Aim. To analyze our own results of the course of early postoperative period in patients who underwent surgical treatment of kidney tumors: partial nephrectomy (PN) and radical nephrectomy (RN) and to identify risk factors for the development of acute kidney injury (AKI).

Materials and methods. The study included 399 patients, of which 276 patients (69.17 %) underwent PN, 123 (30.83 %) underwent RN. According  to the clinical stage of the disease, patients in the PN and RN groups were distributed as follows: cT1a – 160 (91.95 %) and 14 (8.05 %), cT1b – 99 (61.11 %) and 63 (38.89 %) and cT2a – 17 (26.98 %) and 46 (73.02 %), respectively. Operations were performed with open (1.0 %), laparoscopic (39.35 %) and robot-assisted (59.65 %) accesses. AKI was evaluated by the changes in serum creatinine and glomerular filtration rate before surgery and 1–3 days after in accordance with KDIGO criteria.

Results. The overall incidence of AKI after surgical treatment  for kidney cancer at stages cT1a–cT2a was 27.57 %. The incidence of AKI after RN was 65.04 %, after PN – 11.23 %. At stages cT1a, cT1b, cT2a, after nephron-sparing surgery and radical treatment, this indicator was 9.37; 11.11; 29.41 % and 71.43; 63.49; 65.22 %, respectively. For warm ischemia time below 15 and 20 minutes, AKI incidence did not exceed 8.3 and 13.2 %, respectively. For warm ischemia time >30 min, a dramatic increase in AKI incidence was observed.

Conclusion. To preserve kidney function, PN is the operation of choice in surgical treatment of kidney tumors at stages cT1–cT2a. After RN, AKI development was observed 6 times more often than after PN. The following statistically significant predictors of AKI after PN were identified: presence of initial chronic kidney disease in patients, tumor size, operative time above 190 minutes, type of kidney ischemia used, and warm ischemia time above 25 minutes.

Aim. To evaluate the effect of cytoreductive nephrectomy (CN) on overall survival (OS) in patients with metastatic renal cell carcinoma (mRCC) and to identify a group of patients who are candidates for cytoreductive surgical treatment.

Materials and methods. We retrospectively analyzed a database of 403 patients with mRCC treated at the Moscow City Oncological Hospital No. 62 and the City Clinical Oncological Dispensary (Saint Petersburg) between 2006 and 2022. In total, 330 (81.9 %) patients underwent CN. All patients received systemic anti-tumor therapy: targeted anti-angiogenic therapy - 317 (78.6 %), cytokines - 61 (15.1 %), checkpoint inhibitors - 25 (6.2 %). The groups of operated and non-operated patients were unbalanced: CN was more often not performed in patients with multiple metastases, bone and liver lesions, laboratory abnormalities (anemia, increased serum alkaline phosphatase and lactate dehydrogenase) and unfavorable prognosis per IMDC (International mRCC Database Consortium) classification (p >0.05 for all). 

Results. CN was associated with a significant increase in OS compared with primary tumor preservation in situ: median OS was 36 months with 95 % confidence interval 29.1-37.1, and 11 months with 95 % confidence interval 8.1-21.3, respectively (p <0.0001). The benefit for OS in the CN group was also observed in clear-cell mRCC (p <0.0001), grade G3 (p <0.0001), multiple metastases (p <0.0001) groups, and in the IMDC poor prognosis group (p <0.0001). 

Conclusion. CN in selected mRCC patients results in a significant increase in OS. Further research is needed to determine selection criteria for surgical treatment candidates. 

Despite constant improvements in radical prostatectomy technique, some questions on standardization of both perioperative management stages and surgical intervention itself remain.

We conducted an anonymous online survey of 45 oncological urologists from 15 regions of the Russian Federation who are actively involved in the surgical treatment of patients with prostate cancer.

According to the results of the survey, there is huge variability associated, to a great extent, with equipment availability in clinics and the lack of sufficient evidence-based information in some matters of perioperative management.

A detailed study of each step of surgical treatment, clinical trials, and involvement of professional societies will contribute to the standardization of perioperative management of patients and radical prostatectomy technique. 

