Pub Date : 2021-07-25DOI: 10.17650/1726-9776-2021-17-2-128-138
B. Guliev, E. I. Korol, Zh. P. Avazkhanov, K. Yakubov, M. Agagyulov, A. Talyshinskiy
Background. Urinary fistulas (UFs) are one of the most significant complications after partial nephrectomy. Placement of an ureteral stent eliminates urine extravasation in the majority of patients. However, some of them have persistent UFs despite upper urinary tract drainage. Such cases require retrograde injection of fibrin glue into the renal cavity through a ureteroscope or via the percutaneous approach. Some authors reported cases of simultaneous use of 2 stents and percutaneous cryoablation of the fistula, but these techniques are rare and, therefore, it is problematic to evaluate their efficacy.Objective: to evaluate the results of the new treatment method for the elimination of persistent UFs using the retrograde endoscopic percutaneous approach.Materials and methods. This study included 5 patients (3 males and 3 females) with UFs developed after kidney resection. Mean age of the patients was 55.8 years. The tumor size was 2.5 to 4.8 cm; mean R.E.N.A.L. score was 7.8. All patients had earlier undergone minimally invasive partial nephrectomy; the time between surgery and UF development varied between 3 and 10 days. Four out of 5 patients had a large amount of discharge from their paranephral drainage system, examination of which confirmed high creatinine level. Patients underwent flexible ureteropyelography in the lithotomy position. During this procedure, we identified the damaged calyx and then performed percutaneous puncture targeting the distal end of the endoscope at this calyx, ensuring that the tip of the needle appeared in the paranephral cavity in front of the injured calyx. Using the flexible ureteroscope, we inserted the needle into the pelvis, dilated the puncture opening along the string, and installed a nephrostomy drainage system (12 Fr). Then the endoscope was removed and the ureter was additionally drained with a stent. The stent was removed after 8-10 days with subsequent antegrade pyelography. If there was no extravasation, the nephrostomy tube was removed and the patient was discharged from hospital to continue treatment in outpatient settings.Results. All patients with UFs resulting from partial nephrectomy was successfully operated on. No complications were registered. The mean surgery time was 45.0 ± 20.5 min (range: 40-65 min). Only two patients had some discharge from the fistula within 1 day after nephrostomy tube removal and it stopped without any additional interventions. Three patients had their fistula healed immediately. The treatment efficacy during the whole follow-up period of 18 ± 4 months (range: 6-26 months) was 100 %.Conclusion. Ureteral stenting ensures elimination of UFs in the majority of patients after partial nephrectomy. In individuals with persistent UFs, retrograde endoscopic percutaneous drainage of the pelvicalyceal system is the method of choice, because it allows rapid and effective treatment of UFs.
{"title":"Retrograde endoscopic assisted percutaneous treatment of urinary fistulas after partial nephrectomy","authors":"B. Guliev, E. I. Korol, Zh. P. Avazkhanov, K. Yakubov, M. Agagyulov, A. Talyshinskiy","doi":"10.17650/1726-9776-2021-17-2-128-138","DOIUrl":"https://doi.org/10.17650/1726-9776-2021-17-2-128-138","url":null,"abstract":"Background. Urinary fistulas (UFs) are one of the most significant complications after partial nephrectomy. Placement of an ureteral stent eliminates urine extravasation in the majority of patients. However, some of them have persistent UFs despite upper urinary tract drainage. Such cases require retrograde injection of fibrin glue into the renal cavity through a ureteroscope or via the percutaneous approach. Some authors reported cases of simultaneous use of 2 stents and percutaneous cryoablation of the fistula, but these techniques are rare and, therefore, it is problematic to evaluate their efficacy.Objective: to evaluate the results of the new treatment method for the elimination of persistent UFs using the retrograde endoscopic percutaneous approach.Materials and methods. This study included 5 patients (3 males and 3 females) with UFs developed after kidney resection. Mean age of the patients was 55.8 years. The tumor size was 2.5 to 4.8 cm; mean R.E.N.A.L. score was 7.8. All patients had earlier undergone minimally invasive partial nephrectomy; the time between surgery and UF development varied between 3 and 10 days. Four out of 5 patients had a large amount of discharge from their paranephral drainage system, examination of which confirmed high creatinine level. Patients underwent flexible ureteropyelography in the lithotomy position. During this procedure, we identified the damaged calyx and then performed percutaneous puncture targeting the distal end of the endoscope at this calyx, ensuring that the tip of the needle appeared in the paranephral cavity in front of the injured calyx. Using the flexible ureteroscope, we inserted the needle into the pelvis, dilated the puncture opening along the string, and installed a nephrostomy drainage system (12 Fr). Then the endoscope was removed and the ureter was additionally drained with a stent. The stent was removed after 8-10 days with subsequent antegrade pyelography. If there was no extravasation, the nephrostomy tube was removed and the patient was discharged from hospital to continue treatment