[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.