Background. High dose-rate brachytherapy is a new method of interstitial radiation therapy for treatment of localized prostate cancer. The difference from low dose therapy is temporary implantation of radiation sources with targeted high dose-rate irradiation of the affected organ.

Aim. To evaluate 3-year effectiveness and safety of high dose-rate brachytherapy in patients with infravesical obstruction. Materials and methods. Between January of 2017 and December of 2019 at the Central Clinical Hospital “RZD-medicine”, 49 patients  (mean age 67.8 ± 7.5 years) with verified prostate  cancer diagnosis underwent high dose-rate brachytherapy in the regimen of 2 sessions of 15 Gy with ¹⁹²Ir source. The inclusion criteria were disease stage ≤сТ2с, Gleason score ≤7. Patients were divided into 2 groups: 1^st – patients with incidental prostate cancer (n = 21) who previously (more than 6 months ago, mean time 9.4 ± 2.4 months) underwent transurethral prostatectomy; 2^nd – patients with verified prostate cancer (mean prostate volume 56 cm³) and obstructive symptoms without previous transurethral prostatectomy (n = 28).

Results. In both groups, no intraoperative complications were observed. In 6 (28 %) patients of the 1^st group and 2 patients of the 2^nd group, grade II genitourinary toxicity in the form of moderate dysuria and nocturia was observed. Acute gastrointestinal  toxicity was observed in 3 (14 %) patients of the 1^st group, in the 2^nd group such complications were absent. In the 2^nd group during the postoperative period after the 2^nd session, 4 patients (14 %) experienced acute urinary retention requiring cystostomy.

Conclusion. High dose-rate brachytherapy is a safe and effective radical treatment method for patients with localized prostate cancer with obstructive symptoms who have contraindications for surgical treatment.

Background. Laparoscopic radical cystectomy is an established reliable minimally invasive method for the treatment of muscle-invasive bladder cancer. However, in the elderly and patients with serious comorbidities, laparoscopic radical cystectomy is still associated with high risk of complications. There are only a few reports on the use of extraperitoneal access for laparoscopic radical cystectomy in the literature. At the same time, extensive experience has been accumulated in laparoscopic extraperitoneal radical prostatectomy and retroperitoneoscopic operations on the kidney showing significant advantages of extraperitoneal access. Aim. To present initial results of laparoscopic radical cystectomy through extraperitoneal access in medically ill patients.

Materials and methods. Between 2017 and 2021, extraperitoneal laparoscopic radical cystectomy was performed at the Volgograd Regional Uronephrology Center in four male patients with tumors affecting the bladder, stages T2–T4. All patients had serious comorbidities. In 3 patients, grade G₂–G₃ muscle-invasive bladder cancer was histologically verified prior to cystectomy. Two of them had invasion in the posterior urethra. One patient was diagnosed with prostate adenocarcinoma (Gleason score 8 (5 + 3)) with invasion into the bladder wall, ureterohydronephrosis and stage IV chronic kidney disease. None of the patients received neoadjuvant therapy: in 2 cases surgeries were emergency due to recurrent hemorrhages, and 3 patients had significantly decreased kidney function.

Results. All operations were performed completely laparoscopically through extraperitoneal access. In 1 case, urine diversion was performed transperitoneally into a colon conduit. Simultaneous retroperitoneoscopic ureterocutaneostomy was performed in two patients: on one side (in a patient with a single functioning kidney) and on both sides, respectively. In a patient with stage V chronic kidney disease and permanent dialysis, bilateral simultaneous retroperitoneal nephrectomies were performed.

In 2 patients, salvage cystectomy was done for recurrent bleeding that couldn’t be managed by conservative methods. The maximum intraoperative blood loss did not exceed 500 mL. Bowel function in all patients was recovered within 24–36 hours after the intervention.

Conclusion. Laparoscopic  extraperitoneal radical cystectomy is a reproducible minimally invasive surgical procedure for bladder cancer treatment that has advantages in terms of postoperative recovery in patients with severe comorbidities. The use of extraperitoneal access may be a rational alternative for salvage cystectomy in male patients. More observations are needed to determine the place of the method in the surgical treatment of muscle invasive bladder cancer.