in outpatient settings.Results. All patients with UFs resulting from partial nephrectomy was successfully operated on. No complications were registered. The mean surgery time was 45.0 ± 20.5 min (range: 40-65 min). Only two patients had some discharge from the fistula within 1 day after nephrostomy tube removal and it stopped without any additional interventions. Three patients had their fistula healed immediately. The treatment efficacy during the whole follow-up period of 18 ± 4 months (range: 6-26 months) was 100 %.Conclusion. Ureteral stenting ensures elimination of UFs in the majority of patients after partial nephrectomy. In individuals with persistent UFs, retrograde endoscopic percutaneous drainage of the pelvicalyceal system is the method of choice, because it allows rapid and effective treatment of UFs.","PeriodicalId":42924,"journal":{"name":"Onkourologiya","volume":"1 1","pages":""},"PeriodicalIF":0.1,"publicationDate":"2021-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67765364","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-07-25DOI: 10.17650/1726-9776-2021-17-2-157-167
V. Petov, A. V. Sapelko, S. Danilov, Y. Chernov, M. Taratkin, A. Amosov, D. Enikeev, G. Krupinov
The current prostate cancer screening program results in unnecessary biopsies in a quarter of patients, overdiagnosis of clinically insignificant prostate cancer (ISUP 1) and overtreatment. Intoducing multiparametric magnetic resonance imaging into routine practice before biopsy allows to decrease the number of biopsies, thereby reducing the burden on clinicians and increasing the likelihood of detecting clinically significant forms of prostate cancer (ISUP >2). The objective of this literature review is to compare targeted biopsy techniques and to determine their current role in the prostate cancer diagnosis.
{"title":"The role of targeted biopsy methods in the prostate cancer diagnosis","authors":"V. Petov, A. V. Sapelko, S. Danilov, Y. Chernov, M. Taratkin, A. Amosov, D. Enikeev, G. Krupinov","doi":"10.17650/1726-9776-2021-17-2-157-167","DOIUrl":"https://doi.org/10.17650/1726-9776-2021-17-2-157-167","url":null,"abstract":"The current prostate cancer screening program results in unnecessary biopsies in a quarter of patients, overdiagnosis of clinically insignificant prostate cancer (ISUP 1) and overtreatment. Intoducing multiparametric magnetic resonance imaging into routine practice before biopsy allows to decrease the number of biopsies, thereby reducing the burden on clinicians and increasing the likelihood of detecting clinically significant forms of prostate cancer (ISUP >2). The objective of this literature review is to compare targeted biopsy techniques and to determine their current role in the prostate cancer diagnosis.","PeriodicalId":42924,"journal":{"name":"Onkourologiya","volume":"1 1","pages":""},"PeriodicalIF":0.1,"publicationDate":"2021-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67766318","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-07-25DOI: 10.17650/1726-9776-2021-17-2-34-45
S. Rakul, K. Pozdnyakov, R. Eloev
Objective: to analyze complications after laparoscopic and robotic-assisted partial nephrectomy.Materials and methods. In our study was included 246 cases. Intra- and postoperative complications were studied after nephron-sparring surgery. The laparoscopic approach was used in 68 (27.3 %) cases, the robot-assisted - in 178 (71.5 %) cases. Intraoperative complications were assessed according to the Rosenthal classification, postoperative complications - according to the Clavien-Dindo classification.Results. The overall incidence of intraoperative complications was 12.6 %. The most frequent intraoperative complication was bleeding that did not require blood transfusion (grade I) - 5.69 % (laparoscopic approach - in 3 (4.41 %) cases, robot-assisted approach - in 11 (6,18 %) cases). Bleeding requiring blood transfusion and injuries of internal organs, which were restored intraoperatively (grade II), were recorded in laparoscopic and robot-assisted approaches in 4.41 % and 2.25 % of cases, respectively. Complications leading to the loss of organ (nephrectomy, splenectomy) were observed in 2.94 % and 4.49 % of cases, respectively. Intraoperative deaths (grade IV) were not registered.The incidence of postoperative complications was 18.29 %. Minor complications (Clavien-Dindo ≤II) were detected in 16 (6.5 %) patients (laparoscopic approach - 7.35 %, robot-assisted approach - 6.18 %). Serious complications (Clavien-Dindo ≥III) were detected in 29 (11.79 %) cases (with laparoscopic approach - 14.71 %, robot-assisted - 10.67 %). In the group of tumors with the RENAL index 4-6, the incidence of postoperative complications was 14.7 % with the laparoscopic approach, and 7.1 % with the robot-assisted approach; in the RENAL 7-9 group - 21.9 % and 13.0 %, respectively. In the group of tumors of high complexity (RENAL 10-12), only the robot-assisted approach was used, the incidence of postoperative complications was 22.0 %.Conclusion. Partial nephrectomy for kidney tumors is an effective and safe surgical technique. The incidence of complications when using the laparoscopic approach is higher than when using the robot-assisted technique in groups of tumors of simple and medium complexity. For tumors of high complexity, robot-assisted approach is a priority. The largest number of serious complications is observed with partial nephrectomy with complex tumors.
