[A place of robot-assisted cystectomy in treatment of muscle-invasive bladder cancer].

Bladder cancer occupies one of the leading positions in morbidity in the world and constitutes a serious problem for healthcare system. The muscle-invasive bladder cancer is the most aggressive and more difficult to treat with drug therapy. Radical cystectomy is the standard treatment for muscle-invasive bladder cancer, with the most commonly used open approach. Currently, there is an active introduction of minimally invasive procedures, which is due to their advantages in perioperative care. Laparoscopic procedures have been broadly adopted for the oncourological practice, but the real breakthrough in the field of minimally invasive surgery has occurred after implementing of robotic-assisted interventions. It should be noted that the extensive radical procedures are associated with significant intra- and postoperative complications, which directly affects the patients condition and quality of life postoperatively. In this regard, robotic-assisted radical cystectomy appears to be a promising treatment method for muscle-invasive bladder cancer. The aim of this review is to collect and analyze current information on the results of robotic-assisted radical cystectomy, with particular attention to the comparison with open and laparoscopic techniques for different surgical and oncological outcomes.

[Frequency of occurrence and risk factors for acute kidney injury after radical cystectomy].

INTRODUCTION: Various studies have revealed the negative impact of surgery or related factors on the risk of acute kidney injury (AKI). The risk factors and 6-months outcomes in patients with clinical or subclinical manifestations of AKI after radical cystectomy were analyzed. MATERIALS AND METHODS: This prospective study included patients with normal renal function who underwent radical cystectomy. Urine and serum samples were collected to measure the level of neutrophil gelatinase-associated lipocalin (NGAL). RESULTS: Of the 186 patients, 43 (23.1%) had AKI in the postoperative period. The most reliable predictor was the concentration of NGAL in the urine 12 hours after surgery (threshold value of 156.87 ng/ml). In 53 (28.5%) patients with NGAL higher than this value, subclinical AKI was diagnosed. Patients with clinical AKI and patients with subclinical AKI were allocated to the AKI group. Independent risk factors for postoperative AKI were age and obesity. After 6 months the glomerular filtration rate (GFR) in the group with AKI was significantly lower than in the control group, although the baseline GFR was similar. CONCLUSION: Determination of NGAL concentration in urine is recommended for early diagnosis of postoperative AKI, as well as for predicting the functional state of the kidneys 6 months after oncourological procedures. A significant proportion of patients developed subclinical AKI; in this group there was a worse renal outcome in comparison with the group without AKI.

[DNA repair XRCC1, XPD genes polymorphism as associated with the development of bladder cancer and renal cell carcinoma].

We examined the correlations between the polymorphic alleles of the DNA repair genes XRCC1 (c.839G> A, rs25489; and c.1196A> G, rs25487), XPA (c.-4A> G, rs1800975), and XPD (c.2251A> C, rs13181) and the progression and severity of neoplasias in the bladder and kidney in patients of three distinct ethnic groups, Bashkir, Russians, and Tatar, residing in the Republic of Bashkorostan. The study enrolled 468 cancer patients and 351 healthy individuals. Genotyping for polymorphic alleles was carried out using the PCR-RFLP method. We identified a correlation between allele A of the c.839 G>A locus of the XRCC1 gene and the incidence of the bladder cancer (BC) and kidney cancer (KC) in the Tatar study group, using the additive genetic effects model (Odds Ratio (OR) = 5.23 and OR = 3.90). In turn, the heterozygous G/A genotype was present at a significantly higher frequency in the KC patients of Bashkir ethnic origin, compared with the control group (p = 0.0061, OR= 4.72). Additional analysis with consideration of participants' smoking status showed that the G/A genotype is significantly more frequent in smokers with BC (OR = 1.96, p = 0.05) then in healthy smokers. We also determined, using the recessive genetic model, that the genotype A/A of the c. 1196A>G locus of the XRCC1 gene was correlated with a higher risk of BC in the Russian cohort (OR = 2.29, p = 0.0082) and an increased incidence of KC in the Bashkir group (OR = 4.06, p = 0.05). A similar correlation was obtained for smokers. In contrast, the allele c.2251 A>C in the XPD gene correlated with a lower risk for BC and KC in the Tatars (p = 0.0003, OR = 0.48 and p < 0.0001, OR = 0.37) in the additive model and in the Bashkirs (p = 0.0083, OR = 0.12) and Russians (p = 0.0001, OR = 0.14) in the recessive model. Further, we uncovered that polymorphism c.839 G>A in the XRCC1 gene contributes to the progression of noninvasive and invasive BC and promotes KC at early and advanced stages of the disease. Thus, we identified similar correlations between DNA repair gene polymorphism and the incidence and progression of BC and KC. We propose that this result points to the involvement of common pathogenetic mechanisms in the initiation and progression of the urinary neoplasias.