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Objective: to evaluate the outcomes of thrombectomy performed using different surgical techniques in renal cell carcinoma (RCC) patients with extensive tumor venous thrombosis.

Materials and methods. This study included 345 RCC patients with extensive tumor venous thrombosis who underwent surgical treatment.

The median age was 57 years (range: 16—79 years); the male-to-female ratio was 1:1.9. Two hundred and sixty patients (75.4 %) had their tumor thrombus originating from the right renal vein, 85 patients (24.6 %) — from the left renal vein. In 169 patients (49.0 %), the thrombus spread to the retrohepatic inferior vena cava (IVC), while in 176 patients (51.0 %), it spread above the diaphragm (to the intrapericardial IVC in 59 patients (17.1 %) and to the right heart cameras in 117 patients (33.9 %)). Regional metastases were found in 90 individuals (26.1 %), while distant metastases were observed in 124 patients (35.9 %). All patients underwent surgical treatment (radical in 251 patients (72.8 %) and cytoreductive — in 94patients (27.2 %)); the technique of vascular control and circulatory support was chosen individually. In 97 patients (28.1 %), the control over the cranial thrombus boarder did not require opening of the chest cavity; eleven patients (3.2 %) were operated on with cardiopulmonary bypass.

Results. The median surgery time was 215 minutes; the median blood loss was 4500 mL. Intraoperative complications were registered in 209 patients (60.6 %) and postoperative complications were observed in 118 patients (35.1 %) (including those of grade I—II in 43 individuals (12.8 %) and grade III—V in 75 individual (22.3 %)). The in-hospital mortality rate was 10.7 % (37/345). At a median follow-up of 32.3 months, overall and diseasespecific survival rates among all patients were 51.9 % and 68.3 %, respectively; relapse-free survival rate in 226patients who have undergone radical surgeries and discharged from the hospital was 61.5 %; progression-free survival rate in 82 patients who have undergone cytoreductive surgery was 33.0 %. The method ofIVC control and circulatory support had no effect on both short-term and long-term treatment outcomes (p >0.05 for both).

Conclusion. The use of minimally invasive techniques of vascular control and avoidance of cardiopulmonary bypass in carefully selected RCC patients with extensive tumor venous thrombosis do not worsen the outcomes of nephrectomy and thrombectomy.

Objective. The primary endpoint was progression-free survival; secondary endpoints included overall survival, objective response rate and duration, tumor control rate and duration, as well as safety profile of lenvatinib with everolimus in consecutive patients with advanced renal cell carcinoma who had disease progression after targeted antiangiogenic therapy.

Materials and methods. This observational study included 129 consecutive patients with metastatic renal cell carcinoma resistant to targeted antiangiogenic therapy. The median age was 60 years; a male to female ratio was 3.1:1. Twenty-seven patients (20.9 %) had ECOG performance status of 2—4. The majority of study participants (n = 127; 98.4 %) had multiple metastases. Tumor lesions were located in >1 organ in 104 cases (80.6 %). The primary tumor was removed in 110 (85.3 %), including 39 (30.2 %) patients undergone cytoreductive surgery. Seventy patients (54.2 %) had earlier received more than one line of therapy. Upon enrollment, there were 13 IMDC favourable-risk patients (10.1 %), 86 IMDC intermediate-risk patients (66.6 %), and 29 IMDC poor-risk patients (22.5 %). In one patient (0.8 %), the IMDC risk was not estimated. All patients received lenvatinib at a dose of 18 mg/day and everolimus at a dose of 5 mg/day. The median follow-up was 10.5 (1—30) months.

Results. Median progression-free survival was 14.9 (11.9—17.9) months; overall survival was 19.9 (15.2—24.6) months. The objective response rate was 17.0 % (median duration 9.7 (2.8—16.5) months); tumor control rate was 72.9 % (median duration 10.0 (2.5—17.5) months). Adverse events were observed in 112patients (86.8 %) with grade III—IVadverse events registered in 27participants (20.9 %). Five participants (3.9 %) needed inpatient treatment of adverse events; one patient (0.8 %) died due to adverse events. Adverse events required treatment discontinuation in 4 patients (3.1 %), treatment interruption in 35 patients (27.1 %), and dose reduction in 33 patients (25.6 %).

Conclusion. The results of the secondary analysis in the ROSLERCM observational study confirmed the results obtained earlier on the efficacy and safety of the lenvatinib plus everolimus combination in the second- and subsequent-line therapy for advanced renal cell carcinoma resistant to targeted antiangiogenic therapy in consecutive Russian patients.

