COMPARATIVE RESULTS OF THE USE OF MODERN EXAMINATION METHODS IN THE EARLY DIAGNOSIS OF KIDNEY CANCER, IN DETERMINING THE STAGE OF INVASION, AND IN CHOOSING STRATEGIES FOR ITS RADICAL TREATMENT.

This article deals with comparative results of the use of modern examination methods in the early diagnosis of kidney cancer, in determining the stage of invasion, and in choosing strategies for its radical treatment. The research work included 170 patients who were treated in department of urology of Azerbaijan Medical University with the diagnosis of kidney cancer from 2006-2016. The age range of patients was between 23-82 (average 61.7), 93(54.7%) were male and 77 (45.3%) were female. According to the application of radiation examinations, we have divided the patients into two groups who are under our observation. Only ultrasound examination was applied to the patients included in the first group for diagnostic purposes, while modern radiation examinations were applied comprehensively to the patients included in the second group. 63 of the patients included in the first group were satisfied with only the results of the ultrasound examination and the appropriate type of treatment was prescribed without additional examinations. In 107, examinations were applied in a complex manner (USM, CT, MRI). According to the results of our research, the response of USM to the stages of kidney cancer in determining the stage of process invasion is T1-97.9±1.2%, T2-94.2±2.3%, T3-92.2±2.5% %, T4-98.0±1.1%, and its sensitivity is 89.7±5.7% in T1 stage, 87.9±4.0% in T2 stage, 87.3±4.5% in T3 stage, It was 85.0±8.0.9% for T4 stage. In patients with kidney cancer, the diagnostic possibility of ultrasound examination and determination of the stage of invasion was 90.5% correct and 9.5% incorrect. 90.4% correct in the placement of the tumor, 9.6% incorrect, 86.9% correct in determining the size of the tumor tissue, 13.1% incorrect, 92.6% correct in 7.4% in determining the direction of development intrarenal wrong, extrarenal development is completely consistent. Specificity of computed tomography by stages in determining the degree of local spread of the process in patients with kidney cancer: T1-98.6±1.4%, T2-91.7±4.0%, T3-84.5±4.8%, T4-97.3±1.9% sensitivity and T1-90.9±8.7%, T2-80.6±6.6%, T3-80.8±7.7%, T4-72.7±13 it has been like this. Our retrospective review revealed that the screenings related to the stage of cancer development were satisfactory and there was no need for additional more complex and expensive screenings. In other patients (T3-T4), conducting preoperative thoracoabdominal CT and MRI examinations was considered important from the point of view of obtaining effective results in order to put an end to the controversial issues arising in the diagnosis and selection of radical treatment.

COMPARATIVE RESULTS OF MODERN EXAMINATION METHODS IN EARLY DIAGNOSIS OF BLADDER CANCER, DETERMINATION OF THE DEGREE OF INVASION AND SELECTION OF RADICAL TREATMENT TACTICS.

This article deals with comparative results of modern examination methods in early diagnosis of bladder cancer, determination of the degree of invasion and selection of radical treatment tactics. The purpose of the conducted research work is to make a comparative analysis of existing methods of examination related to the stages of development of bladder cancer. The research was carried out on the Department of Urology of Azerbaijan Medical University. In this research work, an algorithm was developed by conducting a comparative analysis among modern methods of radiation examination (Ultrasound, CT, MRI) in determining the location of the tumor in the urethra, the position, size, direction of development and local prevalence of the process, analyzing the results obtained and trying to determine the sequence of profitable examinations for patients. According to the results of our research in ultrasound examination on specific stages of the process in the diagnosis of bladder cancer T1-100,%, T2 - 94.7±2.3%, T3 - 92.2±2.8%, T4 - 96.2±1.7%, and the sensitivity of the study T1 - 93.8± 6.1%, T2 - 92.9±3.4%, T3 - 85.0±4.6%, T4 - 83.3±8.8%. The sensitivity of transrectal ultrasound in determining the degree of invasion of the process T1 - 85.7±13.2%, T2 - 92.9± 19.2%, T3 - 85.7±13.2%, T4 - 100%, specificity T1 - 93.3±6.4%, T2 - 87.5±8.3%, T3 - 84± 7.3%, T4 - 95.0±4.9%. Based on the results of our research, we came to the conclusion that the general analysis of blood and urine, biochemical examination of blood in patients with superficial Ta-T1 stages of bladder cancer, which does not invade deep layers, does not cause hydronephrotic transformation in the upper urinary tract and kidneys, regardless of its size, and is located far from the ureter, the diagnosis is fully specified on the basis of ultrasound examination. At this stage, CT, and MRI methods do not add any information of different importance and can change the surgical tactics.

