[Antibacterial prophylaxis with fosfomycin at the time of the urethral catheter removal after radical prostatectomy (prospective randomized trial)].

AIM: To evaluate the effect of antibacterial prophylaxis using oral fosfomycin during the removal of a urethral catheter after radical prostatectomy on the development of urinary tract infection, severity of leukocyturia and bacteriuria, as well as the severity of lower urinary tract symptoms. MATERIALS AND METHODS: A single-center, non-blind, prospective, randomized controlled trial was carried out. The main group included 40 patients, and the control group included 37 patients. In the group 1, patients received two doses of oral fosfomycin, 3 g, namely in the evening on the day of catheter removal (the first dose) and 48 hours after catheter removal (the second dose). In the group 2, patients did not receive any antibacterial prophylaxis after urethral catheter removal. The endpoints of the study were confirmed episodes of urinary tract infection within 1 month after removal of the urethral catheter, leukocyturia and bacteriuria in urinalysis/urine culture) and severity of the lower urinary tract symptoms assessed by IPSS questionnaire. RESULTS: In the group 2, urinary tract infection was noted in 17.1%, while in the group 2 only in 2.6% of patients (p=0.032). Leukocyturia and bacteriuria were significantly less common in the group receiving antibacterial prophylaxis with fosfomycin (18.4% vs. 48.6%, respectively; p=0.006). Positive urine culture was observed in 7.9% vs. 25.7%, respectively (p=0.035). Four weeks after removal of the urethral catheter, the average IPSS score was significantly higher in the group 2 (13.2 vs. 9.5 points; p=0.002). There were no cases of allergic reaction and pseudomembranous colitis associated with C. difficile in both groups. Diarrhea cured with sorbents was noted in 2 patients (5.2%) in fosfomycin group. CONCLUSION: Antibacterial prophylaxis using two oral doses of fosfomycin 3 g on the day of urethral catheter removal and 48 hours after catheter removal after radical prostatectomy appears to be an effective scheme that reduces the incidence of urinary tract infection and the severity of lower urinary tract symptoms, and is characterized by a minimal risk of adverse events. It is necessary to carried out further research and develop clear recommendations for antibacterial prevention in urological interventions requiring prolonged urethral catheterization.

[Clinical and morphological assessment of the results of a standard robot-assisted nerve-sparing radical prostatectomy and with the use of Retzius-sparing technique].

OBJECTIVE: To compare the perioperative, functional, clinical and morphological results of a standard robot-assisted nerve-sparing radical prostatectomy and with the use of the Retzius-sparing technique. MATERIALS AND METHODS: A prospective analysis was performed of two groups of patients (n=54) who underwent nerve-sparing robot-assisted radical prostatectomy (period from 2017 to 2018). The first group included 29 patients who underwent nerve-sparing robot-assisted radical prostatectomy with Retzius-sparing technique, the second - 25 patients operated on according to the standard method of bilateral nerve-sparing radical prostatectomy. All patients were comparable in baseline characteristics. In all cases, patients had histologically verified localized prostate cancer pT2a-2c. RESULTS: In cases with use Retzius-sparing technique there is no statistically significant difference in the operation time (243.60 min vs 236.64 min, in groups 1 and 2, p>0.05) and intraoperative blood loss (131.20 ml vs 122.57 ml , in groups 1 and 2, p>0.05). Regarding the dynamics of the urinary continence recovery, the Retzius-sparing technique demonstrates advantages in speed and frequency at all follow-up periods (54.13% vs 41.81%; 68.12% vs 59.21%; 94.15% vs 90 , 63%; 98.54% vs 97.12%; 98.62% vs 97.31%; 98.83% vs 97.82% - in one week after removal of the urethral catheter, 1, 3, 6, 9, and 12 months in the first and second group, respectively). The frequency of erectile function recovery after 12 months was 82.17% and 71.14% in the first and second groups, respectively. CONCLUSIONS: Retzius-sparing robot-assisted prostatectomy superior to standard operation in the speed and timing of recovery of urine continence and erectile function.

[Feasibility and risks of nerve-sparing technique of radical prostatectomy in elderly patients].

OBJECTIVE: To evaluate the efficacy and safety of radical prostatectomy (RP) with nerve-saving technique (NST) in patients more or equal 65 years of age compared with a younger group of patients. MATERIALS AND METHODS: The study group comprised 117 patients more or equal 65 years old, the control group - 333 patients <65 years old, who underwent RP with unilateral or bilateral NST from January 2012 to December 2019. The analysis of pathomorphological results, complications rate, recurrence free survival (RFS) and the restoration of erectile function (EF) in both groups was performed. RESULTS: The majority of older patients belonged to intermediate and high risk groups of biochemical recurrence. Extracapsular tumor extension was significantly more often observed in the group more or equal 65 years of age: 16.2% and 6.9%, p=0.028. There were no differences between the two groups in the frequency of serious postoperative complications ( more or equal III class according to the Clavien-Dindo classification): 2.55% and 2.7%; p=0.94. The five-year RFS after RP was 95.4% in the group <65 years old and 92.1% in the group more or equal 65 years old (p=0.31). There was a moderate tendency to a slower recovery of EF in older patients: sufficient EF after 6 and 12 months was observed in 21.9% and 59.4% versus 33.3% and 73% in the group <65 years old (p=0.12). Minimal differences in EF were observed 24 months after RP with bilateral NST (84.2% and 87.9%), and more relevant differences with unilateral NST: 53.8% and 66.7% in the study and control group (p=0.033). CONCLUSIONS: The performance of RP with NST in elderly patients is not associated with additional oncological risks, while the restoration of EF is somewhat slowed down in comparison with a group of patients <65 years of age. Bilateral NST provides high potency recovery results regardless of age.

