[Texture analysis of 3D models for the prediction of the grade of clear cell renal cell carcinoma of the kidney (pilot study)].

AIM: To evaluate the possibilities of textural analysis of 3D models in differentiating the degree of nuclear dysplasia of the clear cell renal cell carcinoma (ccRCC). MATERIALS AND METHODS: The specimens after surgical treatment of 190 patients with ccRCC were analyzed. In all cases, nephron-sparing surgery (NSS) was performed through laparoscopic access. The clinical characteristics were evaluated, including age, gender, tumor localization (side, surface and segments), absolute tumor volume, Charlson comorbidity index, body mass index, nephrometry scores (RENAL, PADOVA, C-index). Patients were divided into 2 groups. In group 1, there were 119 patients with the ccRCC of Grade 1 or 2, while group 2 consisted of 71 patients with ccRCC of Grade 3 and 4. All patients underwent 3D virtual planning of procedure using the 3D modeling program "Amira". At the first stage, two experienced radiologists performed manual segmentation of 3D models of kidney parenchyma tumors. At the second stage, the tumor shape was analyzed with a mathematical calculation of three indicators and more than 300 textural features of statistics of types 1-2 were extracted. Further, an intellectual analysis was carried out. For the evaluation of tumor grade according to Furman system, the classification problem was solved using the machine learning algorithm Stochastic Gradient Descent and cross-validation k=5. RESULTS: The accuracy of classification for the two groups of Grade 1 or 2 and Grade 3 or 4 on the F1 metric was 72.2. To build the model, the following parameters were selected: the absolute tumor volume, the Charlson comorbidity index, "Energy", the first quartile and the second decile of the pixel intensity distribution. CONCLUSION: The texture analysis of 3D models for the prediction of Fuhrman grade in ccRCC demonstrated satisfactory quality for two groups of Grade 1 or 2 and Grade 3 or 4 nuclear dysplasia.

[Use of intelligent analysis in urology].

The main methods of intellectual analysis (IA) used in modern medicine are described in the review. The main areas for IA application in the healthcare are diagnostics, treatment, prognosis of the course and efficiency of treatment in various diseases. The IA is based on mathematical methods and algorithms. The basic concepts of IA along with examples of its use in urological practice are presented in the review.

[Analysis of the learning curve in laparoscopic partial nephrectomy in patients with localized renal parenchymal lesions depending on the nephrometric score].

AIM: to analyze the learning curve of surgeons while performing laparoscopic partial nephrectomy in patients with localized renal parenchymal lesions by calculating the MIC (negative surgical margin, ischemia, and complications) index depending on tumor complexity according to the R.E.N.A.L. and PADUA nephrometric scores. MATERIALS AND METHODS: the retrospective study included the results of laparoscopic partial nephrectomies in 320 patients with localized renal parenchymal lesions. The procedures were carried out by four surgeons from the Institute of Urology and Human Reproductive Health of FGAOU VO I.M. Sechenov First Moscow State Medical University, Moscow, Russia (EC-1; ESH-4; EB-7; ME-13) from January 2014 to June 2019. At baseline, all operators had experience of performing at least 30 laparoscopic interventions. In addition to the standard preoperative examination, a 3D virtual planning was carried out using the Amira 3D modeling program. In all cases, the nephrometric assessment of complexity was performed according to the R.E.N.A.L. and PADUA scores. The learning curve was assessed based on the results of operations based on the MIC index. All surgical interventions were divided into eras. In the era, 40 consecutive procedures for each operator were evaluated. Acquired skills were assessed over two eras. RESULTS: The average age of patients, of which 191 (59.7%) were men, was 54.4+/-11.37 years. The average body mass index was 28.55+/-3.85 kg/m2, the absolute volume of kidney lesions was 26.72+/-43.72 cm3, the average Charlson comorbidity index was 1.46+/-1.29, the average R.E.N.A.L. and PADUA scores were 6.38+/-1.75 and 7.92+/-1.51, respectively, the average duration of procedure was 150.36+/-50.18 min, the average blood loss was 227.94+/-280.22 ml, the average time thermal ischemia was 13.28+/-7.82 min. Postoperative complications were seen in 36 (11.2%) cases, of which grade III and more according to Clavien-Dindo developed in 8 patients (2.5%). A positive surgical margin was found in 4 (1.2%) patients. The overall MIC index was achieved in 243 (75.9%) cases; in era 1 it was seen in 71.9% cases in comparison with 80% in era 2. With the 1st degree of complexity (152 (47.5%) patients), MIC was achieved in 80.9% of cases, compared to 76.6% and 56.8% in patients with 2nd degree of complexity (n=124, 38.8%) and 3rd degree of complexity (n=44, 13.8%), respectively. Rate of MIC achievement in eras 1 and 2 for different surgeons were as following: 65% and 72.5%, 75 and 80%, 87.5 and 85% and 60 and 82.5%, for operator 1, 4, 7 and 13, respectively. Age, tumor complexity, R.E.N.A.L. score and PADUA score were the most significant parameters for determining MIC, identified on the basis of the criterion of equality of group means of discrete analysis. CONCLUSION: In all surgeons, the MIC index increased with the accumulation of experience in performing laparoscopic partial nephrectomy, but was lower with an increased degree of complexity of procedures. The minimum number of laparoscopic partial nephrectomies required to achieve an MIC more or equal 70% should be at least 40.

