[The complex prophylaxis of thromboembolism in oncourologic patients].

One of the major complications in oncourological patients in the hospital is the development of thromboembolic complications. This article is devoted to analysis of the results of the comprehensive prevention of thromboembolic complications in 1006 patients that have received surgical treatment in the Scientific research institute of urology in the period 2009-2011. Carried out the comparative estimation of efficiency of elastic bandaging and elastic compressive knitted wear as a means of non-medicamental prevention of thromboembolic complications in of oncourology. In the study, in addition to assessing the impact of elastic compression on various aspects of the state of the venous system of patients and the hemostasis system is shown that the use of elastic compression hosiery compared with elastic bandaging allows to reduce the incidence of thromboembolic complications.

[Heterotopic urine derivation in females with urinary bladder extrophy].

Fifteen females aged from 17 to 31 years with bladder extrophy (the condition after ureterosygmostomy) have undergone heterotopic urine derivation with creation of a cutaneous urine-retention catheter mechanism. Surgery was indicated in progressive decline of renal function in the presence of renal reflux, total urine incontinence in the failure of pelvic floor muscles and rectal sphyncter apparatus. Creation of cutaneous urine-retention catheter mechanism was made by the following techniques: heterotopic plastic repair from the ileocecal angle by Mainz pouch I (11 patients, 73.4%); heterotopic W ileocystoplasty by Abol-Enein (4 patients, 26.8%). Implantation of both ureters was conducted by Wallace technique in 4 (26.7%) cases. In 7 (46.6%) patients ureteral implantation was performed with antireflux defense by the method of cross dublicate creation. Four (26.7%) patients with small intestinal derivation have undergone extramural implantation of the ureters according to Abol-Enein. The results show that conversion of ureterosygmostomy in heterotopic urine derivation with one-stage genital reconstructive interventions decreases the number of potential complications, improves surgical outcomes and provides much better medico-social rehabilitation. Heterotopic intestinal continent derivation of urine is an operation of choice in women with urinary malformations. In such patients orthotopic urine derivation is impossible.

[The role of low-field strength magnetic resonance imaging in bladder cancer staging].

This article shows the role of magnetic resonance imaging (MRI) in complex diagnostics of urinary bladder cancer. The paper analyzes the authors' own data of urinary bladder MRI in 40 patients with histologically proven bladder cancer. This study demonstrates the additional capacities of low-field strength MRI with enhanced technique including conventional T1-, T2-weighted images along with FLAIR and PD images.

[Oncology and urology: relations between specialities].

The article presents the analysis of present-day medical care for patients with urogenital cancer (UGC) in the Russian Federation (RF). In 2004 cancer treatment service in the RF has 8 Research Cancer and Radiological Institutes, 110 inpatient and 7 outpatient cancer clinics. According to the statistics for 1998, UGC patients are treated in 32 specialized departments in 24 regions. The rest regions provide such care in urological departments and clinics. In view of the importance of oncourology nowadays, we propose to set up an oncourological section at All-Russia Urology Society as a center of integration of efforts of specialists in oncourology.

[Efficacy of detection of specific nuclear protein of matrix 22 in the urine in diagnosis of urinary bladder cancer].

The method is based on enzyme immunoassay for definition of nuclear matrix proteins forming part of the cell nuclear capsule. Quantity of these proteins increase 20-80 times in cancer of the bladder. A total of 83 patients participated in the trial. Group 1 consisted of 18 patients with primary bladder cancer, group 2 - of 26 patients with histologically confirmed bladder cancer recurrence. Group 3 - 19 patients with operated bladder cancer without recurrent disease for at least 6 months. Control group - 20 healthy donors. The test urine sample was placed into a test hole and 30 min later the result was assessed. Overall sensitivity of the method was 52% (p < 0.05). Sensitivity of the test increases with progression of the disease: T1 - 37%, T2 - 75%, T3 - 80% (p < 0.05); G1 - 30%, G2 - 50%, G3 87% (p < 0.05). Overall specificity was 95% (p < 0.05). Thus, nuclear matrix proteins 22 represent a prospective marker of the bladder cancer with high specificity and sensitivity in defining not only primary tumors but also the disease recurrences.

[Endoscopic operations in invasive cancer of the urinary bladder].

