[Long-term results of radical surgery treatment of patients with bladder cancer].

PURPOSE: To investigate long-term results after radical cystectomy in patients with bladder cancer. MATERIALS AND METHODS: Since 1997 to 2020 yy. we have performed 404 radical cystectomy with different methods of derivation for patients with bladder cancer in our clinic. There were 342 (86,4%) men and 62 (13,6%) women. Laboratory study, ultrasound, X-ray, CT. MRI investigations were performed in all patients. RESULTS: Mortality rate was 2,9%. Early and late postoperative complications have occurred in 136 (33,6%) and 98 (41,8%) cases, respectively. Local recurrence has occurred in 33 (8,5%) patients. 10-years overall and cancer-specific survival were 43,4% and 47,2%, respectively. In lymph-negative patients 2-years and 5-years overall survival were 81,2% and 67,2%, respectively. In lymph positive patients 2-years and 5-years overall survival were 46,9% and 13,9%, respectively. In lymph-negative patients 2-years and 5-years cancer-specific survival were 83,6% and 70,7%, respectively. In lymph positive patients 2-years and 5-years cancer-specific survival were 51,0% and 15,1%, respectively. Overall and cancer -specific survival decreased according to increasing pT-stage and histopathologic grade. CONCLUSIONS: pT-stage (pT), lymp nodes status (pN), histopathologic grade ( pG) have a significant independent influence on overall and cancer-specific survival of bladder cancer patients after radical cystectomy.

[Concomitant oncopathological changes in the prostate of urinary bladder cancer patients undergoing radical cystoprostateectomy].

AIM: To determine the incidence of spreading bladder transitional cell carcinoma and primary adenocarcinoma to the prostate in patients with bladder cancer undergoing radical cystectomy. MATERIALS AND METHODS: From 1995 to 2016, 283 men underwent radical cystectomy with removal of the bladder, perivesical tissue, prostate, seminal vesicles and pelvic lymph nodes. Prostate sparing cystectomy was performed in 45 (13.7%) patients. The whole prostate and the apex of the prostate were preserved in 21 (6.4%) and 24 (7.3%) patients, respectively. RESULTS AND DISCUSSION: The spread of transitional cell cancer of the bladder to the prostate occurred in 50 (15.2%) patients. Twelve (3.6%) patients were found to have primary prostate adenocarcinoma. Clinically significant prostate cancer was diagnosed in 4 (33.3%) patients. CONCLUSION: We believe that the high oncological risk of prostate sparing cystectomy, despite some functional advantages, dictates the need for complete removal of the prostate in the surgical treatment of bladder cancer.

[Comparative clinical and morphofunctional evaluation of the intestinal and colonic gastric orthotopic urinary reservoirs at different times of functioning].

The complex clinical and morphological evaluation of different variants of orthopic urinary reservoir (OUR) at different times of functioning was performed. During 1996-2012, orthotopic cystoplasty was performed in 265 patients (ileocystoplasty--in 204, gastrocystoplasty--in 24, and sigmocystoplasty--in 29 patients). There were 207 (77%) men and 61 (23%) women aged 22-75 years (mean age, 57.5 +/- 1,3 years). Cold biopsy over time (1 to 6) was performed in 105 patients. The total number of biopsies was 150. Duration of morphological study was 2-12 years. Clinical examination included assessment of acid-base balance and electrolyte balance of within 3-24 months, evaluation of urodynamic parameters (OUR volume, daytime and nighttime continence, micturition volume), assessment of the frequency and the nature of infection, resistance of microorganisms to antibiotics and the symptoms of inflammatory reaction in period 1-90 months after surgery. Morphological study included histological, histochemical, immunohistochemical, and morphometric methods. Application of a set of clinical, morphological, immunohistochemical examinations is a premise for individual choice of cystoplasty, and creates the preconditions for the correction of the process of adaptation to the OUR, regardless of its form in the early and later stages of its functioning. Due to the good adaptation to the new conditions in all three types of OUR and absence of trends to malignant transformation of its mucosa, the ileocystoplasty is method of choice for creation of OUR, and gastrocystoplasty and sigmocystoplasty are alternatives.

[Ruptures of orthotopic ileoneocystis].

Urgent surgical treatment was conducted in 3 patients admitted to hospital with neocystic rupture which occurred 6, 10 and 22 months after removal of the bladder with orthotopic cystoplasty. Two patients have undergone laparotomy, neocystic defect repair and drainage. In the third patient mobilization of the reservoir was accompanied with accidental cut of the ureters. Relaparotomy was made with bilateral ureterocutaneostomy. Intestinal plastic reconstruction of both ureters followed after stabilization of the patients' condition. Thus, all the patients with ileoneocystis rupture were successfully rehabilitated.

[Radical nephrouretercystectomy].

