Purpose: we reviewed the outcome of surgical treatment of 165 patients with renal cell carcinoma (RCC) invading venous system.

Materials and methods: 3187 patients with RCC were seen at our institution between 1971 and 2004. The vascular extension (stages T3b-T3c) was present in 299 (9,3%) cases. Of 299 patients 82(27,5%) were not considered for surgery, 52(17,3%) underwent palliative nephrectomy and 165(55,2%) underwent radical surgery including radical nephrectomy with thrombectomy. The latter group was retrospectively analyzed. Of 165 cases the tumor thrombus was confined to the renal vein in 58 (35,2%). In patients with IVC involvement 28 (17%) had perirenal, 39(23,6%) subhepatic, 16(9,7%) retrohepatic and 24 (14,5%) — suprahepatic types of tumor thrombi. The surgical technique varied according to the level of tumor thrombus.

Results: The complete removal of primary tumor and venous thrombus was possible in 147 of 165 cases. The histology showed organ-confined tumor in 93 (56,4%) cases. The perirenal fat invasion was present in 66 (40%) and was not assessed in 6 cases. Histology report confirmed the diagnosis of renal cell carcinoma in all patients. The tumor grade occurred to be G1 in 5(3%), G2 — in 52(31,5%), G3 — in 53 (32,1%) and was not mentioned in the histology report in 55 (33,3%) cases. Regional lymph-nodes were positive (pN+) in 29 (17,6%), clear in 131 (79,4%) and not assessed in 5(3%) cases. Distant metastasis were found in 21(12,7%) and were not properly assessed in 5 (3%) patients. Major intra and postoperative complications occurred in 16,3% of cases with the mortality rate of 3,6% (6 patients). Overall 3, 5 and 10 year survival of 165 patients was 58,5%, 46%, and 25% respectively with a median survival of 52 months. Five factors including perinephric fat invasion, presence of lymph node and distant metastasis, poor tumour differentiation and not radical surgery proved to significantly worsen the survival in univariable analysis. Moreover, overall 3,5 and 10 year survival of the patients who did not have these adverse factors, was found to be significantly better — 72%, 62% and 31% respectively. In multivariable regression (Cox stepwise) analysis only 2 factors — the presence of lymph node metastasis and completeness of the surgery influenced the survival.

Conclusions: Although the presence of venous invasion worsens the prognosis of patients with RCC radical surgery gives the chance for cure and long-term survival. With new drug development stratification of patients according to their prognosis could be beneficial.

Differential diagnosis of atypical renal cysts and renal cell carcinoma remains difficult. We analyzed the accuracy of currents methods of visual diagnosis (US, CT, MRT and cyst puncture) in this patients. Surgical exploration was performed in 15 patients. The pathological specimens were compared retrospectively with results of different methods of diagnostics. The classification of Bosniak was used. From all 15 lesions 47,7% proved to be malignant. Our results suggest that radiolodical techniques are not well suites for differentiation of cystics masses Bosniak II and III. Accuracy and specifity of cyst puncture was 71,4% and 77,8%. Mean type of treatment is nephron-sparing surgery. The features of progression of tumor at follow-up 42 months are not fixed.

Background. Radical cystectomy with pelvic lymph node dissection is the standard treatment for patients with invasive bladder cancer. However, many alternative techniques to spare the bladder have been investigated. Single-center, non-randomized studies have reported good patient’s acceptance and reasonably good treatment outcomes.

Methods. We review the experience reported in the literature on bladder-sparing techniques, including transurethral resection, chemotherapy, radiation, and multimodality approaches for muscle-invasive disease focussing on controlled clinical trials.

Results. Most comparative studies indicate that local recurrence and survival outcomes for bladder-sparing approaches are inferior to those from radical cystectomy to control muscle-invasive bladder cancer.

Conclusions. Although molecular biologic techniques may have the capacity to identify a subgroup of patients who may benefit from a bladder-sparing approach, cystectomy is normally required for optimal results. Nevertheless, several alternatives to radical cystectomy for muscle-invasive bladder cancer have been studied. None, however, are reliably superior to radical operative treatment.