Long-term results of conservative treatment of 153 patients with invasive cancer of the urinary bladder were studied retrospectively. The patients had stage T2 (n=121, 79.1%), T3 (n=26, 17%), T4 (n=6, 3.9%). All the patients had transitional cell cancer. GI, G2 and G3 tumors were registered in 104 (68%), 35 (24%) and 12 (8%) cases, respectively. 88 (57.5%) patients received combined treatment, 65 (42.5%) patients--only surgery. In the patients with a small invasive tumor of the urinary bladder subjected to surgery alone (TUR-vaporization), overall 5-year survival was 70.4%. In patients with advanced cancer of the urinary bladder who had received curative radiotherapy in case of superficial residual tumor had TUR-vaporization of the urinary bladder overall 5-year survival was 76.5%. In patients exposed to large-fraction (TFD 20-25 Gy) preoperative radiotherapy followed by TUR-vaporization, survival at this moment was 84.6%. Three-year overall and recurrence-free survival at stage T2 was 97.5 and 47.4%, respectively; at stage T3 and T4 overall 3-year survival was 57.1 and 26.6%, respectively. Thus, the conclusion is that transurethral electrosurgery in conservative therapy of patients with invasive cancer of the urinary bladder is a promising approach.

[Application of principles of evidence-based medicine in cancer of the urinary bladder]. / Primenenie printsipov dokazatel'noi meditsiny pri rake mochevogo puzyriia.

Meta-analysis has been made to answer the question whether a proven advantage exists of chemotherapy of locally advanced and metastatic cancer of the urinary bladder (UB) with gemcitabine+cisplatin over the scheme M-VAC. The data for 1990-2002 obtained from the data base Medline, library of Cocrane Association, proceedings of the symposia and conferences, publications in domestic periodicals Urologiya, Voprosy Onkologii covered 3477 items on UB cancer. Nine publications were selected which seem to use significant information in terms of evidence-based medicine. The patients were divided into two groups. Group 1 consisted of patients with local and metastatic UB cancer treated with the combination gemcitabine+cisplatin (n = 390). Group 2 patients (n = 499) received chemotherapy with M-VAC. By principles of evidence-based medicine, group 1 patients had more frequent unfavourable outcomes (absence of complete and partial regressions)--50 and 42%, respectively. A decrease in the absolute risk is significant (p < 0.05, chi-square = 5.8). It is 8% in the confidence interval (CI) 4,12. A decrease in the relative risk was 19% (CI 13.7-24.3), odds ratio 1.39 in CI 1.3-1.48. Thus, at present there are no reliable data on advantages of local and metastatic UB cancer treatment with the scheme gemcitabine-cysplatin over standard treatment M-VAC.

[Diagnosis and treatment of bladder cancer]. / Diagnoz i lechenie raka mochevogo puzyria.

The authors present a retrospective analysis of the results of transurethral conservative and radical operations in 125 patients with invasive cancer of the urinary bladder (UB) treated in the Research Institute of Urology throughout 1992-2002. Transurethral resection (TUR) of the UB was made in 72 patients. Stages pT2a, pT2b, T3 and T4 were diagnosed in 23 (31.9%), 18 (25%), 14 (19.5%) and 17 (23.6%) cases, respectively. 53 patients with advanced invasive UB cancer have undergone radical cystectomy varying by the method of urine derivation. Stages pT2N0M0, pT3aN0M0, pT3bN0M0, pT4aN0M0 and N1-2 were registered in 4 (7.5%), 13 (25%), 21 (40%), 7 (12.5%) and 8 (15%) patients, respectively. UB cancer recurrences after TUR occurred in 12 (16.7%) patients with stage pT2a, in 8 (11.1%) patients with stage pT2b. Three-year overall and recurrence-free survival after TUR at stage T2 reached 97.5 +/- 3.2 and 47.4 +/- 2.8, respectively, at stage T3 and T4--57.1 +/- 4.3 and 26.6 +/- 3.4%, respectively. Postcystectomy distant metastases to the lungs, bones and iliac lymph nodes after treatment were detected in 3, 2 and 3 patients, respectively. One patient had a local pelvic recurrence. For all 53 patients a 2-year corrected survival made up 68 +/- 12.0%. Thus, transurethral electrosurgery is an effective treatment of invasive UB cancer; the only radical surgical treatment for invasive UB cancer is cystectomy.

