This article discusses the main approaches to performing laparoscopic partial nephrectomy. For the method using warm ischemia, the main studies related to the time of warm ischemia and its effect on renal function have been analyzed. The basic techniques for operations united by the general name zero ischemia kidney resection are also considered. The main positive and negative aspects of induced hypotension are described. The article presents the authors’ own experience in performing normotonic laparoscopic partial nephrectomy.

Objective. Radical nephrectomy with thrombectomy of the inferior vena cava is the preferred treatment for renal cell carcinoma with an tumor thrombosis. We describe our experience and presentreview of the literature evaluating the feasibility and safety of laparoscopic nephrectomy with inferior vena cava thrombectomy.

Materials and methods. The study included 37 patients who underwent laparoscopic radical nephrectomy with level I–III thrombectomy for renal cell carcinoma in our institution from 2018 to 2021. We analyzed the clinical, radiographic, intraoperative, pathological and postoperative parameters of the patients. The literature was reviewed by the Medline search engine, PubMed, with a review of publications on laparoscopic radical nephrectomy with inferior vena cava levelI–IIIthrombectomy.

Results. The mean operation time was 275 ± 60.1 min, the median blood loss was 450 ± 81.6 ml (≥50 % of the circulating blood volume – 32.4 %). Intraoperative complications were observed during 10 (27.0 %) operations. Postoperative complications developed in 29.7 % of patients and reached gradesIII–IV according to the Clavien–Dindo scale on 13.0 % ill. All patients are activated according to the fast track rehabilitation program. The average hospital stay was 5 days. A literature review identified clinical cases and small series demonstrating the technical feasibility and safety of laparoscopic radical nephrectomy with thrombectomy in selected patients.

Conclusion. Laparoscopic radical nephrectomy with thrombectomy is a technically feasible approach in carefully selected patients with level I–III tumor thrombosis. Optimal patient selection, extensive experience in laparoscopy and specialized centers are essential for the safe use of thistechnique.

Background. Currently, there is no single point of view on the timing of safe removal of the urethral catheter in patients who have undergone laparoscopic radical prostatectomy.

Objective of the study: to evaluate the safety and functional results of early removal of the urethral catheter after laparoscopic radical prostatectomy.

Materials and methods. In the period from January 2020 until April 2021, the study included 100 patients with a diagnosis of prostate cancer who underwent laparoscopic radical prostatectomy by one surgeon. Patients were divided into 2 groups. Group A (n = 50) included patients with the urethral catheter removed on the second day after surgery. Group B (n = 50) – the control group – included patients with standard catheter removal (14 days).

Results. According to the results of cystography, in group A extravasation of a contrast agent from the zone of urethrovesical anastomosis was determined in 3 (6 %) cases. Seven (14 %) patients developed acute urinary retention after the removal of the urethral catheter. Among 2 patients acute urinary retention occurred immediately after catheter removal. In 5 cases acute urinary retention developed 2–7 days after catheter removal. These patients underwent repeated catheterization for a period of 2–3 days. In our study, removal of the urethral catheter on the second day increased the dynamic of restoring urinary continence in the postoperative period. The frequency of complete recovery of urinary continence (0–1 pad per day) in the groups A and B, respectively, was: after 1 month – 22 and 16 %, after 6 months – 64 and 54 %, after 12 months – 78 and 78 %. Urinary incontinence in the groups A and B was as follows: mild (2–3 pads per day): after 1 month – 40 and 34 %, after 6 months – 30 and 32 %, after 12 months – 20 and 18 %; moderate (4–5 pads per day): after 1 month – 20 and 26 %, after 6 months – 6 and 10 %, after 12 months – 2 and 2 %; severe (6 pads or more): after 1 month – 18 and 24 %, after 6 months – 0 and 4 %, after 12 months – 0 and 2 %.

Conclusion. Early removal of the urethral catheter (2 days) in patients who underwent laparoscopic radical prostatectomy is a relatively safe method that improves the restoration of urinary continence.