{"title":"Complications of robot-assisted and laparoscopic partial nephrectomy","authors":"S. Rakul, K. Pozdnyakov, R. Eloev","doi":"10.17650/1726-9776-2021-17-2-34-45","DOIUrl":"https://doi.org/10.17650/1726-9776-2021-17-2-34-45","url":null,"abstract":"Objective: to analyze complications after laparoscopic and robotic-assisted partial nephrectomy.Materials and methods. In our study was included 246 cases. Intra- and postoperative complications were studied after nephron-sparring surgery. The laparoscopic approach was used in 68 (27.3 %) cases, the robot-assisted - in 178 (71.5 %) cases. Intraoperative complications were assessed according to the Rosenthal classification, postoperative complications - according to the Clavien-Dindo classification.Results. The overall incidence of intraoperative complications was 12.6 %. The most frequent intraoperative complication was bleeding that did not require blood transfusion (grade I) - 5.69 % (laparoscopic approach - in 3 (4.41 %) cases, robot-assisted approach - in 11 (6,18 %) cases). Bleeding requiring blood transfusion and injuries of internal organs, which were restored intraoperatively (grade II), were recorded in laparoscopic and robot-assisted approaches in 4.41 % and 2.25 % of cases, respectively. Complications leading to the loss of organ (nephrectomy, splenectomy) were observed in 2.94 % and 4.49 % of cases, respectively. Intraoperative deaths (grade IV) were not registered.The incidence of postoperative complications was 18.29 %. Minor complications (Clavien-Dindo ≤II) were detected in 16 (6.5 %) patients (laparoscopic approach - 7.35 %, robot-assisted approach - 6.18 %). Serious complications (Clavien-Dindo ≥III) were detected in 29 (11.79 %) cases (with laparoscopic approach - 14.71 %, robot-assisted - 10.67 %). In the group of tumors with the RENAL index 4-6, the incidence of postoperative complications was 14.7 % with the laparoscopic approach, and 7.1 % with the robot-assisted approach; in the RENAL 7-9 group - 21.9 % and 13.0 %, respectively. In the group of tumors of high complexity (RENAL 10-12), only the robot-assisted approach was used, the incidence of postoperative complications was 22.0 %.Conclusion. Partial nephrectomy for kidney tumors is an effective and safe surgical technique. The incidence of complications when using the laparoscopic approach is higher than when using the robot-assisted technique in groups of tumors of simple and medium complexity. For tumors of high complexity, robot-assisted approach is a priority. The largest number of serious complications is observed with partial nephrectomy with complex tumors.","PeriodicalId":42924,"journal":{"name":"Onkourologiya","volume":"1 1","pages":""},"PeriodicalIF":0.1,"publicationDate":"2021-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67765946","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-07-25DOI: 10.17650/1726-9776-2021-17-2-172-173
Д. В. Перлин
Радикальная нефрэктомия продолжает оставаться «золотым стандартом» лечения злокачественных новообразований почки больших размеров [1]. Многими исследованиями показаны одинаковые онкологические результаты лапароскопических операций с открытыми вмешательствами, при гораздо лучшем косметическом эффекте и меньшем количестве осложнений [2]. В течение трех десятилетий, прошедших после выполнения Ральфом Клейманом первой лапароскопической радикальной нефрэктомии [3], продолжались поиски наименее инвазивных и наиболее эффективных методов этой эндоскопической операции. Ряд исследований посвящен сравнительнению трансперитонеального и ретроперитонеального доступа, оценке методик hand-assistance, NOTES и даже роботической нефрэктомии [4].Разработка целого ряда специальных эндоскопических инструментов и портов для их введения привели к концу первой декады двухтысячных к достаточно бурному развитию, так называемой, однопортовой (single‑port) хирургии [5]. Наша клиника, как и многие коллеги, тоже активно внедряли в этот период однопортовые операции, включая нефрэктомию. Поэтому я не только хорошо понимаю трудности, которые подробно описывают авторы при выполнении основных этапов операции, но и пути их разрешения, такие как перемещение камеры между портами или смена оптики с другим углом зрения. Кроме того, возможно дополнительно использовать отдельный 3-5 мм порт [6], что, впрочем, делает вмешательство «не совсем однопортовым».