Background. Standard first-line therapy options for patients with locally advanced or metastatic urothelial carcinoma (UC) is platinum-based chemotherapy. Currently,  patients  also have access to immune checkpoint inhibitors (ICIs) such as pembrolizumab, nivolumab, and atezolizumab, along with avelumab, which, unlike other drugs in this class, can be used as maintenance therapy after first-line platinum-based chemotherapy.

Aim. To evaluate the effects of using ICIs in treating adult patients with locally advanced or metastatic UC on reducing overall and one-year cancer mortality in Russia.

Materials and methods.  A mathematical model based on overall survival and progression-free survival data from clinical trials has been proposed. This model describes duration of therapy and treatment outcomes for cases of treatment without ICIs (routine clinical practice); with pembrolizumab, nivolumab, and atezolizumab in first and second-line therapy according to real-life clinical practice (current practice); and with avelumab as maintenance  therapy after platinum-based chemotherapy (proposed practice) over a 3-year period. The model was used to estimate the number of lives saved and healthcare system costs when transitioning from historical to current practice, and from current to proposed practice over a three-year horizon, considering the number of locally advanced or metastatic UC patients who may start platinum-based therapy annually in Russia.

Results. Annually, up to 4,182 patients with locally advanced or metastatic UC in Russia can start platinum-based chemotherapy. Compared to  historical  practice, the  use of pembrolizumab, nivolumab, and atezolizumab in the  first and second lines of therapy in accordance with the routine clinical practice allows to reduce mortality from malignant neoplasms by 553 cases over a 3-year horizon. Over the same period, avelumab-based treatment  would additionally save 2,506 lives. Moreover, the cost of saving one life with the use of avelumab amounts to 6.0 million rubles, which is 9 % lower than the cost of saving one life with the use of other ICIs (6.6 million rubles).

Conclusion. The use of avelumab as maintenance therapy after platinum-based chemotherapy in the 1^st line in patients with locally advanced or metastatic UC has a significant and quantifiable impact on reducing cancer-related mortality in Russia.

Hereditary form of prostate cancer is often caused by pathogenic variants in genes associated with the DNA repair system. Identification of genetic aberrations allows to stratify patients into groups for personalization and improvement of therapy effectiveness. With this approach, it is important to take into account that the frequency of pathogenic variants can vary significantly in different ethnic populations.

The article presents a case of metastatic castration-resistant prostate cancer in a carrier of hereditary pathogenic variant in the BRCA2 gene c.6341del (р.Pro2114fs). The results support the need for genetic testing using up-to-date methods capable of detecting rare genetic variants.

Narrowing of ureter can be due to malignant or benign causes. Temporary double-J (DJ) stents, various metallic stent designs, or definitive corrective surgery can be the options management for ureteric stricture. As an alternative from DJ stents, Memokath-051^TM (MMK-051^TM) can be inserted in strictured ureters post radiotherapy for advanced prostate cancer patients. We present a case of an advanced prostate cancer which bilateral DJ Stents placed within MMK-051^TM. A 76-year-old man with underlying hormone sensitive advanced prostate cancer completed radiotherapy. Post radiotherapy he developed bilateral ureteric strictures  and bilateral DJ stents  inserted.  He had to underwent multiple change of stents due to blockage. Patient had MMK-051^TM inserted, however complicated with blockage due to encrustation. Improvisation method done by putting the bilateral DJ stents within the MMK-051^TM. Patient had no more blockage of MMK-051^TM after the placement of DJ stents within it. However, patient succumbed to death a year after the last procedure. Our case report highlighted encrustation of metallic ureteric stents and a novel approach to overcome this problem. Introduction  of additional DJ stents  not only reduced the incidence of MMK-051^TM blockage but also improved the quality of life of the patient.

The standard treatment for metastatic hormone-sensitive prostate cancer does not include external beam radiotherapy (EBRT) and radionuclide therapy with radium-223.