[Successful treatment of an infant with a rare anomaly: iliosacral dystopia of the right kidney and obliteration of the left distal ureter].

In the article a rare case of structural anomaly of ureter, namely obliteration, in 1-year-old infant is reviewed. The obliteration was located in the distal part of the left ureter. There was urine leakage through dilated and inflamed wall of the ureter towards right gluteal region with a formation of retroperitoneal abscess. A diagnosis was established based on preoperative MRI and intraoperative antegrade pyeloureterography. Extravesical Lich-Gregoir ureterocystoneostomy was successfully performed.

[Results of laparoscopic ureterolithotomy depending on the type of laparoscopic approach and location of the stone].

AIM: To investigate the results of laparoscopic management of patients with ureterolithiasis, depending on the type of laparoscopic approach and location of the stone. MATERIALS AND METHODS: This study is a retrospective analysis of 30 ureterolithiasis patients who underwent laparoscopic ureterolithotomy from 2010 to 2015. Patients were divided into four subgroups depending on the type of laparoscopic approach - transperitoneal (n=17) and retroperitoneal (n=13) and on location of stones - upper ureteral stone (n=20) and mid ureteral stone (n=10). The patients comprised 23 (76.7%) men and 7 (23.3%) women aged from 18 to 68 years (mean age 46.2+/-2.3 years). 15 patients had stones in the right and 15 in left ureters. The groups were comparable by sex, age, the severity of hydronephrosis, body mass index, duration of urolithiasis, comorbidities and previous surgeries (p>0.05). RESULTS: There were no deaths, conversion to open surgery or intraoperative complications. The only statistically significant difference between transperitoneal and retroperitoneal approaches was the absence of postoperative complications (p<0.05). The duration of drainage and hospital stay was significantly shorter in patients with mid ureteral stone than in patients with upper ureteral stone (p<0.05). CONCLUSION: Surgical management of patients with ureterolithiasis of various locations using laparoscopic ureterolithotomy by different approaches showed positive results of in all cases thus indicating high clinical effectiveness of this method.

[THE RESULTS OF LAPAROSCOPIC PARTIAL NEPHRECTOMY DEPENDING ON THE TYPE OF ACCESS AND THE TUMOUR SIZE].

Aim - retrospective comparative analysis of results of laparoscopic partial nephrectomy (LPN) depending on the type of access and the size of the tumor. The study included 170 patients undergoing LPN during the period from 2010 to 2015 years. Among the patients was 108 males (63.5%) and 62 women (36.5%) ranging in age from 17 to 80 years (average age 56,6±0.9 years). Depending on the type of access and the size of the tumor patients divided into 4 subgroups-154 patients who performed transperitoneal LRP, 16 patients undergoing retroperitoneal partial nephrectomy, 117 patients with tumor less than 4 cm and 53 patients with tumor more than 4 cm. There were no fatalities in 170 patients undergoing LRN, 3 (1.8±1.0%) patients had conversion, two of which involved open partial nephrectomy and one case involved radical nephrectomy. The duration of the surgery ranged 50-250 min (115.4±2.3 min on average), while time of insufflation ranged 40-240 min (103.8±2.2 min on average). Average intraoperative blood loss constituted 120.6±6.3 ml (15-400 ml), average time of warm ischemia was 22.01±0.83 min. Different intraoperative complications were observed in 4 patients (2.4%), in the postoperative period in 25 patients (14.7±2.7%). Patients spent 2-16 days (average 4.11±0.16 days) in the hospital after surgery. LRP can perform as transperitoneal а retroperitoneal approaches. The large size of kidney tumour, are not a contraindication for laparoscopic organ-preserving surgery and can successfully performed in experienced hands and specialized centres.

[The choice of surgical modality to treat patients with staghorn nephrolithiasis].