Background. In recent years, approaches to performing radical prostatectomy have undergone many modifications to reduce postoperative complications. However, controversy over the technique of radical prostatectomy persists from the moment of its appearance to the present day.

Objective: to assess the state of erectile function, the quality of life of patients with localized prostate cancer before surgery and after performing various types of radical prostatectomy, taking into account the safety of cancer progression.

Materials and methods. We examined 127 patients with localized prostate cancer in low and medium risk groups. Depending on the type of radical prostatectomy, patients were divided into three groups: patients with radical retroperitoneoscopic prostatectomy without preserving the neurovascular bundles, patients with unilateral, and patients with bilateral nerve-sparing prostatectomy. Initially and at the annual stage of the study, the state of erectile function, erection rigidity, quality of life was assessed, and oncological outcomes were analyzed.

Results. One year later, the best results in terms of preserving erectile function were obtained in the group of patients who underwent bilateral nerve-sparing prostatectomy, and in the group without nerve-sparing, the most serious decrease in the level of erection was noted; prostatectomy with unilateral nerve-sparing took an intermediate value. Indicators such as overall satisfaction and quality of life were higher in patients of the nerve-sparing group compared with patients without nerve-sparing. All three types of radical prostatectomy, when strictly indicated, provide similar short-term oncological results.

Conclusion. Intrafascial unilateral nerve-sparing method is indicated for men with a low/intermediate risk of disease progression, both with and without preoperative erectile dysfunction, as it provides similar short-term oncological results and contributes to the restoration of a higher quality of life compared to traditional laparoscopic prostatectomy. The technique with bilateral preservation of intrafascial nerves promotes more effective preservation of erectile function in the postoperative period and can be recommended for young people with a high expectation of preservation of erectile function in the postoperative period.

Objective: to evaluate clinical outcomes in patients with prostate cancer treated with high-dose-rate (HDR) brachytherapy (BT) as monotherapy.

Materials and methods. From January 2015 to December 2017, 97 men with localized prostate cancer underwent HDR-BT as monotherapy, with a temporary implant on a MicroSelectron HDR device. The dose prescription was: 30 Gy in 2 fractions with an interval of 2 weeks. The overall and biochemical survival rate was assessed. The assessment of genitourinary and gastrointestinal toxicity was also carried out. The quality of life associated with urination before treatment and in dynamics during 5 years of observation, as well as the frequency and degree of development of erectile dysfunctionand its dynamics during the entire observation period were analyzed.

Results. The median age was 65.2 (44 to 80) years. Overall, 29 patients had low risk prostate cancer, 63 patients had moderate risk, and 5 patients – high risk. The follow-up period was five years (range, 18 to 72 months). The median follow-up was 54.3 (95 % confidence interval 52.3–59) months. Overall survival and survival without biochemical recurrence were 96 and 99 %, respectively. Toxicity was assessed according to the RTOG/EORTC (Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer) scale for each event. Late genitourinary toxic reactions of grade 1 and 2 were noted in 23.9 and 6.3 %, respectively. Late gastrointestinal grade 2 toxicity was not observed. Genitourinary and gastrointestinal toxic reactions of grade 3 were not observed. The quality of life associated with urination after treatment was comparable to the level of quality of life at the time of inclusion of patients in the treatment protocol. Erectile dysfunction developed to a greater extentin the first 1–2 years after HDR-BT with a subsequenttendency to recovery.

Conclusion. HDR-BT as monotherapy is a safe and highly effective treatment for localized prostate cancer. The fractionation mode in the form of 30 Gy for 2 fractions of 15 Gy with an interval of 2 weeks with or without dose modulation in the area of the tumor focus using a gel has a low toxicity profile from the side of critical organs.