[Evaluation of orgasmic function in patients after radical prostatectomy].

INTRODUCTION: Radical prostatectomy (RP) remains the main treatment method of localized prostate cancer. Satisfactory functional results after RP are essential for both urologist and patient. Preservation of sexual function, particularly orgasmic function (OF) after RP is of the utmost importance today for patients and their sexual partners. MATERIALS AND METHODS: An analysis of 3- and 6-months functional results of 91 patients who underwent RP for prostate cancer is presented in this study. The influence of surgical approach, nerve-sparing surgery (NSS) and other factors for OF recovery was evaluated. RESULTS: OF recovered in 53,8% and 56% patients 3 and 6 months postoperatively, respectively. Positive influence of younger age and NSS on OF recovery was found. CONCLUSION: OF recovered in more than half of patients after RP. The young age, NSS were found to be predictors of RP recovery. Further research is required to determine the more relevant factors for OF recovery after RP.

[Oncological safety of nerve-sparing radical prostatectomy: evaluation of histopathological outcomes and recurrence-free survival].

OBJECTIVE: To evaluate histopathological outcomes and biochemical recurrence (BCR) free survival in patients after nerve-sparing radical prostatectomy (nsRP). MATERIALS AND METHODS: Prospective study group comprised 313 patients who underwent uni- or bilateral nsRP from 2014 to 2018; control group included 592 patients with clinically localized prostate cancer who underwent non-nsRP from 2014 to 2018. Mann-Whitney U-test was performed to assess continuous variables; chi-squared test was used for comparative analysis of categorical data. BCR free survival was evaluated with Kaplan-Meier method, log-rank test was used to compare survival outcomes. RESULTS: Adverse histopathological findings were lower in the study group: extracapsular extension was found in 9,4% and 18,75% (p<0,001), grade group upgrade in 23% and 29,3% (p=0,04), positive surgical margins (PSM) in 15% and 22,1% (p=0,01). Subanalysis according to cancer risk groups showed lower PSM rates in high-risk patients (15,6% and 30,3%, p=0,017) and tendency for higher PSM rates in low-risk patients in the study group with no significant difference (12,6% and 7%, p=0,16). BCR free survival after 12 months was 100% and 88,2%, after 20 months - 92,3% and 86,4%, p=0,04. PSM ratesin the study group were notsignificantly different depending on the type of surgery: 13,9% in robotic-assisted approach and 15,4% in retropubic approach, p=0,75. CONCLUSIONS: Relatively favorable histopathological outcomes and BCR free survival can be achieved after nsRP. However, obtained results could not be considered optimal and clearly indicate the need for further improvement of preoperative planning and intraoperative quality control of surgical treatment.

[Multiparametric magnetic resonance imaging markers of clinically significant prostate cancer].

Authors aimed to assess the correlation between the apparent diffusion coefficient (ADC of the tumor, ADC ratio) and final grade group (GG) after radical prostatectomy (RP), and to determine the threshold values of ADC for detecting clinically significant prostate cancer (PC) with subsequent evaluation in a prospective group. 118 patients with PC were included in the retrospective group. These patients underwent RP from 2012 to 2017 with preoperative 3 Tesla multiparametric MRI (mpMRT) with contrast enhancement in a single center. After analyzing all the MRI studies, the average values of tumor ADC and benign tissue ADC were calculated using the maps of ADC. The prospective part of the study included 60 patients with completed pre-biopsy mpMRI and subsequent RP from January 2018 to March 2019. The prospective part of the study demonstrated the effectiveness of applying the obtained diffusion coefficient thresholds. When used as a criterion for determining clinically significant prostate cancer (GG > 6), threshold value of ADC ratio had sensitivity, specificity, accuracy, positive predictive value and negative predictive value were 84%, 91%, 87%, 94% and 78% respectively.

[Influence of radical prostatectomy on orgasmic function].

This review is dedicated to orgasmic function which is one of the most intimate and crucial aspects of quality of life in patients who underwent radical prostatectomy for prostate cancer. The main risk factors that affect orgasmic function and recovery period after surgery are described.

[COMPARATIVE ANALYSIS OF POSITIVE SURGICAL MARGIN RATES IN PATIENTS UNDERGOING ROBOT- ASSISTED OR RETROPUBIC RADICAL PROSTATECTOMY FOR PROSTATE CANCER].