Background. Prostate cancer is currently one of the most challenging problems in urological oncology due to its constantly increasing incidence and mortality in Russia. Surgery remains one of the most radical treatment options for patients with localized and locally advanced prostate cancer of any risk. Multiple studies have compared long-term and functional outcomes of surgeries performed using different surgical approaches. All studies have demonstrated similar long-term and functional outcomes of open, laparoscopic, and robot-assisted surgeries. Objective: to review the existing literature on this problem and analyze outcomes of surgical treatment in patients who had undergone open or laparoscopic prostatectomy in one of three federal centers of the National Medical Research Radiology Center.

Materials and methods. This retrospective study included 2,772 patients with localized and locally advanced prostate cancer who had undergone surgery in one of the three federal centers.

Results. We evaluated short-term and long-term outcomes of laparoscopic and open radical retropubic prostatectomy (RRP) performed at three federal centers of the National Medical Research Radiology Center. We found that laparoscopic RRP was associated with a longer surgery, lower blood loss, and fewer lymph nodes removed compared to open RRP. Long-term oncological and functional outcomes (prostate-specific antigen relapse-free survival, time to urination recovery) did not significantly differ between patients who had laparoscopic or open RRP.

Conclusion. Both open and laparoscopic RRP are equally effective surgical methods for patients with localized and locally advanced prostate cancer.

Background. Intraoperative rectal injury in patients undergoing prostatectomy is a severe complication, worsens the quality of life and leads to social maladjustment.

Objective. To develop, substantiate the reproducibility and safety of the technique for the formation of fascial duplication in the elimination of damage to the anterior rectal wall during prostatectomy.

Materials and methods. The authors present a description of the technique and their own experience of retropubic prostatectomy with the formation of fascial duplication in the elimination of damage to the anterior rectal wall in 2 patients with prostate cancer. Patients with intermediate risk of recurrence and progression according to the D'Amico index. The observation period is 6 and 11 months.

Results. Prostatectomy revealed damage to the anterior rectal wall and destruction of the external longitudinal muscular layer of the rectum. The rectal defect was eliminated according to the original method. The duration of the operation is 160 and 140 min. Intraoperative blood loss 350 and 150 ml. The first bowel movement on the 5th day. Removal of the urethral catheter on day 10. The period of hospitalization was 11 and 14 days, no postoperative mortality was noted. No lethal outcomes were noted.

Conclusion. A constructively simple surgical technique for the formation of fascial duplication by local tissues in case of intraoperative injury of the rectum during prostatectomy has been developed and implemented into clinical practice.

Background. Radical prostatectomy (RP) remains the gold standard in prostate cancer treatment. RP often has side effects that negatively affects quality of life. Influence on sexual life, in particular, orgasmic function (OF) of patients is one of the most actual issues that require additional research.

Objective. Analysis of OF after RP as well as OF's pathologies are presented in our study.

Materials and methods. The study includes 146 patients with safe sexual life on preoperative period, who underwent RP for prostate cancer in S.P. Botkin City Clinical Hospital. 79.5 % had robot-assisted laparoscopic prostatectomy and 20.5 % — retropubic RP. Mean age of patients was 61.1 ± 6.5 years. Erectile function was assessed by the International Index of Erectile Function (IIEF), the sum median was 25 points. Observation period was 12 months.

Results. OF recovered in 65.7 % of patients in one year after RP versus 30.1 % in erectile function recovery. Climacturia was detected in 21.9 % patients, painful orgasm in 13 % patients.

Conclusion. OF recovered in most patients till the end of the first year of observation. Younger age, safe pre- and postoperative erectile function, nerve-sparing surgery have positively affected OF recovery. Further researches needed to find statistically more relevant OF recovery predictors after RP, prevention of its pathologies.

Objective: to study the anatomical-topographical relationship between the prostate gland (PG) and the vascular structures responsible for erection, to justify the new concept of erectile dysfunction pathogenesis after brachytherapy of prostate cancer (PCa).

Materials and methods. The study included 66 patients with verified or suspected PCa. All patients performed magnetic resonance imaging 1.5 T in accordance with the established protocol (hybrid method of visualization of internal pudendal arteries (IPA)). 16 patients simultaneously performed computed tomography on a topometric tomography. The resulting images were analyzed using the Eclipse 4.0 (Varian Medical System, USA) system, which provides 3D models of PG, pelvic bones and critical structures of interest: IPA, cavernous crura and penile bulb.