Background. Prostate cancer is one of the actual problems of modern oncology. The incidence of prostate cancer is steadily increasing despite of popularization of screening and early diagnostics. It is worth to highlight separately the castration-resistant prostate cancer which develops on the average 2 years after surgical or medicinal castration. For the patients with metastatic castration-resistant prostate cancer (mCRPC) the main purpose of treatment is increasing of overall survival while maintaining the quality of life. Currently there are several treatment options for mCRPC: chemotherapy, inhibitors of androgen receptor pathway,systemic alfa-radiotherapy, PARP-inhibitorsfor homologousrecombination DNA repair deficiency. Using of several sequential lines of mCRPC therapy leads to maintaining the patients’ quality of life and increasing its duration. Systemic alfa-radiotherapy is using since 2013 – the first is radium-223 which was approved by Food and Drug Administration according the results of the phase III trial ALSYMPCA. In Russian Federation radium-223 was approved in 2016.

Objective: to evaluate the efficiency and safety oftherapy with radium-223 as well as pain response at patients with mCRPC.

Materials and methods. 67 patients were included in this analysis who received radium-223 therapy at Scientific Research Institute of Tomsk National Research Medical Center of Russian Academy of Sciences and Tomsk Regional Oncology Dispensary.

Results and conclusion. Radium-223 has demonstrated its efficiency for mCRPC patients with good safety profile and positive pain response and maintaining the QoL.

Background. The addition of enzalutamide to standard androgen deprivation therapy (ADT) significantly increases overall survival and progression-free survival in patients with metastatic hormone-sensitive prostate cancer (mHSPC) compared with ADT.

Objective: to evaluate the incremental cost/effectiveness ratio (ICER) of enzalutamide use in patients with mHSPC and the ICER of enzalutamide as the first-line therapy for metastatic castration-resistant prostate cancer (mCRPC) from the Russian healthcare system perspective and to assess the contribution of enzalutamide into the reduction of mortality of mHSPC patients in the Russian Federation on the horizon until 2024.

Materials and methods. Standard ADT regimens for mHSPC were used as a comparator as it is the most common treatment for mHSPC in Russia. We proposed a Markov model of mHSPC progression on enzalutamide + ADT (hereinafter enzalutamide) or ADT + 1st generation antiandrogen (hereinafter ADT) based on ENZAMET trial data. Model was used to calculate the average life-years gained (LYG) and costs of mHSPC and post-progression mCRPC treatment. Simulation period was 15 years with one cycle of 1 month. In the “cost–effectiveness” analysis, we calculated enzalutamide ICER compared to ADT. In addition, we calculated ICER for enzalutamide plus ADT vs ADT in the first-line therapy of mCRPC as a benchmark based on PREVAIL trial data. In both cases, the average LYG over a 15-year period was used as an efficacy criteria. To assess the contribution of the enzalutamide into the reduction of mortality rate of mHSPC patients, the potential number of patients who could be treated with enzalutamide on the horizon of 2021–2024 was taken into account.

Results. According to the Markov model, the average LYG over a period of 15 years for enzalutamide was 7.59 years compared to 5.12 for ADT. The average enzalutamide therapy costs were 11,193,802 rubles per patient for 15 years, which were 8,597,131 rubles higher than when using ADT (2,596,672 rubles). ICER for enzalutamide (vs ADT) in mHSPC treatment was 3,484,362 rubles per one life-year gained. ICER for enzalutamide in the first line of mCRPC treatment (vs ADT) was 5,899,418 rubles per one life-year gained. The combination therapy with enzalutamide + ADT in Russia can be started annually by 2,410 mHSPC patients. If they all receive enzalutamide a total of 561 averted deaths among prostate cancer patients can be expected in 2021–2024.

Conclusion. In the Russian healthcare system, ICER for enzalutamide in mHSPC was 3,484,362 rubles and the ICER for enzalutamide in mCRPC was 5,899,418 rubles. Enzalutamide can make a significant contribution to achieving the target cancer mortality rates by 2024.

Leiomyosarcoma of the bladder is an extremely aggressive malignant tumor. Today in the world literature there are a little more than 200 described cases of bladder leiomyosarcoma. In all the cases described, the neoplasm originated from the proper muscle layer of the bladder. In this work, we present a unique clinical case – bladder leiomyosarcoma originating from the muscular elements of the bladder mucosa.

