[Retrograde intrarenal surgery: a modern view of the problem].

Retrograde intrarenal surgery (RIRS) is a rapidly developing field of endoscopic management of urolithiasis. Previously considered an additional technique in patients with lower calyx stones that do not respond to extracorporeal shock wave lithotripsy, now the RIRS along with percutaneous surgery is gaining a leading position in the management of kidney stones. Currently, it is recommended as the main surgical modality for treating stones less than 2 cm, especially in cases where extracorporeal shock wave lithotripsy is not feasible or not desirable. Retrograde intrarenal surgery has no specific contraindications, except for the active inflammatory process in the urinary tract, and can be used even in patients with various coagulopathies. In this paper, we present information on the history of the emergence and advances of RIRS, indications and contraindications, preoperative patient care, the choice of anesthesia, the surgical technique and features of the ureteral sheaths, strings, and lithoextractors. Recommendations for laser lithotripsy, postoperative care and possible complications with a review of the current literature are presented.

[Use of multiparametric magnetic resonance imaging in t-staging of prostate cancer: a multicenter study].

AIM: The study aimed to analyze the diagnostic performance of preoperative multiparametric magnetic resonance imaging (mp-MRI) in the staging of prostate cancer (PCa) versus postoperative histological examination and determine the most sensitive pulse sequence from the mp-MRI protocol in estimating the local extent of PCa. MATERIALS AND METHODS: The study comprised 112 men aged 52 to 84 years with a morphologically verified diagnosis of prostate cancer. All patients underwent pelvic mp-MRI before radical prostatectomy (RPE) no earlier than six weeks after the prostate biopsy. Radical prostatectomy was performed within two weeks after mp-MRI. MP-MRI findings and the results of postoperative histology were compared using a binary logistic regression model. RESULTS: The sensitivity, specificity, diagnostic accuracy, positive (PPV) and negative (NPV) predictive values for predicting extracapsular extension were 87.5, 92.6, 91, 84 and 94.3%, respectively; for predicting seminal vesicles invasion, they were 85, 95, 90, 80.9 and 96.7%, respectively. When stratified by the presence or absence of the pseudocapsule invasion, the reliability of detecting the tumor spread for different types of images decreases in the following order: DWI - T2 + DWI - T2 VI - DCE-MRI. CONCLUSION: mp-MRI has high sensitivity, specificity, general diagnostic accuracy, high NPV, and PPV values in detecting an extracapsular extension of prostate cancer. According to the binary logistic regression model, the greatest contribution to the decision on the presence or absence of extracapsular extension is also made by the DWI.

[The role of waterjet dissection in improving erectile function and continence after nerve-sparing prostatectomy].

INTRODUCTION: Erectile dysfunction (ED) and urinary incontinence (UI) following radical prostatectomy (RP) adversely impact patients psycho-emotional status reducing the quality of life and treatment satisfaction. AIM: To investigate the rates of regaining continence and erectile function (EF) after nerve-sparing radical retropubic prostatectomy (NS-RRP) and nerve-sparing laparoscopic radical prostatectomy (NS-LRP) in the early postoperative period. MATERIALS AND METHODS: The study comprised 116 patients who preserved sexual activity and the ability to have sex. 64 patients underwent standard resection of NVB (34 RRP and 30 LRP) and in 52 patients the NVB resection was performed using a waterjet dissector (WD) (30 RRP and 22 LRP). All operations were performed by one surgeon with the experience of over 350 RRP and 150 LRP. The study patients had low and moderate risk prostate cancer, according to DAmico risk classification. RESULTS: Our study findings showed that patients who underwent the WD of NVB had significantly greater IIEF-5 scores (by 2.8 scores) at 8 weeks than after the standard NS-RP. After 6 month follow-up the scores increased by 3.5 points. Patients who underwent NS-RP + WD achieved a successful sexual intercourse 3 months after surgery (regardless of the use of PDE5 inhibitors). In the group of patients who underwent standard NS-RP, it took a longer time to achieve a successful sexual intercourse. Sixty-seven percent of patients who underwent NS-RP + WD were fully continent at one month follow-up after removal of urethral catheter, while most patients treated with standard NS-RP (41%) had mild stress UI. After 3 months follow-up, among patients who underwent NS-RP + WD only one patient had mild stress UI and the vast majority (95%) of patients were fully continent. At 6 months after removal of the urethral catheter there were no significant differences between the groups in regaining urinary continence. CONCLUSIONS: Waterjet dissection of NVB significantly improves patients postoperative quality of life due to early recovery of urinary continence and EF.