Introduction. Primary multiple tumors (polyneoplasia) represent synchronous or consecutive and independent from each other development of two or more tumors. Frequency of urinary tract tumors composing primary multiple tumors is from 10 to 13,5%. There is a constant growing interest in primary multiple tumors due to the increase of patients with this kind of disease. Up to the present, many issues related to diagnostics and method choice to treat primary multiple tumors remain questionable.

Materials and methods. In our research, 1632 patients with urinary tract tumors were treated in the N.N. Burdenko Main Military Hospital's Oncourology Department from December 1998 to December 2005. Out of them, 570 (34,9%) were patients with prostate cancer, 469 (28,8%) with bladder cancer, 442 (27,1%) patients with kidney tumors, and 78 (4,8%) with renal pelvis tumor. Out of all patients included in our research, 89 (5,6%) patients were with primary multiple tumors. In average, these patients were 69 years old. Out of them, 8 patients had tumors of three organs.

Results. Nephrectomy (366) and/or kidney resection (114) were performed to patients with kidney tumors. Bladder transurethral resection, bladder resection, and cystectomy with various methods of urine derivation (118) (bilateral ureterocutaneostomia (86), Shtuder's plastic surgery of artificial bladder - 22, Bricker's formation of a urinary duct - 8, and 2 bladder plastic surgery with a skin-muscle graft) were performed to patients with bladder cancer. Prostatectomy (109), or hormonal therapy and radiotherapy were performed to patients with prostate cancer. 42% of patients were diagnosed with urinary system cancer as a part of primary multiple tumors in the first stage, 28% in the second, 18% in the third, and 12% in the forth. The group of patients with kidney tumor 42 (54%) had the largest amount of primary multiple tumors due to cancer of both kidneys 26 (33,8%). In one case, the second tumor was diagnosed 13 years after the first tumor had been diagnosed. During the first month after the first tumor had been diagnosed 42,7% (42), the second one was diagnosed. In a period from 3 to 6 months, the second tumor was diagnosed in 18,2% (16) cases. In cases when cancer was diagnosed for the first time, there were 45% (40) tumors of the first stage, 16% (15) of the second stage, 14,5% (12) of the third, and 24,5% (21) of the forth.

Conclusion. Urinary tract tumors composing primary multiple tumors are not rare, and their diagnosis mainly is incidental. Results of treatment depend not only on the spread of tumor process but also on timely and appropriate combined treatment. Surgery treatment of synchronically diagnosed tumors has to be performed with one surgery, and not to be divided into several operations, because with this method, time factor is very important.

Objective. To compare the immediate and long-term results of laparoscopic and open radical nephrectomies in renal parenchymal tumors.

Subjects and methods. The study covered 195 patients who underwent nephrectomy in 1986 to 2006. Their median age was 54,1 years; male/female ratio was 1,5:1. All the patients were divided into 2 groups. A study group comprised 102 (52,3%) patients with renal tumors, including 93 (91,2%) with renal-cell carcinoma (pT1-3N0-1M0-1) and 9 (8,8%) with benign tumors, who had undergone laparoscopic nephrectomy. Ninety-three (47,7%) patients who had undergone open radical nephrectomy for localized renal cancer were retrospectively selected for a control group. The median follow-up in the laparoscopic and open surgery groups were 19,6±13,2 and 62,3±35,9 months, respectively.

Results. The median time of laparoscopic nephrectomy was significantly more than that of open surgery (170 and 100 min, respectively; p < 0,001). The median blood loss volume did not differ in the groups (280,1 and 283,5 ml, respectively; p = 0,342). In the study and control groups, the frequency of intraoperative complications was 10,9 and 4,3% (p = 0,075) and that of postoperative ones was 10,8 and 7,5%, respectively (p > 0,05). In 8 (7,9%) cases, conversion was required to suture defects of large vessels. In the laparoscopic group, the median length of stay was significantly less than that in the control group (7,0±3,6 and 12,0±3,1 days, respectively; p < 0,001). The differences were insignificant in the average cost of endoscopic and open surgeries. Questionnaire survey revealed a significant improvement in the quality of life after surgery via laparoscopic access. Relapses were detected in 2 (2,2%) patients from the study group: a local recurrence in 1 (1,1%) patient and metastases in 1 (1,1%); and in 5 (5,4%) control patients: metastases in 4 (4,3%), local relapse and distant metastases in 1 (1,1%; p = 0,271). In renal cancer patients undergoing laparoscopic and open nephrectomies, overall, specific, and relapse-free 4-year survival rates were 100; 100, and 94,9% and 96,4, 97,5, and 96,2%, respectively (p > 0,05).