Objective: to analyze histological structure and identify predictors of detecting malignant non-seminoma in residual tumor masses obtained from patients with testicular non-seminomatous germ cell tumors (TNSGCTs) who had not achieved complete serological and radiological response to chemotherapy (CT).

Materials and methods. This study included 96 out of 703 patients with TNSGCTs (13.7 %) operated on in N.N. Blokhin National Medical Research Center of Oncology. The inclusion criteria were as follows: verified advanced TNSGCT, elevated levels of alpha-fetoprotein and/or chorionic gonadotropin at the moment of CT initiation, at least 3 completed courses of first-line or second-line platinum-based CT, residual tumor foci after CT visualized with radiological methods, alpha-fetoprotein >7.29 IU/mL or chorionic gonadotropin >5 mIU/mL 3 weeks after the initiation of the last CT course, and surgery after CT. Histological examination of the primary tumors demonstrated that they contained elements of seminoma (n = 14; 14.6 %), teratoma (n = 29; 30.2 %), choriocarcinoma in (n = 23; 23.9 %), embryonal carcinoma (n = 45; 46.9 %), and yolk sac (n = 18; 18.8 %). All study participants received first-line CT; 58 of them (60.4 %) also received second-line CT. All patients underwent surgery after CT, including retroperitoneal lymph node dissection (RPLND) (n = 96; 100 %) and excision of extra-retroperitoneal lesions (n = 8; 8.3 %).

Results. Histological examination of excised retroperitoneal masses showed that they contained areas of necrosis and fibrosis (n = 25; 26.0 %), teratoma (n = 29; 30.2 %), and viable malignant non-seminoma (n = 42; 43.8 %). There was a strong positive correlation between the existence of residual malignant non-seminomatous components in retroperitoneal masses and presence of choriocarcinoma (r = 0.300; р = 0.004), as well as the absence of embryonal carcinoma in the primary tumor (r = –0.300; р = 0.004), invasion of retroperitoneal metastases into major vessels and/or adjacent organs (r = 0.243; р = 0.017), and second-line CT prior to RPLND (r = 0.413; р <0.0001). Patients having ≥3 risk factors were significantly more likely to have residual malignant non-seminoma in retroperitoneal masses than patients who had 0–2 risk factors (73.5 % vs 27.3 %; р <0.0001). Excised residual extra-retroperitoneal masses contained areas of necrosis and fibrosis (n = 3; 37.5 %), teratoma (n = 1; 12.5 %), and malignant non-seminoma (n = 4; 62.5 %). Concordant structure of retroperitoneal and extra-retroperitoneal lesions was observed in 4 patients (50.0 %).

Conclusion. Malignant non-seminomas were detected in 43.8 % of retroperitoneal and 62.5 % of extra-retroperitoneal residual tumorsremoved after CT in patients with advanced TNSGCTs and incomplete serological and radiological response. Discordant structure of metastases at different locations was observed in 50 % of patients. Our finding can be used to select candidates for surgical excision of residual tumors among these patients.

This article touches upon topical problems of modern medicine, representing the difficulty of timely diagnosis of oncological diseases of arduous localization and management of patients with malignant neoplasms. As an example, a clinical case of primary urethral melanoma is presented, illustrating a complex of aspects associated with the rarity of detecting malignant neoplasms of a given localization. The creation of standardized tactics for managing patients with rare malignant tumors and the correct interpretation of research results at the diagnostic stage, play an important role in improving the quality and life expectancy of patients. A step-by-step analysis of difficult situations will increase the alertness of doctors of all specialties.

The ureter is a unique tubular structure, extremely sensitive to exogenous influences and directly affects to renal function. The injuries of the ureter remain one of the most difficult problems requiring an extraordinary surgical approach in urology. Extended strictures and obliterations of the ureters of various origins in the absence of timely treatment are accompanied by irreversible changes in the upper urinary system and renal parenchyma. Obstructive uroteropathy with transformation of the ureter wall, pelvis and kidney parenchyma in the case of oncology disease is caused directly by the tumor itself or invasive growth or complication of treatment. Therefore, the determination of indications and algorithms for ureteral reconstruction are cornerstone problem in urology daily practice.