Results. The average volume of PG was 44.9 ± 18.7 (14.4—98.0) cm³. The width of penile bulb was 1.83 ± 0.38 (1.1—2.93) cm. According to the implantation technique of in brachytherapy, the damage to penile bulb can be observed in less than a fifth of patients — 18.5 % of cases.

Analysis of the 3D models showed that the overlay of the distal third of the IPA on the predominantly anterior and, in part, lateral aspects of the PG was noted in 58 (87.9 %) of 66 observations. The average value of PG in a group with no interference was 25.7 ± 3.9 (18.2—29.9) cm³, with its presence — 47.6 ± 18.4 (14.4—98.0) cm³. The average length of the IPA, coinciding with the projection of the PG on the right and left is virtually no different (p >0.05) and is about 2.5 cm, and the maximum remote point of this combination lies in relation to the outer contour of the gland within 1 cm. The correlation analysis showed a strong direct correlation between the volume of PG with all the parameters of mutual spatial anatomy of the prostate and IPA (R = 0.63—0.71; p <0.0001).

Conclusion. The anatomical-topographical relationship between PG and critical structures, among which the IPA plays a special role, points to the likely predominantly traumatic genesis of erectile dysfunction after PCa brachytherapy, as well as a number of other invasive procedures performed by perineal access (saturation biopsy).

Prostate cancer (PCa) is one of the most common malignant tumor in men. Significant advances have been made in the early detection and treatment of localized PCa, but metastatic castration-resistant PCa (mCRPC) remains one of the most challenging problems to treat in oncology. To improve treatment outcomes for patients at this stage of the disease, it is necessary to develop personalized therapy options based on the definition of biological predictors. In mCRPC, mutations in DNA repair genes are detected in ~23 % of patients with mCRPC. Detection of these mutations in patients with PCa has important clinical relevance. PCa with mutations in DNA repair genes may be sensitive to poly(ADP-ribose)-polymerase (PARP) inhibitors. Several studies II and III phase have demonstrated the effectiveness of PARP inhibitors with a high objective response rate in the treatment of mCRPC in patients with mutations in the DNA repair genes, which is definitely a more personalized approach to treatment. Identification of hereditary mutations in DNA repair genes is an important prognostic factor for the proband's relatives (for both men and women), which can later be used for genetic counseling of patients and the application of strategies to reduce the risk of malignant diseases.

Background. Bladder cancer (BC) is a common urological cancer, 75 % of which are non-muscle invasive BC. After removal of the primary tumor, the adequate classification of malignancy and the defining of tumor progression risk remains an important issue, since it is associated with frequency of cystoscopy and choice of the BCG- or chemotherapy management.

Objective: improve the algorithms of prognosis in intermediate-risk patients with non-muscle-invasive bladder cancer with the consideration of molecular characteristics of the primary tumor.

Materials and methods. We studied 125 BC samples; mutations in the FGFR3, PIK3CA, TERT, and TP53 genes were determined by polymerase chain reaction and Sanger sequencing, as well as the expression of the FGFR3, EGFR, ERBB2, FOXA1, and GATA3 genes using realtime polymerase chain reaction.

Results. Somatic mutations in the studied loci were detected in 65.6 % of the samples, five new mutations were identified. A decrease of the mutation frequency in the FGFR3 and TERT genes was shown, an increase — TP53 in order (Ta—T1/low G) > (T1/high G) > (>T2/any G). The largest area under the ROC curve (0.807 ± 0.092, р = 0.004) was demonstratedfor the prognostic classifier with the independent variables: mutation in FGFR3 and/or TERT; mutation TP53; overexpression of the FGFR3 gene. The FGFR3, TERT mutations and/or FGFR3 overexpression in the absence of TP53 mutation indicates minimally invasive primary tumor. On the contrary, harboring TP53 mutation indicate the features of muscle-invasive BC at the genetic level. Using this algorithm, we reclassified 21 of T1G3 BC cases as having characteristics associated with non-invasive tumor in 43 %, and invasive BC in 57 % of patients.

Conclusion. The aforementioned prognostic model could be used as additional laboratory test in assessing the malignancy and progression risk of non-muscle invasive BC.

Background. Radical cystoprostatectomy is currently considered the most time-consuming operation with a large number of possible complications. Over the past decades, heterotopic reconstruction of the bladder using a segment of the ileum has become the optimal method of urine derivation. To date, we have successfully used a modification of V-shaped heterotopic ileocystoplasty.

Objective: to compare early postoperative complications in patients who underwent radical cystoprostatectomy with the formation of a Bricker conduit and with a modified V-shaped heterotopic conduit.