Conclusion. Laparoscopic nephrectomy is the method of choice in treating renal cancer — pT1—3aN0M0, which yields the same long-term results as open surgery and provides a better quality of life.

Objective. The more and more increasing availability of hemodialysis has limited the number of bench surgeries followed by autotransplantation for complex cases of renal-cell carcinoma (RCC) in solitary kidneys during the 1980's and 1990's. However, during recent years, quality of life issues, cost aspects, as well as the relatively high attrition rate under long-term hemodialysis have sparked renewed interest in organ-preserving bench surgery strongly driven by patients' demands.

Material and Methods. We reviewed our experience with 36 recent cases of bench surgery and autotransplantation for complex RCC, collected prospectively in our database.

Results. All tumors were invariably RCCs. Thirty-three, 3, and 1 cases were diagnosed as having clear-cell, papillary, and chromophobe carcinomas, respectively. All cases were preoperatively examined by imaging procedures as «organ-confined», whereas definitive pathology revealed a tumor stage ranging from pT1 to pT3a, always pN0, and M0. There were few surgical complications that were significant. One perioperative myocardial infarction-induced death occurred on postoperative day 5, one kidney was lost due to transplantation failure, and one patient was on hemodialysis for 3 weeks until complete functional recovery occurred. After a relatively short median follow-up of 2,8 years, one patient had distant metastasis and another patient had a recurrent renal tumor after 13 months.

Discussion. Analysis of our personal experience with 21 retrospective cases from 1992 to 2000 and 36 prospective cases (this series) from 2001 to 2006 has shown that bench surgery and autotransplantation for complex cases of RCC are feasible and probably cost effective. There is a clear need for strict inclusion criteria, such as an imperative indication and organ-confined (hence, surgically curable disease) stages, a multidisciplinary team approach, suitable infrastructure, and experience in major surgical procedures. If these criteria are met, bench surgery followed by autotransplantation has become again a valuable last resort and is apparently safe.

Оbjectives. To asses the direct results of surgical treatment of localized RCC with the help of NSS and RN, and to asses the possibilities of usage of domestic medication Perftoran with the aim of anti-ischemic protection.

Materials and Methods. 187 patients with localized RCC have been treated in our center for 5 years. 118 (63,1%) patients underwent RN and 69 (36,9%) underwent NSS. The mean age in the group of RN was 55,3 and NSS — 55,7. The mean size of the tumor in RN group was 37,91 mm and in the group NSS it was 29,86 mm. 47 patients (68,1%) had elective indications for NSS and 22 (31,9%) patients had imperative indications. Clamping renal artery was used with 21 patients, warm ischemia was used with 16 patients and cold ischemia was used in 5 cases. The mean duration of ischemia was 18,38 minutes. Perfusion of Perftoran was used through the renal artery.

Results. Post-operative mortality was noted in neither group. Early post-operative complications (within 30 days after the operation) in NSS group were noted with 10 patients. Those in RN group were noted with 1 patient. Reoperations were performed for 2 patients in NSS group and for 1 patient in RN group.

Conclusions. NSS is an effective means of control of RCC less than 4 cm with acceptable number of post-operative complications. We obtained good direct results using Perftoran for anti-ischemic protection.

Introduction & Objectives. Cell adhesion molecules play an important role in the pathogenesis of renal cell carcinoma (RCC). Glycoprotein IIIa gene (gp3A) encodes the beta chain of integrin receptor and contains Pl1llA (Leu33Pro) polymorphism. The authors have earlier investigated a role of GP3A polymorphism in prostate cancer and determined that the PlA2 polymorphism of gp3A gene increased the risk of prostate cancer development and invasion. The aim of the study was to examine an association of PlA polymorphism with sporadic RCC patients in the Moscow region.