The results of radical nephrouretercystectomy (NUCE) are presented for 13 patients (9 males and 4 females, age 44-70 years, mean age 58 +/- 1.7 years). One-stage NUCE was made in 11 patients, two- or three-stage--in 2 patients. Indications for NUCE were the following: urothelial cancer, urogenital tuberculosis, microcystis, neurogenic dysfunction of the urinary bladder complicated by definite renal dysfunction. Postoperative complications arose in 3 patients. Lethal outcomes were absent. The results presented say in favour of extended surgery in involvement of the kidney, ureter, urinary bladder, prostate, urethra. Radical NUCE is primarily indicated in cancer of the renal pelvis, ureter with muscular invasion into the bladder wall, non-functional kidney due to ureteral obstruction with a tumor or scar.

[The results of orthotopic plastic reconstruction of the urinary bladder with gastric and iliac graft].

To compare the results of postoperative plastic reconstruction of the urinary bladder (PRUB) with gastric and iliac graft, we studied 205 patients (150 males, 73.2%; 55 females, 26.8% aged 23-72 years, mean age 62.1 +/- 0.5 years) who had undergone orthotopic PRUB. Artificial bladder was created in 26 (12.7%) patients of a stomach pedicle segment, in 174 (84.9%)--of a detubulated iliac segment, in 5 (2.4%)--of a sigmoid segment. Early and late postoperative complications in using small intestinal segment reached 14.0 and 10.4%, respectively, lethality being 2.6%; in using gastric segment made up 3.9 and 8.7%, respectively, lethal outcomes were absent. Patients after PRUB had neither disorders of acid-base balance nor defects in electrolytic balance of blood. Urodynamic parameters were close to physiological ones. Thus, satisfactory clinical and functional results of urinary bladder orthotopic reconstruction even in long-term follow-up confirm advantages of orthotopic reconstruction of the lower urinary tracts in diseases of the urinary bladder.

[Urodynamics of artificial urinary bladder].

Radical cystectomy with creation of orthotopic reservoir from various segments of gastrointestinal tract was made in 120 patients (99 males, 21 females, age 37-74 years) with muscular-invasive cancer of the urinary bladder (UB) in 1996-2004. Replacement of UB was made according to the Studer and Hautmann method in 38 and 27 patients, respectively. S-cystoplasty was performed in 31 patients. The gastric segment was used for creation of the reservoir in 24 patients. Three patients died. Three to twelve month follow-up recorded the best functional results in patients after Studer cystoplasty.

[Orthotopic replacement of the urinary bladder in females].

Orthotopic cystoplasty for various diseases of the urinary bladder was made in 58 females aged 22 to 78 years (mean age 52.5 +/- 5.8 years) in 1996-2005. Surgery was indicated in muscular-invasive cancer of the bladder (n = 35, 60.3%), microcystis (n = 21, 36.3%), bladder atonia (n = 1, 1.7%), vesicovaginal fistula (n = 1, 1.7%). The reservoir was made of iliac segment in 50 (86,2%) patients, of gastric body - in 8 (13.8%) patients. Postoperative complications arose in 7 (12.1%) patients, late complications occurred in 4 (6.8%). Postoperative lethality was not registered, 12 months later 3 (5.2%) patients died of cancer progressiion. Day continence after ileo- and gastrocystoplasty was 93.3 and 87.8%, night - 45.2 and 32.8%, respectively. Urodynamics was satisfactory. Chronic continence occurred in 3 (5.6%) patients. Satisfactory clinical and functional results of artificial reservoir creation in females support advantages of this method of urine derivation. Gastrocystoplasty is a promising method of urinary bladder replacement. It is important to assess function of the lower urinary tract before operation. Reservoir-vaginal fistula is a new kind of urogenital fistulas. It is treated by transvaginal fistuloraphy.

[Short-term results of radical cystectomy]. / Blizhaishie rezul'taty radikal'nykh tsistéktomii.

The paper presents the results of 114 radical cystectomies made in 1996-2002. The age of 114 patients (103 males, 11 females) ranged from 37 to 78 years (mean age 57.5 years). Transient cell carcinoma was diagnosed in 81.5% patients. Supravesical urine derivation was conducted by means of ureterocutaneostomy and transureteroureteronephrostomy in 9 (7.9%) patients, ureterosygmoanastomosis--in 43 (37.7%) patients, artificial orthotopic urinary bladder was created in 7 (6.1%) patients of a gastric segment and in 55 (48.2%) patients of the ileum. Postoperative complications were observed in 28 (24.6%) patients, intestinal obstruction being a prevailing complication. Five patients died: 2 of pulmonary artery thromboembolism, 1 of acute cardiac failure, 1 of sepsis and 1 of gastric bleeding. Continent methods of urine derivation were preferred, such as ureterosygmoanastomosis by Mainz-Pouch II and creation of orthotopic urinary bladder of the stomach or of the ileum.

