SIGNIFICANCE OF ADC MEASUREMENTS AS RADIOLOGICAL MRI MARKER IN DETECTION OF METASTATIC LYMPH NODE INVOLVEMENT IN PATIENTS WITH PROSTATE CANCER.

BACKGROUND: In spite of significant advances in diagnosis of prostate cancer (PCa), the detection and differential diagnosis of metastatic lymph node involvement remains an important clinical dilemma in a large number of cases. Contrast-enhanced abdominal computed tomography and magnetic resonance imaging (MRI), in part when using T1-weighed images (T1-WI and T2-WI), allow evaluating indirectly the presence of invasion in regional lymph nodes by assessing their diameter and morphology. Nonetheless, these techniques do not appear to be sufficiently sensitive for direct identification of lymph nodes with metastatic lesions. AIM: To study the significance of the apparent diffusion coefficient (ADC) of diffusion-weighted MRI in detection of metastatic lymph node involvement in PCa patients. MATERIALS AND METHODS: The study involved 35 patients with histologically verified PCa. Based on multiparametric prostatic MRI findings and pathomorphological reports, we have performed ADC measurements for pelvic lymph nodes either with (n = 15, mean size 1.78 ± 0.59 cm) or without metastases (n = 20, mean size: 0.94 ± 0.06 cm) in PCa patients who underwent radical prostatectomy with lymph node dissection. RESULTS: No significant diffe-rences were observed when comparing mean sizes of N+ and N- pelvic lymph nodes. At the same time, when comparing mean ADC values for N+ and N- pelvic lymph nodes, we observed a statistically significant difference: 0.74 ± 0.09 · 10-3 mm2/s in metastatic lymph node vs 1.05 ± 0.23 · 10-3 mm2/s in lymph nodes without metastatic involvement (p < 0.001). CONCLUSION: The use of ADC for diffusion-weighted MRI may provide valuable information for detection of metastatic lymph node involvement in patients with PCa.

Quality of life in patients after radical cystectomy with modified ureterocutaneostomy and Bricker urinary diversion.

BACKGROUND: Radical cystectomy (RC) has been used for over 100 years as an effective treatment of muscle invasive bladder cancer (MIBC). However, the main surgical challenge is not only to remove an affected organ but also to replace its functional component - urine diversion. The aim of our work is to study the efficacy of the modified ureterocutaneostomy technique by estimating the quality of life in post-RC patients with MIBC. MATERIALS AND METHODS: A retrospective analysis of the cases of 40 patients was provided. Two groups were delineated depending on urinary diversion: 20 patients with urinary derivation by the modified ureterocutaneostomy method, and 20 patients - with Bricker conduit. All patients were matched by mean age, gender, American Society of Anesthesiologists status, disease stage and duration. 16 (80%) and 15 (75%) patients from the study and control groups, respectively, passed 3 courses of standard preoperative polychemotherapy with gemcitabine-cisplatin. Quality of life was assessed using the health survey SF-36 form (developed at the US Medical Research Institute), adapted at the National Cancer Institute (Ukraine). RESULTS: Comparing patients after ureterocutaneostomy or Bricker surgery, no statistical discrepancy was noted before surgery and after 3 months. A statistical difference in perioperative parameters was noted only when comparing the surgery duration and length of stay in hospital. CONCLUSIONS: The modified ureterocutaneostomy technique contributes to performing surgery faster and more effectively since an intestinal stage is skipped in surgery. Our findings indicate that ureterocutaneostomy technique may be used as a standard of care for post-RC patients with MIBC.

[TACTICS OF TREATMENT OF PATIENTS FOR ONCOLOGICAL DISEASES IN IATROGENIC INJURY OF UPPER URINARY WAYS].

Results of examination and treatment of 119 patients for oncological diseases were analyzed, in whom iatrogenic injury of ureter (IIU) have occurred. Remission of oncological diseases plastic operations were performed in 48 (40.3%) patients, reconstructive - in 23 (19.3%), restoration - in 3 (2.5%); while a progress - palliative nephrostomy in 41 (34.5%) patients. In 4 (3.4%) patients dynamical observation was conducted. The method of operative treatment was selected, taking into account efficacy of treatment of oncological diseases; mechanism of IIU; level of obstruction and irreversibility of changes in wall of ureter; character of injury (one-sided, bilateral, injury of ureter of a single kidney); anatomo-functional changes of upper and lower urinary ways; the patient state severity.