Transurethral removal of tumor with following intravesical chemotherapy with Gemicitabine were performed to 14 patients with superficial bladder cancer relapses after TUR with adjuvant intravesical BCG – therapy. Adjuvant treatment was initiated 2 – 3 weeks after TUR: 1000 mg of gemicitabine was solved in 100 ml of physiologic solution and instillated into the bladder 2 times a week for 3 week. After 1 week break the second course of chemotherapy was carried out.

Treatment was well tolerated by all patients. The follow-up period ranged from 1,5 to 22 months (mean 10,6±7,0 months). After mean period of 11,3 months 10 patients were disease free. Recurrence developed in 4 patients with multifocal bladder relapses. No disease progression was registered. Adjuvand intravesical chemotherapy with Gemicitabine is effective in patients with recurrences of superficial bladder cancer and is well tolerated.

The data of prospective randomized trial including comparative analysis of two treatment arm results are reported. The patients of group A underwent TUR with following intravesical electrophoresis of 50 mg of chemotherapeutic drug Doxorubicin whereas patients of group B were treated with TUR which followed by intravesical instillation of Doxorubicin. Each group included 17 patients with superficial bladder cancer. In group A complete remission were registered in 11 (64,7%), partial regression in 3 (17,6%) and stabilization in 3 (17,6%) patients. In group A complete remission were found in 6 (35,3%), partial regression in 2 (11,8%) and stabilization in 9 (52,9%) patients. Intravesical electrochemotherapy with Doxorubicin is more effective in comparison to standard intravesical chemotherapy with the same drug, which was expressed by higher rate of positive responses to treatment. The positive response rate were 82,4% in group A verse 47,1% in group B, 2-year survival rate was also better in group A (75% verse 51,9%).

Objective: The morbidity of multiple urological malignances is steadily grown. Incidental prostate cancer in patients with bladder cancer seems to be fairly often. This is one of the reasons of that the question of partial sparing of prostate in patients undergone radical cystoprostatectomy is still discussable. Purpose: The present study is designed to evaluate the incidence of simultaneous prostate and bladder cancer in patients undergoing radical cystoprostatectomy in Moscow Scientific Research Institute of Oncology.

Materials and methods: From 1994 to 2005, 113 men (mean age 59,5 years), with no evidence of prostatic malignancy on preoperative clinical and biochemical assessment, underwent cystoprostatectomy for TCC of the bladder in our institute. The bladder was adequately sampled and the entire prostate sectioned at 5-mm intervals and examined histologically, in order to identify unsuspected prostatic cancer (PCa).

Results: 10 out of 113 patients (8,8%) were found to have PCa. Four (3,5%) had cr. in situ, five (4,4%) had high grade prostatic intraepithelial neoplasia (PIN). All tumors were clinically significant, except cr. in situ and PIN. Almost all tumors (7,9%) were organ confined (pT2a—T2c), except one (0,9%), which was locale advanced (pT3a). Glaeson score was 2—4 in 5 (26,3%) and 5—7 in 5 (26,3%).

Conclusions: Incidental PCa is quite a common finding in cystoprostatectomy specimens of bladder cancer patients. This demands careful and complete excision of the prostate in patients with muscular-invasive bladder cancer.

Radical retropubic prostatectomy is one of the most often used treatments for localized prostate cancer. An important part of surgery follow-up is quality of life assessment. Surveys before the prostatectomy and every 3 months (up to one year) after it were made. The matters of incontinence, erectile and bowel dysfunction and the worry caused by them and their influence on social activity and quality of life were focused on. None of the patients showed heavy incontinence. Only 23.1% of patients had to use adult diapers from time to time one year after the surgery. One year after the surgery none of the patients expressed any regret regarding the treatment choice or its aftermath. Radical retropubic prostatectomy for prostate cancer being made in centers where it's a routine surgery doesn't lead to any substantial incontinence or quality of life degradation.