[Adherent Perinephric Fat: a prognosis and influence of perioperative results of organ-sparing procedures in localized kidney parenchyma tumors].

The results of recently published articles on the etiology and pathogenesis of "Adherent Perinephric Fat" (APF) are presented in the review. The current possibilities for predicting the presence of APF based on clinical data and imaging methods are highlighted, as well as the to an influence of ARF on perioperative results of organ-sparing procedures using various surgical approaches in patients with localized kidney parenchyma tumors.

[Results of analysis of the structural and functional state of the kidneys by the method of mathematical processing of contrast-enhancing MD-CT data in patients with urolithiasis].

INTRODUCTION: and Objectives: to date there have been several hypotheses on the causes of kidney stone formation. Compromised intrarenal blood flow might play one of major roles in stone formation. Advances in software and 3D technologies have unveiled the nature of contrast medium flow in the intrarenal structures. Mathematical analysis and 3D rendering of computed tomography (CT) scans was utilized for inrarenal contrast medium flow assessment in patients with stone kidney disease. This study aimed at assessing split glomerular filtration rate (sGFR) in patients at the initial stage of stone kidney disease (SKD). sGFR was measured by means of mathematical analysis of 3D rendering abdominal contrast enhanced CT scans. As well as that, possible correlations between irregular inrarenal contrast medium flow and causes of stone formation were considered. MATERIALS AND METHODS: 23 patients of both sexes with stone kidney disease (SKD) were recruited. They underwent US/Dopler investigation of the kidneys and the bladder, plain X-ray, histopathological evaluation of the tissues (those patients who were operated on), spectroscopic analysis of the stone(s). Mathematical analysis of 3D rendering of CT scans was utilized for sGFR assessment (sGFR reference value: 0,55% of contrast medium per second). Inclusion criteria are as follows: 1) newly diagnosed SKD; 2) stone size less than 1,5-2,0 cm 3) stones that do not block urine flow 4) non-operated young patients; 5) patients free of comorbidities. Inclusion criteria were set to mitigate the effects of other factors that might influence on intrarenal blood flow and conduct the study per se. RESULTS: Mathematical analysis of 3D rendering of CT scans allowed to elucidate changes in sGFR in 22 (95,6%) patients out of 23. HypErfiltration (hyperF) was detected in 10 (43,5%) patients, hypOfiltration (hypoF) was detected in 11(47,8%) patients. sGFR values were statistically significantly different in these groups both on the left (p=0,000142) and on the right (p=0,00068). No significant gender differences were observed (hypoF group aged 25-67 years with the mean age of 43,5 years; hyperF group aged 17-57 years with the mean age of 39 years (p=0,563). Ultrasound Doppler renal resistive index in renal arteries was within the normal range in both groups with no statistically significant difference between the groups. However, 1 patient demonstrated no sGFR changes. Another patient had hyporfiltration on the left (0,48%) and hyperfiltration on the right (0,62%) Conclusions: sGFR alterations (hypo- or hyperfiltration) were detected in the majority of the patients with SKD (95,6%). This in turn might be suggestive of compromised intrarenal blood flow. Further studies are needed to elucidate the optimal management of these patients.

[Multidisciplinary approach in urology. Laser technologies: faster, simpler, more efficient].