{"title":"Review of the article “Laparoscopic single port radical nephrectomy challenges: a case presentation”","authors":"Д. В. Перлин","doi":"10.17650/1726-9776-2021-17-2-172-173","DOIUrl":"https://doi.org/10.17650/1726-9776-2021-17-2-172-173","url":null,"abstract":"Радикальная нефрэктомия продолжает оставаться «золотым стандартом» лечения злокачественных новообразований почки больших размеров [1]. Многими исследованиями показаны одинаковые онкологические результаты лапароскопических операций с открытыми вмешательствами, при гораздо лучшем косметическом эффекте и меньшем количестве осложнений [2]. В течение трех десятилетий, прошедших после выполнения Ральфом Клейманом первой лапароскопической радикальной нефрэктомии [3], продолжались поиски наименее инвазивных и наиболее эффективных методов этой эндоскопической операции. Ряд исследований посвящен сравнительнению трансперитонеального и ретроперитонеального доступа, оценке методик hand-assistance, NOTES и даже роботической нефрэктомии [4].Разработка целого ряда специальных эндоскопических инструментов и портов для их введения привели к концу первой декады двухтысячных к достаточно бурному развитию, так называемой, однопортовой (single‑port) хирургии [5]. Наша клиника, как и многие коллеги, тоже активно внедряли в этот период однопортовые операции, включая нефрэктомию. Поэтому я не только хорошо понимаю трудности, которые подробно описывают авторы при выполнении основных этапов операции, но и пути их разрешения, такие как перемещение камеры между портами или смена оптики с другим углом зрения. Кроме того, возможно дополнительно использовать отдельный 3-5 мм порт [6], что, впрочем, делает вмешательство «не совсем однопортовым».","PeriodicalId":42924,"journal":{"name":"Onkourologiya","volume":"1 1","pages":""},"PeriodicalIF":0.1,"publicationDate":"2021-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67765801","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-07-25DOI: 10.17650/1726-9776-2021-17-2-72-82
V. Solodkiy, A. Pavlov, A. D. Tsibulskii, G. Panshin, A. Dzidzaria, R. I. Mirzahanov
Background. Prostate cancer (PCa) in the Russian Federation takes the leading place in the prevalence of cancer among the male population.Objective: to investigate the effect of increasing a single focal dose in high-dose-rate brachytherapy (HDR-BT) in combination with external beam radiotherapy on biochemical failure-free survival and local control in patients with high-risk PCa. Materials and methods. The study included 350 men with PCa in the group of high and extremely high risk of progression. All patients included in the study were divided into 4 groups. Groups 1, 2 and 3 included 276 patients who received HDR-BT with a 192Ir source with a single dose per fraction: 10 Gy (n = 83), 12 Gy (n = 46) and 15 Gy (n = 147). Group 4 included 74 patients who received low-dose-rate brachytherapy with 125I sources up to a total focal dose of 110 Gy. At the 2 stage, external beam radiotherapy was a conventional fractionation (single dose of 2 Gy, total - 44-46 Gy).Results. Of 350 patients over a 5-year follow-up period, PCa recurrence was noted in 65 (18.6 %). The 3- and 5-year biochemical failure-free survival rates in the general cohort of patients were 87.4 and 81.4 %. 5-year biochemical failure-free survival was significantly higher in group 3 relative to group 4 and amounted to 89.8 and 74.2 % (p = 0.03). Increasing the dose for HDR-BT from 10 to 12 Gy per fraction significantly reduced the frequency of local relapses from 15.7 % (in group 1) to 2.2 % (in group 2) (p = 0.0001) while maintaining the level of genitourinary and gastrointestinal toxicity. Conclusion. The use of a combination of brachytherapy and external beam radiotherapy in patients with high risk PCa is highly effective in achieving local control of the tumor. The optimal fractionation regime for HDR-BT remains a matter of debate. The use of 15 Gy per fraction for HDR-BT in combination with external beam radiotherapy is the most optimal fractionation regimen in patients with high-risk PCa.