The article describes a clinical case of successful use of EBRT and radionuclide therapy with radium-223 in a patient with primary high-volume metastatic hormone-sensitive prostate cancer.

The patient  received diagnosis of prostate cancer сT3bN1M1b (Gleason score 8 (4 + 4)), stage IV (metastases in the bones, extraperitoneal and intrathoracic lymph nodes; prostate specific antigen (PSA) level was 4280 ng/mL). Between October of 2017 and January of 2018, the patient received 6 cycles of chemohormonal therapy (degarelix + docetaxel). Bilateral orchiectomy was performed on 05.02.2018, and the patient underwent palliative EBRT on cervical vertebrae between 04.10.2017 and 19.10.2017 with total dose of 32.6 Gy (equivalent to 38.5 Gy). The patient received systemic radiotherapy with one injection of samarium oxabifor (153Sm) 40 mCi (21.03.2018) and radium-223 (4 injections once a month (17.04.2018, 15.05.2018, 14.06.2018, 10.07.2018) + 2 injections 1 time per 3 months (October 2018, January 2019)). Partial response was achieved in the form of PSA decrease from 4280 ng/mL (September 2017) to 0.505 ng/mL (May 2019). Palliative EBRT for the prostate and pelvis was performed between 14.11.2018 and 19.12.2018 for total dose of 62.5 Gy (equivalent to 69 Gy). For 2 years remission was observed with PSA level of 0.3–0.5 ng/mL. In December of 2020, biochemical recurrence was diagnosed: PSA level increased from 0.61 ng/mL in October to 1.43 ng/mL on  28.12.2020.  The  second  course  of  radionuclide  therapy  with  radium-223  5,500  MBq/mL  was  performed  (22.01.2021, 05.03.2021, 02.04.2021) with increase of PSA level to 1.92 ng/mL (May of 2021) and independent decrease to 0.542 ng/mL (June of 2022). In December of 2022, biochemical recurrence was observed with a small increase of PSA level to 1.67 ng/mL. Currently, the disease is stabilized.

Carcinosarcoma is a rare type of prostate neoplasms and accounts for less than 1 % of all malignant tumors of the prostate.  This kind of tumor is characterized by the absence of prostate-specific antigen elevation in most cases, which leads to diagnosis of metastatic disease in a quarter of patients.  Moreover, carcinosarcoma of the prostate has an extremely poor clinical prognosis. From the morphological point of a view, biphasicity is a typical feature for these tumors. As a rule, epithelial component is represented by poorly differentiated acinar adenocarcinoma. However, in some literature cases adenogenous component was represented by ductal or neuroendocrine carcinoma. Sarcoma component can be represented by any sarcoma type. Currently, pathogenesis of carcinosarcomas isn’t clear. In this report, we describe a clinical case of carcinosarcoma of the prostate in a 72-year-old male.

Metanephric adenoma is a rare benign kidney tumor with a favorable prognosis. These neoplasms are often interpreted as malignant at the preoperative stage, since they do not have specific characteristics showing during instrumental imaging methods, which leads to excessive surgical treatment in the context of nephrectomy volume. Therefore, histological verification is the gold standard for diagnosis. The morphological features of metanephric adenoma are in many ways similar to such kidney tumors as papillary renal cell carcinoma and nephroblastoma (Wilms’ tumor), so sometimes additional research methods are required, including immunohistochemical and molecular genetic ones. In this article, we report a rare clinical case of metanephric adenoma in a forty-seven-year-old woman. The results of clinical and instrumental exams, as well as morphological features of the tumor are presented. A review  of the literature on the clinical, morphological, and molecular aspects of this tumor is also presented.

Background. With increasing life expectancy in cervical cancer patients, new medical and social problems associated with radiation therapy become apparent.  The combination of radiation therapy and chemotherapy is an important therapeutic component in treatment of malignant neoplasms of the genital area in women, but the frequency and severity of side effects has been increasing. Radiation complications occur in 20–50 % of patients.  In 5 % of patients, they can represent a severe and potentially life-threatening condition. Prevention of negative effects on the genitourinary system in cervical cancer patients receiving radiation therapy on the pelvis is a matter of importance.

