, timely detection, and correction of the adverse reactions of Sunitinib, which enables the treatment to be performed safely and in adequate doses.