{"title":"Low and high-dose-rate brachytherapy in combination with external beam radiotherapy for high risk prostate cancer","authors":"V. Solodkiy, A. Pavlov, A. D. Tsibulskii, G. Panshin, A. Dzidzaria, R. I. Mirzahanov","doi":"10.17650/1726-9776-2021-17-2-72-82","DOIUrl":"https://doi.org/10.17650/1726-9776-2021-17-2-72-82","url":null,"abstract":"Background. Prostate cancer (PCa) in the Russian Federation takes the leading place in the prevalence of cancer among the male population.Objective: to investigate the effect of increasing a single focal dose in high-dose-rate brachytherapy (HDR-BT) in combination with external beam radiotherapy on biochemical failure-free survival and local control in patients with high-risk PCa. Materials and methods. The study included 350 men with PCa in the group of high and extremely high risk of progression. All patients included in the study were divided into 4 groups. Groups 1, 2 and 3 included 276 patients who received HDR-BT with a 192Ir source with a single dose per fraction: 10 Gy (n = 83), 12 Gy (n = 46) and 15 Gy (n = 147). Group 4 included 74 patients who received low-dose-rate brachytherapy with 125I sources up to a total focal dose of 110 Gy. At the 2 stage, external beam radiotherapy was a conventional fractionation (single dose of 2 Gy, total - 44-46 Gy).Results. Of 350 patients over a 5-year follow-up period, PCa recurrence was noted in 65 (18.6 %). The 3- and 5-year biochemical failure-free survival rates in the general cohort of patients were 87.4 and 81.4 %. 5-year biochemical failure-free survival was significantly higher in group 3 relative to group 4 and amounted to 89.8 and 74.2 % (p = 0.03). Increasing the dose for HDR-BT from 10 to 12 Gy per fraction significantly reduced the frequency of local relapses from 15.7 % (in group 1) to 2.2 % (in group 2) (p = 0.0001) while maintaining the level of genitourinary and gastrointestinal toxicity. Conclusion. The use of a combination of brachytherapy and external beam radiotherapy in patients with high risk PCa is highly effective in achieving local control of the tumor. The optimal fractionation regime for HDR-BT remains a matter of debate. The use of 15 Gy per fraction for HDR-BT in combination with external beam radiotherapy is the most optimal fractionation regimen in patients with high-risk PCa.","PeriodicalId":42924,"journal":{"name":"Onkourologiya","volume":"1 1","pages":""},"PeriodicalIF":0.1,"publicationDate":"2021-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67766803","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-07-25DOI: 10.17650/1726-9776-2021-17-2-104-111
A. Novikov, R. Leonenkov, D. Temkin, M. V. Borovik, E. S. Shpilenya, N. V. Alferova
In 90-95 % of cases, urothelial cancer primarily affects the bladder and in about 5-49 % of patients it can be located near or completely close the orifice of the ureter. Metachronous urothelial cancer of the upper urinary tract occurs, as a rule, 3 or more years after transurethral resection of the primary bladder tumor or radical cystectomy, and its frequency with involvement of the ureteral orifice ranges from 0 to 20 %, reaching 51 %. Currently, there are no clear recommendations and diagnostic and treatment algorithm for the management of this category of patients. This review examines the frequency, possible causes and risk factors for recurrence of upper urinary tract tumors, indications for organ-preserving treatment, features of surgical technique for transurethral resection of ureteral orifice tumors, emerging complications and methods of their prevention.