Materials and methods. In order to study and compare the complications that occurred in the first 30 days after surgery, we retrospectively selected patients after radical cystoprostatectomy with heterotypic ileocystoplasty. Patients were divided into two groups: 1^st — patients with Bricker ileocystoplasty (n = 46), 2nd — patients with modified V-shaped heterotopic ileocystoplasty (n = 49).

Results. The greatest number of complications was registered in patients of 2nd group — 19 (41.3 %), in patients of 1^st group — 14 (28.6 %). Repeated surgical interventions were required in 6 (12.2 %) patients of 1^st group, in 5 (10.8 %) of 2^nd group. Fatal outcomes were registered in 3 (6.1 %) patients of 1^st group, in 2 (4.2 %) of 2^nd group. The number of pyelonephritis in the first 30 days in patients of 1^st group was 8.2 %, 2^nd group — 23.9 %.

Conclusion. Modified V-shaped heterotopic urine derivation is easily feasible. This method should be used in patients with chronic pyelonephritis against the background of previously diagnosed ureterohydronephrosis, which is a fairly frequent consequence of the invasive nature of the growth of bladder cancer with ureteral obstruction.

This article analyzes first results of the randomized phase III clinical trial CheckMate 274 that has demonstrated the advantage of adjuvant immunotherapy with nivolumab, a PD-1 inhibitor, over placebo in high-risk patients with muscle-invasive urothelial carcinoma after radical surgery

This review of bladder cancer describes modern clinical and pathologic features of the neoplasm, reports new data about treatment and prognosis of this disease.

After almost 40 years since the first-ever magnetic resonance imaging (MRI) of the prostate has been made the technology has made significant strides forward: dynamic contrast-enhanced imaging, diffusion weighted imaging and MR spectroscopy being a few among the others. Moreover, the development of high power magnets and phased array coils had contributed to the drastically improved quality of the imaging. These improvements have increased the detection quality for the clinically significant prostate cancer (PCa) and early recurrences, enabling physicians to create a more personalized treatment plan easier and quicker. PROMIS (the Patient-Reported Outcome Measurement Information System) 2017 and PRECISION (Prostate Evaluation for Clinically Important Disease: Sampling Using Image Guidance or Not) 2018 studies underline the importance of MRI in detecting clinically significant PCa and avoiding overly aggressive diagnostic of clinically insignificant PCa. A large number of articles devoted to analyzing the role of MRI in diagnosing PCa (localization and staging) do not come to a uniform conclusion. This can be, in part, explained by the different study designs and protocols, as well as other controllable factors in the MRI studies themselves. The goal of this article is to attempt to analyze the role of MRI in diagnosing PCa since its advent, through its' current stage of development, as well as to explore the forward looking scenarios and opportunities for this extremely useful imaging modality.

Prostate cancer (PCa) is in second place in oncological morbidity in males and is the fifth leading cause of death among the world's population. According to current world statistics, over the past 20 years there has been an increase in primary morbidity, as well as mortality from PCa. The key to diagnosing PCa is a prostate biopsy. Nevertheless, a systemic biopsy under transrectal ultrasound control is the subject of discussion and debate in oncourology, as it has significant drawbacks that affect the qualitative result of the diagnosis of PCa. Given the importance of adequate and staged PCa, various methods of targeted biopsy under magnetic resonance control have been proposed.

This review will examine the main features and significance of targeted prostate biopsy, as well as the role of magnetic resonance imaging in the early diagnosis of PCa. The method of targeted biopsy of the prostate gland can improve the detection of PCa in relation to clinically significant forms. In addition, this method is extremely promising and requires further study to further improve the quality of early diagnosis of PCa, especially when selecting patients for radical surgical treatment.

Prostate cancer is the most common urological malignancy in men. Radical prostatectomy (RPE) ensures high rates of relapse-free survival. Urinary incontinence is a frequent complication after RPE that significantly reduces the quality of life and leads to social maladaptation of the patient. Advances in pelvic anatomy, optimization of surgical techniques, and implementation of laparoscopic and robot-assisted surgery have improved functional results of RPE. However, the increasing incidence of prostate cancer leads to an increase in the number of patients after RPE and, accordingly, patients with urinary incontinence. Therefore, issues related to etiology, pathogenesis, and prevention of urinary incontinence after RPE remain highly relevant. Numerous publications suggest that etiology of urinary incontinence after RPE is multifactorial. The purpose of this literature review is to provide an overview of studies on urinary incontinence after RPE. We analyze the role of preoperative and intraoperative parameters as possible risk factors for urinary incontinence after RPE.