[Short-term outcomes of radical surgery for bladder cancer]. / Blizhaishie rezul'taty radikal'noi operatsii pri rake mochevogo puzyria.

A total of 102 radical cystectomies have been conducted for 1996-2001 (94 males, 8 females, age 37-78 years, mean age 57.5 years). Most of the patients (81.4%) were diagnosed to have transitional cell carcinoma. Supravesical urine derivation was made by means of ureterocutaneostomy and transureteroureteronephrostomy in 7(6.9) patients, ureterosigmoanastomosis--in 41(40.2%), Sigma-rectumpouch--in 1(0.9%) patients, ileocystoplasty, largely by Hautmann and Studer was carried out in 52(51%) patients. Postoperative complications developed in 25(24.5%) patients who often had adhesive ileus. Four patients died: 2 of pulmonary artery thromboembolism, 1 of acute cardiac failure and 1 of sepsis. Methods of continence urine derivation were preferred, such as ureterosigmoanastomosis by Mainz-Pouch II and creation of orthotopic bladder of the ileum.

[Effect of erythrocytes isolated from the blood of animals with experimental tumors on the proliferative activity of cultured tumor cells]. / Vliianie éritrotsitov, vydelennykh iz krovi zhivotnykh s éksperimental'nymi opukholiami, na proliferativnuiu aktivnost' kul'tiviruemykh opukholevykh kletok.

It has been established that erythrocytes taken from blood of mice with experimental tumors being in the active phase of growth, or of mice with a recidivation of the primary tumor intensify proliferative processes in the culture of tumor cells. Erythrocytes from animals with tumors being in the stationary phase of growth did not reveal such a capacity. The authors connect such an effect with the erythrocyte transport function due to which they can store up those factors excreted by tumors which stimulate proliferation. It is supposed that the test defining the peculiarities of the effect of erythrocytes on the proliferative capacity of tumor cells in the tissue culture can be used for the judgement about an individual activity of the growth of primary tumors as well as for the diagnostics of recidivation of tumor growth.

[Influence of interferon on the toxic effect and antitumor activity of vinblastine in the combined therapy of metastatic Lewis carcinoma]. / Vliianie interferona na toksicheskii éffekt i protivoopukholevuiu aktivnost' vinblastina pri kombinirovannoi terapii metastaziruiushchei kartsinomy L'iuis.

Antitumour and antimetastatic effects of the combination of vinblastine (VLB) and L-cell interferon were examined. It is shown that mice with 3LL carcinoma are more sensitive to common toxic effect of VLB than intact animals. Interferon (IF) decreases the toxic effect of VLB in tumour-bearing mice, and thus provides a possibility to increase the total therapeutic dose of the cytostatic. The combination of VLB and IF showed a synergistic inhibitory effect on the development of carcinoma metastases and significantly increases the survival rate of the tumour-bearing mice. Neither synergistic nor additive antitumour effects of the combined therapy were observed on the primary tumour. IF suppresses the primary tumour growth more significantly when given by intratumoural injection. At the same time the inhibition of metastase development was more efficient with intraperitoneal injection of IF.

[Detection of chalones produced by a primary tumor in the blood of mice with Lewis carcinoma]. / Obnaruzhenie v krovi myshei s kartsinomoi L'iuis keilonov, vydeliaemykh pervichnoi opukhol'iu.

The substance fraction precipitated in 81% ethanol from blood or tumour tissue of mice with Lewis (3LL) carcinoma on the 13th, 20th and 32nd day after the tumour transplantation is established to inhibit the processes of proliferation in the cell culture of the same tumour. The fraction isolated on the 7th day after transplantation stimulated the proliferation. No inhibition of proliferation was observed when studying the effect of the same fraction isolated on the 13th and 20th day from blood of mice with B-16 melanoma on the 3LL carcinoma. This fact suggests a tissue-specific action of proliferation inhibitors isolated from blood of mice with Lewis 3LL carcinoma and permits considering them as chalones. An assumption is advanced that the primary tumour synthesizing chalones and secreting them into blood can regulate not only its own growth but also the growth of remoted metastases.

[Determination of the mitotic index in tumors by using cell suspensions]. / Opredelenie mitoticheskogo indeksa v opukholiakh s ispol'zovaniem kletochnykh suspenzii.

A new variant of the method for mitotic index determination is offered. For this, a tumor cell suspension is obtained by treating the tumor with a 0.3% trypsin solution. Then the cells are transferred to a hypotonic solution where these undergo lysis and, in result, the nuclei are seen to be released in the medium. The ratio of nuclei being in meta- and anaphase is determined. Determination of the mitotic index in tumors using this method allows to avoid a technical error associated with the fact that the proliferative activity is not uniform in different parts of the tumor.