AIM: Improvement in the results of the treatment of patients suffering from staghorn and multiple nephrolithiasis, using open method of surgery and a retrospective analysis of the surgical data. MATERIAL AND METHODS: There was executed asurgical treatment of the 730 patients with staghorn and multiple nephrolithiasis in the period from 1998 to 2012. 480 of the patients had one-sided staghorn stones and 250 of them had double-sided staghorn stones. Age of the patients varied from 4 to 76 years old (average - 49). There were 351 men (48,0%) and 379 women (51,9 %). 290 (39,8%) patients had only staghorn stones, but 440 (60,2%) patients suffered from staghorn stones combining with multiple ones. RESULTS: There were executed 1065 surgical operations at the 730 patients. There was used pyelotomy and nephrolithotomyfor the purpose of the ablation of stones. Nephrostomy was placed on the right of the 116patients (15,8%), on the left - 93patients (12,7%), pyelostomy on the right - 46 patients (6,3%), on the left - 31patients (4,2%), intrarenalstent on the right - 181 patients (24,7%), on the left - 167patients (22,8%), stent and nephrostomy on the right - 29 patients (3,9%), on the left - 6 patients (0,8%). Surgical operations of 184 patients (25,2%)fulfilled throughcross-clamping of the nephritic artery.Cross-clamping time of the nephritic artery in average was 16.5 minutes (5-50), average duration of the surgical operation - 2,6 hours (1,5-6), intraoperative hemorrhage - 110 ml (50-300). During the re-examination there was found that 175 patients (23,9%) had recurrent stones.During first ten years after operation there were found recurrent stones at 238 patients (32,6%), 100 (13,6%) of them had the second operation. CONCLUSION: Taking into account that minimally invasive methods of the staghorn and multiple nephrolithiasistreatment is ineffective and demand a few courses of medical treatment, open surgical operations still have a leading positions as they create extensive possibilities for the favorable and safe revision of the kidney during ablation of stones.

[Laparoscopic radical nephrectomy].

OBJECTIVE: Evaluation of retrospective results of treatment of patients with kidney cancer, who have undergone a laparoscopic or a retroperitoneoscopic radical nephrectomy. MATERIALS AND METHODS: We have conducted a retrospective analysis of 185 patients with kidney tumour, who have undergone a laparoscopic or a retroperitoneoscopic radical nephrectomy during 2010-2015. Amongst the participants there were 116 men (62.7%) and 69 women (37.3%) aged 29-86 (average age of 58.1 years). 150 patients (81.1%) have performed radical nephrectomy by transperitoneal access, while 30 patients (16.2%) experienced identical process through retroperitoneal access. 5 cases (2.7%) hybrid technique was utilized. 97 patients performed nephrectomy on the right side, 88 patients on the left side. 178 patients (96.2%) had a single kidney tumours, while 7 (3.8%) had multiple tumours ranging between 2-8. 15 patients, who experienced a laparoscopic radical nephrectomy, had a thrombus in kidney vein (level 1 under Mayo classification). 1 patient had a thrombus in vena cava (level 2). RESULTS: Only one of the patients suffered a fatal outcome. 12 patients (6.5%) had a conversion. The duration of operation ranged between 50-215 minutes (average of 104.3 minutes), time of insufflation ranged between 36-205 minutes (average of 96.2 minutes). Average intraoperative blood loss constituted 147.8 ml. Patients spent 2-18 days (average 4.1 days) in the hospital after the surgery. CONCLUSION: There is an obvious advantage to utilizing a laparoscopic or a retroperitoneoscopic intervention in order to treat kidney cancer. The process constitutes minimal invasiveness, low death rates, minimal intraoperative blood loss and fast rehabilitation of the patients. 72% of patients who have who have experienced surgical intervention, such as radical nephrectomy, spent only 3-4 days in the hospital.

Epidemiology of urolithiasis among the population of Balakan region of the Republic of Azerbaijan.

The aim of the research was to conduct the study of epidemiological risk-factors of urolithiasis in Balakan region according to age, sex and BMI. 176 from 10 to 83 years old patients having cystic calculi disease that were assigned to hospital examination and treatment in Central Hospital of Balakan region during 2007-2011 98 (55,68%) male and 78 (44,32%) female were investigated. The average age was 47,3±17,67 for general patient group, 49,79±19,75 in males and 43,5±14,37 in females. The males/females ratio among the patients was 1,26:1. It was found that: a) the urinary stones with oxalate content were more frequent in people with overweight (25-29,9 kg/m2); b) the urinary stones with urate and phosphate content was more frequent in people with overweight (25-29,9 kg/m2) and in female group with normal weight (18,5-24,9 kg/m2).