Aim. To evaluate the clinical efficacy of a phytotherapeutic  preparation Canephron  N containing centaury, lovage root, rosemary leaves in the prevention of radiation cystitis during chemoradiotherapy in patients with advanced cervical cancer.

Materials and methods. The study included 60 patients with locally advanced cervical cancer receiving radical chemoradiotherapy. The patients were divided into 2 groups: treatment  group consisting of patients receiving phytotherapeutic preparation Canephron N for prevention of radiation complications, and control group consisting of patients not receiving symptomatic treatment.  The treatment results were evaluated using questionnaires, clinical, laboratory and instrumental studies. The obtained data were compared with the results of treatment of the control group which were not prescribed a medication for prevention of urological complications.

Results and conclusion. The use of Canephron N in accompanying therapy had significantly decreased the risk and incidence of radiation cystitis.

Renal cancer (RC) is one of the three most common diseases in oncologic urology. Its accurate diagnosis and prognosis remain difficult and important problems. Some cases of RC are associated with hereditary cancer syndromes and are caused by germline mutations. This review describes monogenic forms of hereditary RC (von Hippel–Lindau syndrome, Birt–Hogg– Dubé syndrome, hereditary leiomyomatosis and renal cell cancer, hereditary papillary renal carcinoma, BAP1 tumor predisposition syndrome) and diseases with several candidate genes (SDH-mutated tumors, tuberous sclerosis complex). Additionally, the review discusses the increased risk of RC in patients with frequent hereditary cancer syndromes predisposing to the development of a wide range of tumor types: Lynch and Li-Fraumeni syndromes. RC in combination with other carcinomas can develop in patients carrying pathogenic mutations in the candidate genes of different hereditary cancer syndromes –  multi-locus inherited  neoplasia  allele syndrome (MINAS)  –  which is especially important  due to the growing role of high-throughput sequencing in practical oncologic genetics. Additionally, guidelines on modern laboratory genetic diagnostics and active surveillance are presented for each syndrome.

This article discusses the  choice of surgical access in renal cancer complicated by tumor thrombus with invasion into the inferior vena cava and the right atrium. This clinical scenario poses a major challenge to the surgeons, as tumor thrombus can obstruct access to the surgical area and increase the risk of complications. This article discusses various surgical access techniques that  can be used in treatment  of kidney cancer complicated by tumor thrombus of the inferior vena cava and right atrium, including open surgery, robotic surgery, and minimally invasive techniques. An analysis of factors to consider in selection of the optimal surgical access was perfomed.

The review covers reduced kidney function in the context of renal cell carcinoma. According to international studies, some patients  already have chronic kidney disease at time of disease onset. Surgical treatment  leads to a decrease in the total number of functioning nephrons. Drug therapy causes several adverse events including nephrotoxicity. The review discusses the problem of using combination regimens in patients with solitary kidney.

Background. Currently, kidney cancer remains one of the most common oncourological diseases with relatively high mortality rate.

Aim. To study the main epidemiological indicators of malignant neoplasms of the kidney in various regions of Russia and Saint Petersburg.

Materials and methods. Based on the data from the Department of Medical Statistics of Tumor Diseases of the Medical Information and Analytical Center, the epidemiological indicators of malignant neoplasms of the kidney for the period between 2016 and 2021 in Russia, individual Federal Districts of the country and Saint Petersburg were analyzed.

Results. Despite the  increase in the  prevalence of malignant  neoplasms of the  kidney,  medical oncological care for the population is at an appropriate level. Most cases of the disease are diagnosed at early stages, there is a decrease in patient mortality rates and an increase in 5-year survival, which indicates the effectiveness of ongoing anticancer measures. In a number of Federal Districts, a number of indicators showed a negative trend compared to the all-Russia data, which requires close attention.

Conclusion. The analysis of statistical  data of patients with malignant neoplasms of the kidney can be used to optimize the algorithms for diagnosing and treating  this category of patients,  as well as to improve oncological care for the population.