Laser technology has taken a place among the methods of treatment of various urological diseases. The new laser devices are being developed in addition to commonly used. Physicists of the russian NTO "IRE Polus" in collaboration with doctors from Sechenov University have developed a new generation laser device - thulium fiber laser. It has been actively used since 2017 for laser enucleation of prostate. Later the laser was used for treatment of bladder tumor, lithotripsy. The device has already managed to prove its efficacy in in-vitro experiments and clinical practice surpassing foreign analogues.

[Multidisciplinary approach in urology. 3D-technologies in urology].

AIM: to show the importance of interdisciplinary interaction in the process of applying 3D technologies in surgical treatment of patients with urological diseases starting from planning of the treatment tactics using a virtual surgical model with the possibility of preoperative training on a personalized 3D-printed model, ending with the use of the obtained data as navigation during real surgical intervention.

[Multidisciplinary approach in urology. Current imaging studies in urology].

Imaging studies play a crucial role in the diagnosis of urologic diseases. X-ray and ultrasound studies are used as first-line diagnostic methods. Computed tomography and magnetic resonance imaging (MD-CT and MRI), radionuclide and hybrid methods allow to clarify diagnosis. Currently, the trend "from simple to complex" contributes to obtaining maximum information in the shortest possible time with a minimum cost.

[Multidisciplinary approach in urology. Clinical aspects].

A solving diagnostic and therapeutic problems in patients with various urologic diseases often requires a cooperation between different specialists which emphasizes the interdisciplinarity of our discipline. A number of clinical manifestations and diseases that urologists have to deal with and in which they definitely need a timely assistance from other specialists are described in the article. Determining the connecting links in the work of different specialists, we tried to recall the main " intersection points" and draw attention to the necessary cooperation.

[3D-technologies in planning and navigation for laparoscopic interventions in patients with renal and ureteric stones].

AIM: to evaluate the possibilities and efficiency of using 3D technologies for the laparoscopic interventions in patients with renal and ureteric stones. MATERIALS AND METHODS: A retrospective analysis of the results of surgical treatment of patients with renal and ureteric stones performed in the urology clinic of the I.M. Sechenov First Moscow State Medical University of Minzdrav of Russia for the period from January 2012 to December 2017 was carried out. During this period a total of 4958 interventions were done. Among them, 98 laparoscopic (1.97%) surgeries were performed, including nephron-sparing interventions (n=47; 48%), pyelolithotomy (n=15; 15.3%), ureterolithotomy (n=32; 32.65%) and partial nephrectomy (n=4; 4.05 %). The average patients age was 55.76+/-10.5 (29-80) years. There were 51 men (52%) and 47 women (48%). The mean stone density was 1237.6+/-354.6 HU (from 500 to 1913 HU). In 14 (22.9%) cases, nephrostomy tube or ureteric stent had been put before surgery. In addition, 40 (40.8%) patients previously underwent one surgical intervention on the kidneys and 17 patients with urinary stone disease (17.3%) underwent surgery more or equal 2 times. 88 (89.8%) patients had severe concomitant diseases and the most common pathology in 51 (52.0%) patients with urinary stone disease was arterial hypertension. In 11 (11.2%) cases, the interventions were performed in patients with abnormal kidneys, including horseshoe kidney (n=6; 6.1%), duplicated collecting system (n=3; 3.1%) and pelvic kidney (n=2; 2%). In addition to standard preoperative diagnostic methods in 22 cases (22.4%) the 3D-planning and multivariate virtual performing of intervention based on the multidetector computer tomography scan was done using Amira 3D-modeling program. Among these patients, virtual interventions were performed prior to all pyelolithotomy and partial nephrectomy. Intraoperative data of virtual constructions were used by surgeons as navigation. The interventions were performed by seven urologists at the clinic with various experience in laparoscopic surgery. RESULTS: The mean duration of laparoscopic pyelolithotomy, laparoscopic partial nephrectomy, laparoscopic ureterolithotomy and laparoscopic nephrectomy was 183.2+/-69.6, 201.3+/-35.2 min, 97.6+/-43.7 and 165.4+/-92.3 min, respectively. The minimal blood loss was observed during laparoscopic ureterolithotomy (53.33+/-31.2 ml). During these interventions, in 8 cases (8.16%) a flexible endoscope was used for inspection and complete removal of stones. Intraoperative complications were noted in 6 patients (6.1%). There were 4 conversions to open surgery (4.1%). Postoperative surgical complications were observed in 1 (1%) patient, while non-surgical complications developed in 4 patients (4.1%). There was no mortality. CONCLUSION: Laparoscopic access for the treatment of patients with urinary stone disease should be used for the treatment of patients with large, long-standing ureteral calculi and patients with kidney stones who have concomitant pathology of kidney or upper urinary tract (UPJ obstruction, kidney tumors) requiring surgical intervention. Laparoscopic access should be considered primarily for the planning of laparoscopic partial nephrectomy and laparoscopic nephrectomy in patients with urinary stone disease. The use of 3D computer-assisted technologies is advisable for patients with urinary stone disease and abnormal kidneys if laparoscopic pyelolithotomy, partial nephrectomy or ureterolithotomy is planned.