The article presents a hypothesis about the influence of TP53 gene on the development of prostate, kidney, and bladder cancer through negative regulation of retrotransposons. The p53 protein is a transcription factor that controls the expression of various protein-coding genes. The promoter regions of endogenous retroviruses contain almost ideal binding sites for p53, which suppresses translation of these elements and LINE1s. The TP53 gene contains retrotransposons, which promote mutations due to recombinations. Germinal mutations of the TP53 gene in Li–Fraumeni syndrome cause a deficiency of the p53 protein, which leads to the activation of retroelements, which, in turn, cause loss of heterozygosity of the second TP53 allele. The result is a “vicious circle” that stimulates genomic instability and carcinogenesis. This mechanism is possible for sporadic urogenital system malignant neoplasms development, where TP53 mutations are most often identified, acting as drivers of carcinogenesis. At the same time, pathological activation of retroelements is found in many malignant neoplasms. Moreover, the “vicious circle”, when a deficiency of an oncosuppressor causes activation of retroelements that contribute to inactivation of other oncosuppressors, is characteristic not only for р53. Retroelements can be controlled by other oncosuppressor genes that contain hot spots of insertional mutagenesis and retrotransposons (which contribute to recombination events). I suppose that pathological interregulation of retroelements and tumor suppressors is a universal mechanism of carcinogenesis in the development of sporadic malignant neoplasms and hereditary tumor syndromes. Chromoplexy observed in 90 % of prostate cancer samples may reflect these events, since activated retroelements in carcinogenesis contribute to complex chromosomal rearrangements.

Soft tissue sarcomas are a rare group of malignant tumors that develop from different types of connective tissue. One of the histological variants of primary renal sarcoma is renal leiomyosarcoma. Leiomyosarcoma of kidneys can develop from the renal vasculature, renal veins, pelvic muscles, smooth muscle components of the renal capsule. Clinical and radiologic signs of leiomyosarcoma are nonspecific. Diagnosis is based on histological and immunohistochemical studies after surgical intervention. This article presents a clinical case of diagnosis and treatment of leiomyosarcoma of the renal vein.

Paratesticular sarcoma is a rare malignant tumor. In this regard, the correct diagnosis can be difficult and made only by the method of exclusion. Radiation diagnostics is used at all stages of the examination of patients with scrotal neoplasms and is highly effective in the primary staging of the disease, in assessing the effectiveness of treatment and in identifying the progression and recurrence of the disease. This article presents a clinical case of diagnosis and surgical treatment of paratesticular sarcoma.

Background. With a constant increase in the number of renal transplant recipients and an increase in their life expectancy, the number of complications associated with immunosuppressive therapy is progressively increasing. The incidences of oncological diseases are approximately 100 times higher than the incidence in the general population. Skin neoplasms constitute a significant part of oncological diseases after kidney transplantation.

Materials and methods. In our clinic in the period from 2010 to 2017, four patients with malignant neoplasms of the skin were observed. Three of them developed Kaposi’s sarcoma in the period from 6 months to 6 years after kidney transplantation, one was diagnosed with squamous cell skin cancer 10 years after the operation.

Results. After histological verification, excision of neoplasms was performed in two cases, followed by a decrease in the dosage of immunosuppressive drugs; in one case, a complete conversion of immunosuppressive therapy was performed. During therapy, stabilization of the condition was noted, however, further deterioration in the function of the graft was noted, which led to the loss of kidney function and removal of the grafts. A patient with basal cell skin cancer underwent surgical treatment with a course X-ray radiation, but further progression led to the death of the patient.

Conclusion. Kidney transplant patients are at high risk of developing skin malignancies and death from cancer. Early detection of the disease and complete withdrawal of immunosuppressive drugs – calcineurin inhibitors, despite the high probability of loss of graft function are still often remain necessary conditions for the treatment of patients with skin malignant neoplasms.