[Modern aspects of diagnostics and treatment of renal infarction].

One of the causes of acute kidney injury is the renal artery thrombosis. Clinical manifestations depend on the level of thrombus. This pathology is characterized by non-specific clinical manifestations in the early period, the complexity of differential diagnosis, often delayed verification of the diagnosis and unfavorable prognosis in case of prolonged (5-7 days) anuria. There is no generally accepted protocol for the diagnosis and treatment of renal artery thrombosis. To clarify the diagnosis, intravenous urography, radionuclide renography, and contrast-enhanced computed tomography are recommended. Until recently, patients with suspected renal artery thrombosis were treated with anticoagulant therapy and renal replacement therapy with hemodialysis, which is required constantly as renal function was usually irreversibly impaired. Surgical treatment is effective only in the first hours. The outcome is often unfavorable, the probability of hemorrhagic complications is high. Due to the rare frequency of detection and verification of renal infarction, no consensus has been reached regarding the diagnosis or treatment of this condition.

[Ultrasound-based techniques of targeted prostate biopsy].

The article is devoted to the multiparametric ultrasound techniques for prostate biopsy targeting. This literature review illustrates the variety of ultrasound-based targeting procedures and presents data concerning the diagnostic value of each. A special attention is given to every targeted technique limitations and the opportunity for the MTI-fusion.

[Current approaches to targeted prostate biopsy].

Currently, prostate cancer (PCa) is the second most common malignancy in men after lung cancer and the fifth leading cause of death worldwide. According to world and national statistics, over the past 20 years, there has been a steady increase in both incidence and mortality from PCa. Prostate biopsy is the cornerstone of the PCa diagnosis. However, recently, systematic transrectal biopsy as a standard approach has been questioned, since it has significant drawbacks that reduce the quality of PCa diagnosis. Considering the clinical importance of accurate PCa staging, MRI-guided targeted biopsy has been developed, which is currently the most accurate technique for taking a sample of tissue from suspicious areas. The optimal approaches to targeted prostate biopsy and the potential possibilities of including multiparametric MRI in the primary diagnostic algorithm are highlighted in this review, based on the results of large studies. The method allows to increase the overall PCa detection rate, the detection rates of clinically significant PCa, reduce the frequency of diagnosis of low-risk tumors and increase the overall accuracy of PCa detection, which has an outmost importance for the patient selection for active surveillance and to control disease progression.

[A comparison of knot-free and interrupted suturing of vesicourethral anastomosis during learning curve of radical prostatectomy].

BACKGROUND: Laparoscopic radical prostatectomy (LRP) is the most popular treatment method for localized prostate cancer worldwide. This is a technically-demanding procedure with a long learning curve. Therefore, an improvement of the surgical technique is very important in order to simplify training for LRP. Dorsal vein ligation and vesicourethral anastomosis (VUA) are two major problems for surgeons with insufficient experience in LRP. Previous studies have shown that between 50 and 250 procedures are required in order to get necessary skills. AIM: to compare and study the advantages of the "free-tie" technique and interrupted suture during the formation of VUA during learning curve of LRP. MATERIALS AND METHODS: a single-center retrospective analysis was performed by evaluating operational reports, video recordings and histories of patients who were operated at Saint Petersburg Public Hospital of Saint Luca from 2016 to 2018. A total of 114 patients were included in the study, 56 of them were undergone to "free-tie" technique and 48 patients had interrupted suture. All procedures were performed by four surgeons with an experience of less than 100 LRP. The evaluation criteria included the time of formation of VUA, the duration of whole procedure, the duration of bladder catheterization, frequency of anastomotic leak and stress urinary incontinence. RESULTS: For surgeons who learned the technique of LRP, the use of a continuous suture with a self-anchoring V-loc thread allowed to reduce significantly the time of formation of VUA and ligation of dorsal venous plexus. Such a suture is more convenient for the surgeon than interrupted suture and makes LRP more proficient and efficient, allowing to reduce the time of procedure, the duration of catheterization, postoperative complications rate associated with anastomotic leak, and also to lower frequency of stress urinary incontinence and obstruction of VUA. This technique may reduce the period necessary for mastering LRP. CONCLUSION: "Free-tie" VUA is a safer and more effective technique compared to interrupted suture technique during learning curve of LRP. According to our work, this technique allows surgeons with insufficient suturing experience to easily overcome the steep training curve.