[Urinary stone disease. Part V. Drugs used for metaphylaxis of urinary stone disease].

The stages of postoperative metaphylaxis, drugs used for correction of metabolic disturbances are reviewed. In addition, the basic principles of drug metaphylaxis in various types of stone formation are described.

[Urinary stone disease. Part IV. Recurrence prevention for urinary stone disease].

The place and indications for recurrence prevention of urinary stone disease, general principles of recurrence prevention, role of mineral water and changes of dietary habits during recurrence prevention are reviewed in the article.

[Zero-ischemia nephron-sparing interventions for renal tumor. do we need 3D-modeling?]

INTRODUCTION: our aim was to assess and compare a zero ischemia enucleation and enucleoresection of tumor, as well as classical partial nephrectomy. In addition, we defined a role of a three-dimensional reconstruction of the tumor for the planning of intervention. MATERIALS AND METHODS: a total of 83 patients with localized renal tumors were included in the study. There were 48 men (57.8%) and 35 women (42.2%), with mean age 56.8+/-11.9 years. The patients were divided into 3 groups depending on the type of intervention. The enucleation, enucleoresetion and classical partial nephrectomy with removal of 0.5-1 cm margin of normal parenchyma was performed in Group 1 (n=41), Group 2 (n=31) and Group 3 (n=11), respectively. A computer program Amira was used for the reconstruction of 3D-model of tumor during preoperative planning. On the basis of 3D-model, an information about the structures situated beneath the tumor was obtained, as well as anatomy of vessels and relationship between the renal pelvis system and the tumor. RESULTS: In all cases the interventions were performed laparoscopically. Transperitoneal access was used in 34 (41%) cases, while retroperitoneal access was chosen in 49 patients (59%). The amount of blood loss was higher in 23 patients (27.7%) with tumors located in renal sinus (205.7+/-29.1 ml), than in patients with exophytic and endophytic tumors (142.3+/-15.2 and 208.2+/-35.9 ml, respectively; p=0.005). The duration of the surgery was less in those cases where parenchyma was under the bottom of the tumor, according to the 3D-model (58.3+/-6.8 min), compared to the patients with collecting system or vessels located under the tumor (87,6+/-5.2 min, p=0.005). The amount of blood loss was 179.4 +/- 41.8 ml in patients with one vessel located beneath the tumor, according to the 3D-model, in comparison with those cases with three vessels (360.0+/-87.2 ml). There was no need for clamping of the renal vessels or conversion to the open surgery. In the enucleation group, neither intraoperative nor postoperative complications were observed. CONCLUSION: According to the results, we can conclude that 3D modeling undoubtedly gives clear advantages for the urologist during the planning of the intervention. Tumor enucleation seems to be the optimal method of partial nephrectomy, which allows to perform a dissection near to the renal sinus with the small risk of complications.

[Methanaphylaxis of urolithiasis. Part 3. The factors associated with increase in incidence of urinary stone disease. Current views on the mechanisms of stone formation].

All theories of stone formation are based on the common condition, which is the supersaturation of stone-forming elements. The microelements involved in the stone formation, the most common metabolic disorders and their role in stone formation are discussed.

[Clinical case of delayed diagnosis of tuberous sclerosis].

A clinical case of successful drug treatment of multiple renal angiomyolipomas in patient with tuberous sclerosis is presented, which suggests potential role of medical treatment of benign kidney tumors.

[Computer-assisted laparoscopic surgery for renal carcinoma].

