Renal angiomyolipoma (RAML) is a most common benign tumor. It consists of fat, vascular, epithelioid cells, and smooth-muscle elements. Two types are described: isolated RAML and RAML associated with tuberous sclerosis. Tuberous sclerosis-associated RAML accounts for 20% of the tumors; these lesions are typically larger than RAMLs; they are often bilateral and multiple and tend to grow. The adequate diagnostic tools for RAML include ultrasonography and computed tomography. Fine-needle biopsy can elucidate the diagnosis of RAML in difficult cases. Most minor lesions are asymptomatic and those smaller than 5 cm need only a regular follow-up without intervention. Nephronsparing surgery is recommended if large RAMLs or symptomatic lesions are present. In these cases, the optimum treatment is partial nephrectomy or selective renal embolization. Angioembolization of RAML is a new technique which obviates surgical disadvantages. Positive immunoreactivity to HMB-45 and α-smooth muscle actin is diagnostic for RAML and distinguishes it from renal cell carcinoma.

Surgical treatment of 5 patients with renal cancer metastases in pelvic bones is analyzed. Resection of pelvic bones is an intricate surgical intervention with a high incidence of complications, and therefore the indications for this intervention in patients with metastases in pelvic bones should be discussed with the chemotherapist, radiologist, and oncourologist. A clinical example of a patient with renal cancer metastasis into the ileosacral articulation is presented.

As high as 40% of patients have locally advanced pelvic tumors without distant metastases and many of them have previously undergone radical treatment. The only possible treatment for these patients is combined and expanded surgery.

Subjects and methods: In 1996 to 2004, a total of 38 patients with locally advanced pelvic tumors involving the bladder underwent different types of evisceration at the Department of Radiosurgery, Russian Cancer Research Center. There were internal fistulas in 18 cases. Total evisceration was performed in 4 (10.5%) patients, subtotal supralevator evisceration in 25 (65.8%), subtotal infralevator evisceration in 3 (7.9%), and frontal evisceration in 6 (15.8%) patients. Thirty-one (81.6%) patients underwent ureteral reconstruction without ureterostomy; normal stool restored in 35 (92.1%) patients.

Results: One (2.6%) patient died intraoperatively. Twenty-eight patients had postoperative complications that needed resurgery in 12 cases. Three patients with the single-stage ileal orthitopic bladder reported that they had a fair urinary retention. One patient complained about nocturnal urinary incontinence. Stool retention was fair in all cases.

Conclusion: Careful selection of patients, comprehensive preoperative preparation, and improved surgical performance will reduce the incidence of postoperative complications.

In the past 15 years, the results of studies on neoadjuvant chemotherapy have been contradictory. The 2005 meta-analysis pooled data on 3005 patients with bladder cancer. The results of the analysis show an absolute increase in survival by 5% over 5 years when neoadjuvant chemotherapy was used in combination with cisplatin in patients with T2-T4aN0 bladder cancer. These data are of clinical significance for patients with Stage 0-1 bladder cancer and creatinine clearance >50 ml/min and in those aged under 70 years.

With neoadjuvant chemotherapy used in combination with transurethral resection and radiation teletherapy, 5-survival rates are about 50%. Neoadjuvant chemotherapy with platinum agents should be used in multimodality treatment for invasive bladder cancer.

Objectives: To evaluate the effect of an intravesical mitomycin C (MMC) protocol in patients refractory to prior intravesical BCG treatment for superficial transitional cell carcinoma, in an effort to prevent or delay recurrence and radical cystectomy.

Methods: Patients who demonstrated biopsy proven superficial tumor recurrence after prior BCG treatment received six weekly intravesical instillations of MMC 40 mg, followed by monthly instillations of MMC 40 mg for 10 to 20 months. Interval cystoscopy, biopsy, and urine cytological evaluations were performed to evaluate recurrence and progression until last recorded follow-up date.

Results: 19 consecutive patients were treated based on order of presentation after BCG failure. 53% (10/19) of patients had a complete response to mitomycin, 5% (1/19) had a partial response, and 42% (8/19) had evidence of recurrence. Average disease-free interval after start of mitomycin treatment was 16 months, 22 months for complete responders. Stage progression occurred in 16% (3/10) of patients; no patients developed muscle invasive disease. 26% (5/19) of patients completed the entire protocol, reasons for withdrawal included significant side effects or tumor recurrence.

Conclusion: The results suggest that mitomycin C salvage chemotherapy is a possible alternative to cystectomy for high-risk recurrent superficial transitional cell cancer disease after BCG failure.

Intravesical immunotherapy with the BCG vaccine «Imuron» along with courses of maintenance therapy has been performed in 25 patients. During a more than 10-year follow-up, there are 20 (80%) survivors; of them 15 (75%) patients have no recurrences. The used treatment regimen is effective and allows a long monitoring of the disease with the good quality of life. The occurrence of recurrences in 5 (25%) patients in the late period of the follow-up (after 8-13.5 years) leads to the conclusion that patients should be long followed up by an oncourologist and undergo cytoscopic studies with photodynamic diagnosis.

Prostate cancer is well-known to be a multifactorial disease and this explains the baffling complexity of its study. Novel advances in molecular medicine have permitted detection of considerable molecular changes underlying the development of prostate cancer. Unfortunately, emerging “pure scientific” findings have left far behind their clinical use and prostatic-specific antigen (PSA) still remains the only achievement in molecular pathology that has found wide clinical application. This review discusses the most significant and clinically relevant advances in molecular pathology with respect to prostate cancer.

Prostate cancer (PC) is one of the most common malignancies in males. Hormonal therapy (HT) is the method of choice in treating disseminated PC. LHRH agonists are used for therapy of disseminated and metastatic PC; a number of studies have shown the advantages of adjuvant and neoadjuvant HT for its locally advanced process over radiotherapy (RT) alone and radical prostatectomy (RPE). Diferelin (tryptorelin) that has been used for over 20 years is one of the most studied LHRH agonists. The efficiency of HT with diferelin is comparable with that of bilateral orchiectomy, the quality of life being much higher in the patients receiving this drug. The efficiency of intermittent diferelin HT is shown to be the same as that of continuous HT, by considerably improving the quality of life. Diferelin may be used for evaluation of the hormonal sensitivity of a tumor and for choice of an efficient treatment policy. Comparison of diferelin with other LHRH agonists has yielded comparable results in the trend of prostate-specific antigen levels and testosterone concentrations to decrease.

Among more than 300 patients with end-stage radiation-induced bladder and rectal lesions treated at different institutions of Russia, the authors observed 38 patients with severe profuse hemorrhage after megavoltage radiotherapy for localized forms of prostate cancer. The pathogenetic mechanisms of a radiation lesion and profuse bleeding from the bladder and rectum are substantiated. Effective treatments in such patients are given.

For patients with metastatic prostate cancer, palliative treatment is largely based on relief of skeletal pain. To evaluate a palliative effect and to reveal the positive and negative effects of a refresher course of systemic radiotherapy with strontium-89 chloride (⁸⁹SrCl₂), the authors assessed the results of comprehensive examination and the parameters of life quality in patients with metastatic prostate cancer who had taken 2—3 courses of systemic (⁸⁹SrCl₂) radiotherapy.

The lecture presents the currently available data on the prevalence of upper urinary tract tumors, their etiology and epidemiology, and anatomical pathology. The clinical manifestations of the disease are stated. The bulk of the lecture is dedicated to the diagnosis of tumors of the renal pelvis and ureter. Treatment options, such as open and endoscopic surgery, radio- and chemotherapy, are discussed.