[A comparison between enucleation of the prostate using holmium and thulium laser in volume over 80 cc: retrospective clinical study with 12-months follow-up].

AIM: The aim of our study was to evaluate efficiency of thulium laser enucleation of the prostate (ThuLEP) for the treatment of benign prostatic hyperplasia (BPH). MATERIALS AND METHODS: A retrospective analysis of 112 patients with BPH who underwent ThuLEP (n=60) or holmium laser enucleation of the prostate (HoLEP) (n=52) at our institution from January 2017 to June 2017 was carried out. The perioperative data and complication rate were assessed. Severity of lower urinary tract symptom (LUTS) was evaluated after 1, 6 and 12 months using International Prostate Symptom Score [I-PSS], quality-of-life [QoL] score and maximum flow rate [Qmax]. To shorten learning curve, we modified the technique and simplified the intervention. To reduce noise during surgery, we performed ThuLEP using Vela XL. RESULTS: There were significant differences in pre- and perioperative parameters, including operative time (113.15+/-12.14 vs. 118.08+/-15.76 min, p=0.46), decrease in serum sodium concentration (3.49+/-0.83 vs. 3.48+/-0.84 mmol/L, P=0.97), hemoglobin drop (1.37+/-0.18 vs. 1.43+/-0.38 g/dL, p=0.65), catheterization time (2.15+/-0.38 vs. 2.27+/-0.39 days, p=0.52) and hospital stay (6.95+/-0.82 vs 7.56+/-1.36 days, p=0.25) between the two groups (ThuLEP and HoLEP). Compared with the HoLEP group, intraoperative noise was lower in ThuLEP group (47.22+/-10.31 vs. 59.45+/-9.65 db, p<0.05). At 1-, 6- and 12 months follow-up, the LUTS severity (I-PSS, QoL score and Qmax) were significantly improved in both groups in comparison with the baseline values. Furthermore, there was no difference in LUTS severity between two groups (p>0.05). CONCLUSION: ThuLEP is comparable to the holmium laser in terms of efficiency, safety and indications and represent minimally invasive treatment option for patients with LUTS secondary to BPH.

[Comparative assessment of treatments for prostate adenoma greater than 100 cm3].

AIM: To compare holmium laser enucleation of the prostate (HoLEP) and endovideosurgical (EVS) adenomectomy in the treatment of prostate adenoma. MATERIALS AND METHODS: We compared treatment results of 180 patients with prostate adenomas greater than 100 cm3 who underwent EVS adenomectomy (n=90) and laser enucleation of the prostate (n=90). The analysis included the following parameters: duration of catheterization, length of postoperative hospital stay, I-PSS score, maximum urinary flow rate measured by uroflowmetry and complications according to Clavien-Dindo grading systems. RESULTS: There were no significant differences in patient age, preoperative prostate size, glandular tissue weight, and operative time. The duration of catheterization (p=0.0008) and length of postoperative hospital stay (p<0.0001) were significantly shorter in the HoLEP group. Both groups showed a statistically significant improvement in functional performance at three months post-surgery. Complications in the HoLEP and EVS adenomectomy group occurred in 18 (20%) and 23 (25.55%) patients, respectively (p>0.99). CONCLUSION: The two methods mentioned above are widely used in the treatment of prostate adenoma. However, holmium laser enucleation of the prostate shows similar short-term functional results and complication rates compared with EVS adenomectomy for prostate adenomas greater than 100 cm3. The patients of the HoLEP group had better results regarding the duration of catheterization and length of postoperative hospital stay. Therefore, laser enucleation is the preferred surgical modality for prostate adenomas greater than 100 cm3.