AIM: To investigate the effectiveness and benefits of using 3D planning and virtual surgery in the management of patients with localized renal carcinoma undergoing laparoscopic surgery. MATERIALS AND METHODS: A retrospective analysis was performed on 558 patients with renal cell carcinoma (RCC) who underwent surgical treatment at the Clinic of Urology, I.M. Sechenov First MSMU from January 2012 to May 2017. Of them, 244 (43.7%) and 314 (56.3%) patients underwent laparoscopic radical nephrectomy (LRN) and laparoscopic partial nephrectomy (LPN), respectively. In addition to the standard diagnostic work-up, 248 (44.4%) patients underwent multispiral computed tomography (MSCT) for 3D modeling and virtual surgery using the 3D modeling program Amira. Matched pairs of patients with and without 3D planning were selected based on similarity of urologists experience in performing the operation, the size and location of the tumor (relative to the renal segment, anterior and posterior surfaces), and the surgical approach. As a result, two homogeneous subgroups of patients were chosen comprising those who underwent LRN (22 pairs of patients) and LPN (53 pairs of patients). RESULTS: Patients with RCC who underwent LPN with 3D planning had a significant advantage over patients without virtual planning: by warm ischemia time 12.0+/-6.4 min (p=0.010), operative time 113.4+/-39.4 min (p=0.0001), blood loss 102.8+/-98.2 ml (p=0.001). Among patients with RCC who underwent LRN, the subgroup with 3D planning also had an advantage: operative time was 135.2+/-27 and 202.9+/-55.5 min (p=0.0001), blood loss was 143.2+/-137,4 and 472,0+/-395,4 ml (p=0,014), and regarding the rate of intraoperative (p=0,017) and postoperative (p=0,017) complications. CONCLUSION: The use of computer-assisted 3D planning and virtual operations improves immediate results of surgery in RCC patients undergoing organ-sparing and organ-removing laparoscopic surgery.

[Multi-parametric MRI/US fusion guided biopsy for the diagnosis of prostate cancer. ur experience].

INTRODUCTION: Prostate cancer is one of the most common types of cancer in men. The gold standard for the detection of prostate cancer is ultrasound guided transrectal prostate biopsy. The detectability of cancer using this method is from 30 to 50%. As a result, many men undergo multiple repeat biopsies for suspected prostate cancer. The European Association of Urology does not give any recommendations on this matter. A revolutionary new method in the diagnosis of prostate cancer is a targeted prostate biopsy using a fusion of multiparametric magnetic resonance imaging (MRI) and ultrasound. MATERIALS AND METHODS: At the R.M. Fronstein Clinic of Urology, 55 patients with suspected prostate cancer from September 2017 to January 2018 underwent fusion prostate biopsy. Of them, 21 patients had negative primary biopsies. Two patients had verified prostate cancer. 32 patients did not undergo primary biopsies. RESULTS: The findings of the study suggest that using MRI-ultrasound fusion for guidance of targeted prostate biopsy improves the quality of the histological material, allows patients to avoid unnecessary biopsy, reduces the number of punctures, thereby offering higher diagnostic performance in detecting prostate cancer. MRI-ultrasound fusion targeted biopsy has a high sensitivity in detecting clinically significant cancer and low for clinically insignificant cancers. CONCLUSION: The technique affords accurate detection of the location and extent of pathological lesions in the prostate thus allowing focal therapy for prostate cancer.

[A new method of evaluation of split renal function based on contrast-enhanced multislice spiral computed tomography].

INTRODUCTION: Traditionally, evaluation of the split renal function is performed using nephroscintigraphy. However, as shown in several studies, there might be quite significant inaccuracy in the interpretation of dynamic nephroscintigraphy results. But due to the lack of alternative methods for evaluation of split renal function, nephroscintigraphy remains the method of choice. AIM: To investigate the feasibility of digital analysis of contrast-enhanced MSCT imaging for evaluation of the split renal function. MATERIALS AND METHODS: This is a prospective study conducted at the R.M. Fronshteyn Clinic of Urology from November 2015 to February 2017. The study comprised 31 patients with urolithiasis (n=7), hydronephrosis (n=9), kidney cancer (n=14) and urinary bladder tumor (n=1). During the preoperative period, the patients underwent contrast-enhanced MSCT, 3D-reconstruction, and digital analysis. The obtained data were compared with the results of dynamic nephroscintigraphy. RESULTS: Contrast-enhanced MSCT findings were not inferior to data obtained with dynamic nephroscintigraphy regarding information content (p<0.004). CONCLUSIONS: The new method of digital processing of three-dimensional contrast-enhanced MSCT allows for concomitant assessment of both the anatomical features of the kidney and renal function that may help to improve the accuracy of surgical planning to choose the optimal extension of the intervention.