Material and methods. We determined the genotype of gp3A of 100 patients with RCC and 30 age-matched controls, by using polymerase chain reaction was used.

Results. The distribution of PlA polymorphism in the Moscow population was 76% of PlA1/A1 allele, 22% of PlA1/A2 allele and 2% of PlA2/A2 allele. Sixty (60%) patients with RCC had PlA1/A1 allele, 33 (33%) had PlA1/ A2 allele and 4 (4%) had PlA2/A2 allele. The frequency of PlA1/A2 allele was significantly higher in RCC patients (33%) than in the population (22%) (p < 0,02). Analyzing the genotype subject to TNM stage in patients with localized cancer (T1—2N0M), allele PlA1/A1 was determined in 27 (60%), PlA1/A2 in 15 (35,6%), and PLA1/A2 in 2 (4,4%). Among the patients with invasive cancer (T3—4N0—2M0), 23 (82,1%) and 5 (17,9%) had PLA1/A1 allele and PLA1/A2, respectively. Also, 13 (48%) patients of those with metastatic cancer had PLA1/A1; 12 (44,5%) and 2 (7,5%) had PLA1/A2 and PLA2/A2 alleles, respectively. As for the metastatic group, the frequency of PlA1/A2 genotype was significantly higher (44,5%) than that in the population (22%) (p = 0,02). The OR RCC development for PLA1/A2 genotype as compared to PlA1/A1 was 2,1 for localized cancer and 3,17 for the metastatic group.

Conclusions. PlA2 polymorphism of gp3A gene increases the risk of RCC and metastasis. The course of RCC in patients carrying PlA2 polymorphism is characterized by a more rapid metastatic progression. Comparison of the results of the invasive and metastatic groups can lead to some conclusions. PlA2 polymorphism may be of more considerable importance in metastatic processes than in the development of RCC. The determination of PlA polymorphism seems to be a new predictor of RCC and it is useful and suitable for screening of high-risk patients.

The data of 668 radical cystectomies were used to study the results of treatment in 151 (22,6%) patients with urinary bladder cancer (UBC) metastasizing to the regional lymph nodes and to evaluate the impact of lymphodissection extent on the detection rate of metastases and on survival.

In UBC, routine lymphodissection significantly increases the detection rate of regional metastases as compared with limited lymphodissection from 17,8 to 24,8% (p = 0,04). Expanded lymphodissection in patients with UBC with regional metastases could significantly increase overall 5-year survival (p = 0,006).

In patients with UBC metastasizing to the regional lymph nodes, the survival rates found after cystectomy using the currently available urine derivation techniques suggest that orthotopic urine derivation may be used in this group of patients after radical operation. Among all factors influencing survival in such patients, the degree of involvement of regional lymph nodes (p = 0,04) and the extent of lymphodissection (p = 0,02) are of independent prognostic value.

The paper presents the results of using Vero-Mitomycin in patients with superficial bladder carcinoma (SBC). The study included 23 SBC patients over 18 years of age, with invasion levels of pTa, pT1, and differentiation grades of G1—2, ECOG 0 or 1, who were treated at the Department of Oncourology, P.A. Herzen Moscow Research Oncological Institute. The patients were given 6 intravesicular instillations of Vero-Mitomycin in a single dose of 40 mg. During a follow-up, a recurrence developed in 9 (39.1%) patients, a tumorous process progressed in none patient. There were recurrences at 12—16 months. The acute cystitis syndrome was revealed in 2 patients (after 4 and 6 instillations of the drug). Hematological toxicity was not observed. Thus, Vero-Mitomycin is one of the drugs of choice for the first-line intravesicular chemotherapy in patients with low and moderate risk SBC. Intravesicular chemotherapy with Vero-Mitomycin is an effective and low-toxic preventive method against recurrent SBC.