[Standardization and its importance in rendering medical care to patients with cancer of the bladder]. / Rol' standartizatsii v uluchshenii organizatsii pomoshchi bol'nym rakom mochevogo puzyria.

There are only as many as 31 specialized oncourological departments in 24 of 89 (27%) Federation Subjects in the Russian Federation that can render the oncourological care at the municipal and federal levels. As for other remaining 65 (73%) Subjects, the urologists are preoccupied with diagnosis and treatment of urinary-bladder cancer in them. Russian patient-care facilities have presently differing opportunities in the sphere of diagnosis and treatment of the mentioned pathology. Their related outfit for this purpose is on the whole unsatisfactory. An optimal management of medical care rendered to the discussed category of patients and targeted at promoting its quality and efficiency is possible only on the basis of standardization of diagnostic and treatment approaches. The stage-nature of medical care rendered to such patients is closely related the standardization issues. An accurate definition of stages and of patient-care facilities, which would be in charge for the above stages, would, in the end, clearly depict a sequence of steps for the diagnostic-and-therapeutic schemes applicable to patients with cancer of the urinary bladder. This, in its turn, would optimize the diagnostic-and-therapeutic process and outline the priority spheres in healthcare financing.

[Indications for one-stage and delayed urethrectomy after radical cystectomy in patients with invasive cancer of the urinary bladder]. / Pokazaniia k odnomomentnoi i otsrochennoi uretréktomii posle radikal'noi tsistéktomii u bol'nykh invazivnym rakom mochevogo puzyria.

Our aim was to determine indications for urethrectomy in patients with muscle-invasive cancer of the urinary bladder (UBC) which is essential for choice of urine derivation. A total of 51 patients with invasive UBC at the age of 33-78 years (mean age 60 years) were treated: 7 patients with pT2bN0M0, 1 patient with pT2bN1M0, 18 patients with pT3aN0M0, 3 patients with pT3aN1M0, 14 patients with pT3bN0M0, 6 patients with pT4aN0M0, 2 patients with pT4bN0M0. Urethrectomy was indicated for men with involvement of the prostatic urethra (stage t4a) and urinary bladder cervix, multiple tumors of the bladder, pelvic lymph node lesions, detection of tumor cells by instant biopsy in the free urethral edge, poor differentiation of the tumor (G3) in combination with one of the above factors, emergence of urethrorrhagia late after cystectomy; for women with involvement of the bladder cervix and Lieutaud's triangle in combination with poor differentiation of the tumor cells (G3). Cystectomy was followed by urine derivation of the following type: uretero-ureteroanastomosis with nephrostomy (n = 2), ureterocutaneostomy (n = 3), Briker's operation (n = 22), ureterosygmoanastomosis with creation of sigmoid reservoir (method Mainz pouch II) (n = 21), Studer orthotopic plastic reconstruction (n = 2) and Hautmann plastic surgery (n = 1). Urethrectomy was made in 16 patients. One-stage operation was conducted in 14 patients (suprapubic approach--8 males, perineal one--in 6 females). Delayed urethrectomy was made in 2 patients. Intra- and postoperative complications caused by urethral removal were absent. Corrected 2-year survival for all 51 patients was 70.8 +/- 11.3%. Among the deceased were 2 patients who had undergone urethrectomy at the stage T2b and T4a 5 and 8 months after primary operation, respectively. Thus, we believe that urethrectomy must be made in the above indications and poor differentiation of the tumor cells (G3).

[Organization of care for patients with urinary bladder cancer in the Russian Federation and approaches to its improvement based on standardization of a diagnostic and therapeutic process]. / Organizatsiia pomoshchi bol'nym rakom mochevogo puzyria v Rossiiskoi Federatsii i puti ee uluchsheniia na osnove standartizatsii lechebno-diagnosticheskogo protsessa.

Present-day medical facilities for treating patients with cancer of the urinary bladder in the Russian Federation (RF) are insufficient. In 1998, urological cancer in RF was managed only in 31 specialized departments working in 24 of 89 (27%) administrative units of the RF. In the other 65 (73%) units only urologists deal with diagnosis and treatment of urinary bladder cancer. These nonspecialized departments lack special equipment and personnel. Therefore, effective management and organization of medical care for urinary bladder cancer can be achieved on the basis of standardization of diagnostic and therapeutic methods and definition of stages in treatment policy. This helps to outline priorities in financing health services.