The issue of comparative evaluation of oncological and functional outcomes of robot-assisted radical prostatectomy (RARP) and radical retropubic prostatectomy (RRP) is widely discussed in the international literature. A key point in studying the oncological efficacy of both techniques is a comparative evaluation of positive surgical margin (PSM) rates as one of the main prognostic factors influencing the further course of prostate cancer. Available data so far are inconsistent, which prompted us to conduct our own research. A retrospective analysis was performed in two groups of patients who underwent RARP (n = 63) and RRP (n = 116) from January 2014 to April 2015. Despite a general trend towards lower PSM rates in RARP group compared to RRP group (12.7 and 21.6%, respectively, p = 0.09), no significant differences were found in the stratification of patients in both groups depending on the risk of prostate cancer progression and pathological stage. These data show the potential equality of the two methods regarding intraoperative control of resection margins.

[Comparative analysis of histological and long-term oncological outcomes after radical prostatectomy in patients matching johns hopkins and the royal marsden hospital criteria for active monitoring].

A retrospective comparative analysis of results of treatment of patients with prostate cancer who met the most stringent (Johns Hopkins - JH; 74 patients) and the most mild (Royal Marsden Hospital - RMH; 263 patients) selection criteria for the management according to the strategy of active monitoring was performed. Significant differences in the frequency of detection of adverse histological features and biochemical recurrence-free survival after radical prostatectomy in patients eligible for JH and RMH criteria were not identified. Extracapsular extension occurred in 2.7 and 4.9% (P=0,33), seminal vesicle invasion - in 1.4 and 2,6% (P=0.43), positive surgical margins - in 6, 8 and 7.2 % (P=0.56) Gleason score increase - at 6.8 and 9.1 % (P=0.49), respectively. Five-year disease-free survival rates were 95.7 and 95,8% (P=0.41). Regardless of the protocol selection for active monitoring, precise examination of patients and staging of the disease are absolutely necessary, as well as the future well-designed studies on the comparative analysis of the effectiveness of active monitoring and early curative treatment in the settings of national health care.

[Significance of heparin elimination from plasma in the assessment of coagulogram and antithrombin III activity]. / Znachenie éliminatsii iz plazmy geparina dlia otsenki koagulogrammy i aktivnosti antitrombina III.

An original adsorbent for non-fractionated and low-molecular weight heparin (fraxiparin,Sanofi) has been developed and tried in experiments and in a clinical setting. Tests carried out in 58 patients with disseminated intravascular coagulation and thromboses treated with heparin demonstrated the possibility of obtaining objective data on the status of the blood clotting system. Heparin adsorption is particularly important in measurements of heparin III activity, for even low concentrations of heparin mask the defect of this anticoagulant.

[Hemodynamics during epidural anesthesia in combination with transcranial electroanesthesia in pulmonary surgery]. / Gemodinamika pri épidural'noi anestezii v kombinatsii s transkranial'noi élektroanesteziei pri operatsiiakh na legkikh.

Pulmonary surgery performed under epidural anesthesia (EA) combined with transcranial electrical anesthesia (TEA) was characterized by minimum adverse hemodynamic reactions, typical of EA alone, and reduced overall dose of the local anesthetic with minimum volume of the infusion therapy and adequate anesthetic protection. The absence of marked hemodynamic reactions in this type of combined anesthesia made it possible to use it during pulmonary surgery in the most severely ill patients whose cardiovascular system is already compromised by the primary pulmonary disease.

[Effect of diuretics on the activity of the blood kallikrein-kinin system in experimental inflammation]. / Vliianie diuretikov na aktivnost' kallikrein-kininovoi sistemy krovi v usloviiakh éksperimental'nogo vospaleniia.

Experimental inflammatory edema induced by subplantar administration of dextran was shown to activate the blood kallikrein-kinin system in rats. Furosemide, dichlothiazide and ethacyrnic acid (50 mg/kg) prevented this effect. Ethacrynic acid exerted the most pronounced action.

[Mediastinal cysts]. / Kisty sredosteniia.

In the department of thoracic surgery of the Kostroma Region Hospital from 1967 to 1980 thirty one patient were operated upon for mediastinal cyst. Most of the patients did not have any complaints at the admission, clinical symptoms of the others having not characteristic picture. The mediastinal cysts should be treated only surgically. Results of operations were good.

[Complications and their prevention in the surgical treatment of lung diseases in the elderly]. / Oslozhneniia i ikh profilaktika pri khirurgicheskom lechenii zabolevanii legkikh u pozhilykh bol'nykh.

According to the author's data, of 579 elderly patients operated for different diseases of the lungs complications were observed during operation in 24,5% of cases such as cardiac arrhythmia, hemorrhages, acute disturbance of ventilation and cardiac arrest. Postoperative complications (tracheobronchial obturation, pneumonia, cardiac rhythm disturbance, pulmonary-cardiac insufficiency, incompetence of the bronchial stump and thromboembolism) took place in 40,6%. Postoperative lethality was 7,4%. Most frequent complications appeared following pulmonectomy. Great importance is attached by the author to prophylactic measures reducing the postoperative lethality.