Introduction and Objectives. The low specificity of PSA for the early diagnosis of prostate cancer was a reason for elaboration of new diagnostic methods. The aim of the study was to create novel diagnostic indices of random mathematic combinations of numeric clinical patient parameters and to estimate these values as a diagnostic tool for the detection of prostate cancer.

Material and Methods. A total of 326 male patients aged 47—83 years (mean age was 65.56.5 years) who had undergone TRUS-guided 12-core systematic transrectal prostate biopsy were included in the study. The detection rate of prostate cancer was 43,6%. To compare the accuracy of the diagnostic indices, receiver-operator characteristic (ROC) curves were plotted for any of the indices and the areas under ROC curves were calculated. Age, prostate volume, transition zone volume, peripheral and central zone volume, concentration of PSA, and biopsy result were recorded in the patients.

Results. A total of 37 indices were generated. The maximal accuracy equal to 0,664 was in «PSA Density in Transition Zone (PSAD-TZ) × Age». «PSAD × Age» and «PSAD-TZ» with an accuracy equal to 0,656 and 0,655 were on 2nd and 3rd rank positions, respectively. PSA with an accuracy of 0,583 was on 31st rank position only. With 90% specificity, the sensitivity of «PSAD × Age», «PSAD-TZ × Age», and «PSA» were 24, 22, and 19%, respectively. With 80% specificity, the sensitivity of «PSAD-TZ × Age», «PSAD × Age», and «PSA» were 47, 40, and 30%, respectively. With 90% sensitivity, there were no differences in the reduction in unnecessary biopsies. At the same time, with 80% sensitivity, «PSAD-TZ*Age» showed a 17% reduction in unnecessary biopsies as compared with «PSA» (р = 0,001).

Conclusions. The indices «PSAD-TZ × Age» and «PSAD × Age» may be used in counseling patients with suspected prostate cancer. Further multicenter studies may be required to evaluate the effectiveness of the novel indices widely used in clinical practice.

Objective. To develop new directions in the assessment of quality of life (QL) for the implementation of adequate therapeutic, corrective, and rehabilitative measures after radical prostatectomy (RPE).

Subjects and methods. 56 patients with localized and locally advanced prostate cancer (PC) who underwent different RPE modes in 2001 to 2006 were examined. The patients' functional status was evaluated, by analyzing the parameters of their objective, subjective, psychophysiological, and social status.

Results. There were correlations between the patients' psychological, subjective, social, and objective statuses and the frequent complications of RPE, such as urinary incontinence and erectile dysfunction. For adequate QL assessment, the authors developed a score rating system for the above statuses.

Conclusion. Comprehensive examination using the proposed procedure makes it possible to reveal correlations between patients' different statuses in many QL aspects and to break the vicious circle of the detected abnormality.

Objective. To define the prognostic value of the growth rate (GR) in the level of prostate-specific antigen (PSA) after radical prostatectomy (RPE).

Materials and methods. The data on 48 patients who underwent RPE in 1999—2006, in whom a biochemical recurrence was verified on the basis of the results of PSA monitoring, were retrospectively analyzed. PSA GR was calculated for each patient. Correlation analysis using the major predictors was also made.

Results. During a follow-up, overall and tumor-specific survivals were 91,7 and 93,8%, respectively. Five-year relapse-free survival calculated by the Kaplan-Meier method was 67%. PSA GR proved to be an independent predictor of relapse-free survival. Generalization was more common at a PSA GR of > 2 ng/ml/year while a PSA GR of 1,0—2,0 ng/ml/year is more typical of the development of a localized recurrence.

Conclusion. Analysis of post-PRE PSA GR makes it possible to predict the postoperative course of prostate cancer, to reveal its early progression, and to perform therapy in due time. For early diagnosis of its clinical progression, it is expedient to assess a combination of predictors, by making up progression-risk groups.

The authors present the data available in the literature on the incidence of nephroblastoma of the horseshoe kidney in children. They note the rarity of this pathology in the pattern of renal malignancies, diagnostic difficulties, and no consensus as to its treatment policy. The authors describe their observation of a 3-year-old child with nephroblastoma with bilateral involvement of the horseshoe kidney.