[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.

[Using of a dismountable 3D-model of the collecting system with color segmentation to improve the learning curve of residents].

AIM: to determine the efficiency of using a non-biological dismountable 3D-model of the collecting system with color segmentation for better understanding of its anatomy by residents and to determine the optimal tactics of percutaneous nephrolithotomy (PNL). MATERIALS AND METHODS: 3D-models of the collecting system were developed based on CT data of 5 patients with staghorn stones, for whom PNL was planned. CT images were obtained in the Dicom format. RadiAnt DICOM Viewer was used for delineation and segmentation of the collecting system with 3D visualization. Using slicer 4.8.1 software, virtual models were processed to convert DICOM files to STL format. Then, virtual color extraction of each group of calyxes was performed for convenient disassembling and intraluminal study of the anatomy of the collecting system. The final stage included the printing of each area by the method of layer-by-layer deposition using a 3D printer Picaso designer X. To assess the efficiency of the dismountable 3D-model that simulates a certain collecting system, a questionnaire was used. It allowed to evaluate the understanding of the anatomy of the collecting system by residents, as well as the ability to determine the optimal calyx for PNL by comparing the answers with the result of a survey of practicing urologists who had performed more than 50 cases. RESULTS: After studying 3D-models by residents, determination of the number of calyxes in each group was not statistically significantly different from those for practicing urologists who used CT images. The choice of the calyx for primary puncture was not different between groups. However, residents chose the calyx for additional access worse (p=0.009). CONCLUSION: The dismountable 3D-model of the collecting system is promising for training of residents and planning PNL. Studying the anatomy of a single group of calyxes as well as the entire collecting system allows to choose the optimal calyx for percutaneous puncture during PNL.

[Percutaneous nephrolithotripsy in patients after different methods of urinary diversion].

The study presents the results of percutaneous nephrolithotripsy (PNL) in patients who underwent different methods of urinary diversion. MATERIALS AND METHODS: The study included the results of PNL in 16 patients (study group) with kidney stones who were subjected to different methods of urinary diversion. Earlier, 2 (12.5%) patients underwent bilateral ureterosigmoidostomy for bladder exstrophy, 12 (75%) experienced radical cystectomy with orthotopic ileocystoplasty and 2 (12.5%) - heterotopic cystoplasty. The control group comprised 30 patients with large kidney stones and normal function of the lower urinary tract. In the main group, the mean stone size was 2.5 (2.2-3.6) cm in the control group - 2.6 (2.4-3.8) cm. The puncture of the kidney cavity system and nephrostomy dilatation were performed under ultrasound and fluoroscopic guidance, respectively. We compared such factors as the surgery duration, the number of intra- and postoperative complications, blood loss and length of hospital stay. There were no hemorrhagic complications requiring blood transfusion. Exacerbation of chronic pyelonephritis occurred in 4 (25%) patients of the study group and in 3 (10%) of the control group (p<0.05). The two groups did not differ in the effectiveness of PNL (87.5 and 90.0% in the study and control groups, respectively), the blood loss volume and the length of hospital stay. CONCLUSION: PNL enables high effectiveness in removing large kidney stones with minimal complications in patients undergoing different methods of urinary diversion.