The emergence and continuous development of immune checkpoint inhibitors (ICIs) therapy brings a revolution in cancer therapy history including urothelial carcinoma. Early accurate targeting and adequate treatment are critical to patient prognosis and overall survival. To overcome these limitations, two strategies are actively being pursued: identification of predictive biomarkers for clinical response to ICIs and multi-pronged combination therapies. Biomarkers might allow clinicians to practice a precision medicine approach in ICIs (biomarkerbased patient selection). The development of predictive biomarkers is needed to optimize patient benefit, minimize risk of toxicities, and guide combination approaches.

The greatest focus in clinical trials and reviews has been on tumor-cell PD-L1 expression. Although PD-L1 positivity enriches for populations with clinical benefit, PD-L1 testing alone is insufficient for patient selection in most malignancies. In this review, we discuss the status of PD-L1 testing and explore emerging data on new biomarker strategies with tumor-infiltrating lymphocytes, mutational burden, immune gene signatures, microsatellite instability and molecular subtypes.

The objective of the study was to analyze the taxonomic structure of urinary infection pathogens and determine the susceptibility of ESKAPE group microorganisms (Escherichia coli, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, Enterococcus spp.) isolated from cancer patients with nosocomial infections in 2018—2020 to antimicrobials.

Materials and methods. 413 (71.9 %) strains of ESKAPE group bacteria from 228 patients were studied. Microorganisms were identified and antibiotic resistance was determined using Vitek-2 System (France) and MicroScan WalkAway (Germany / USA) analyzers.

Results and conclusion. All gram-positive microorganisms were highly sensitive to vancomycin and teicoplanin, linezolid, tigecycline, and daptomycin, which can be used in the treatment if clinical indications are seen. Among gram-negative bacteria, the percentage of ESBL producers was 60—70 %, the percentage of carbapenem-resistant bacteria was minimalfor E. coli, rnmpared to the rest - 40—50 %, demonstrating the need to limit the use of carbapenems in the clinic.

Carcinosarcoma is an exceedingly rare and highly aggressive malignant tumor. Some patients with carcinosarcoma have normal levels of prostate specific antigen; therefore, digital rectal examination is the only method of early diagnosis in them. In this article, we report a case of prostate carcinosarcoma and describe its diagnosis and treatment.

The article is dedicated to two Nobel laureates Charles Brenton Huggins and Francis Peyton Rous.

Charles Huggins research on prostate cancer has changed the attitude of scientists to understanding the development of all malignant cells and for the first time gave hope for the prospect of treating advanced forms of cancer. Dr. Huggins' was a pioneer in the understanding of the physiology and biochemistry of the male urinary tract and was able to extend his discoveries from this area to many other areas. In 1966, Dr. Huggins received the Nobel Prize for his research on the relationship between hormones and prostate cancer.

Francis Peyton Rous discovered that sarcomas in chickens can be transmitted by birds of the same inbred population not only by inoculating tumor cells, but also by injecting a submicroscopic agent extracted from them. This discovery gave rise to the viral theory of cancer causality. He was able to prove that some “spontaneous” chicken tumors, apparently classic neoplasms, are actually triggered and controlled by viruses that also determine their shape.

In 1966, Dr. Huggins received the Nobel Prize (with virologist Peyton Rous) for his research on the relationship between hormones and prostate cancer. The Nobel Committee cited his fundamental discoveries concerning the hormonal dependence of normal and neoplastic cells in experimental animals and their immediate practical application for the treatment of human prostate and breast cancer. In 1966, Peyton Rose was awarded the Nobel Prize.

Kaposi's sarcoma is a malignant vascular tumor associated with human herpesvirus-8 (HHV-8). The disease primarily affects the skin, mucous membranes, lymph nodes, and even internal organs in late stages. Kaposi's sarcoma of the penis is usually found in patients infected with human immunodeficiency virus (HIV) and is exceedingly rare in HIV-negative patients.

In this article, we report 2 cases of Kaposi's sarcoma in a 42-year-old and 55-year-old patients. Both patients denied any homosexual relationships. Their tumors were represented by 5-mm nodules located close to the external urethral orifice. Both patients have undergone tumor excision. Histological and immunohistochemical examinations demonstrated Kaposi's sarcoma. The 55-year-old-patient had positive nuclear staining with anti-HHV-8 antibodies in the tumor cells, although no anti-HIV antibodies were found in his serum. The 42-year-old patient had a clinically significant increase in the level of human papillomavirus 51 (HPV-51) DNA detected using polymerase chain reaction in his urethral swab sample (3.2 х 10 5 Lg). Both patients were alive after 36 and 34 months, respectively, without signs of disease progression.