{"title":"Transurethral resection of bladder cancer involving the orifice of the ureter","authors":"A. Novikov, R. Leonenkov, D. Temkin, M. V. Borovik, E. S. Shpilenya, N. V. Alferova","doi":"10.17650/1726-9776-2021-17-2-104-111","DOIUrl":"https://doi.org/10.17650/1726-9776-2021-17-2-104-111","url":null,"abstract":"In 90-95 % of cases, urothelial cancer primarily affects the bladder and in about 5-49 % of patients it can be located near or completely close the orifice of the ureter. Metachronous urothelial cancer of the upper urinary tract occurs, as a rule, 3 or more years after transurethral resection of the primary bladder tumor or radical cystectomy, and its frequency with involvement of the ureteral orifice ranges from 0 to 20 %, reaching 51 %. Currently, there are no clear recommendations and diagnostic and treatment algorithm for the management of this category of patients. This review examines the frequency, possible causes and risk factors for recurrence of upper urinary tract tumors, indications for organ-preserving treatment, features of surgical technique for transurethral resection of ureteral orifice tumors, emerging complications and methods of their prevention.","PeriodicalId":42924,"journal":{"name":"Onkourologiya","volume":"1 1","pages":""},"PeriodicalIF":0.1,"publicationDate":"2021-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67765297","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-07-25DOI: 10.17650/1726-9776-2021-17-2-17-32
V. Matveev, M. Volkova, N. Vashakmadze, I. Stilidi
Objective: to describe the technique of nephrectomy and thrombectomy used in patients with renal cell carcinoma (RCC) and tumor venous thrombosis of various levels, and to identify risk factors of in-hospital death among operated patients.Materials and methods. This study included 768 patients with RCC and tumor venous thrombosis who have undergone surgical treatment. Median age was 58 years (range: 16-82 years); the male to female ratio was 2.3:1. The symptoms of venous tumor thrombosis were identified in 199 patients (25.9 %). In the majority of patients (n = 509; 66.3 %), the tumor thrombus originated from the right renal vein. The cranial border of the tumor thrombus was located in the perirenal inferior vena cava (IVC) in 219 patients (28.5 %), subhepatic IVC in 201 patients (26.2 %), intrahepatic IVC in 171 patients (22.3 %), and above the diaphragm in 177 patients (23.0 %). We used an individual approach to choose an optimal method of vascular control and to identify indications for circulatory support. Two-thirds of patients (n = 512; 66.7 %) underwent temporary block of the second renal vein; 268 patients (34.9 %) - temporary block of the hepatoduodenal ligament and right heart; 11 patients (3.2 %) were operated on with cardiopulmonary bypass.Results. The median surgery time was 190 ± 63.6 min; median blood loss was 3,000 ± 71.6 mL (≥50 % of circulating blood in 35.1 % of patients). Intraoperative complications were registered in 23 patients (3.0 %); eight patients (1.0 %) died during surgery with 4 of them died due to pulmonary embolism (0.5 %), 3 died due to hemorrhagic shock (0.4 %), and 1 died due to myocardial infarction (0.1 %). One hundred and ninety individuals (25.0 %) developed postoperative complications with Clavien-Dindo grade III-V complications observed in 115 cases (15.1 %). Forty-one patients (5.3 %) died in the early postoperative period. The causes of death included multiple organ dysfunction (n = 21; 2.8 %), pulmonary embolism (n = 7; 0.9 %), sepsis (n = 6; 0.8 %), stroke (n = 4; 0.5 %), myocardial infarction (n = 2; 0.2 %), and RCC progression (n = 1; 0.1 %). We have identified several independent risk factors for in-hospital mortality, including ascites (hazard ratio (HR) 8.3; 95 % confidence interval (CI) 3.2-21.4; p < 0.0001), preoperative pulmonary embolism (HR 3.5; 95 % CI 1.3-9.4; p = 0.013), supradiaphragmatic thrombi (HR 1.5; 95 % CI 1.1-2.0; p = 0.003). The in-hospital mortality rate was 3.5 % (20/575) among patients with no risk factors, 9.8 % (16/163) among those with 1 risk factor, 40.0 % (10/25) among those with 2 risk factors, and 60.0 % (3/5) among those with 3 risk factors (area under the curve (AUC) 0.705; p <0.0001 for all).Conclusion. The incidence of severe complications and postoperative mortality rate in RCC patients with tumor venous thrombosis who have undergone nephrectomy and thrombectomy were 15.1 and 6.4 %, respectively. Risk factors for perioperative mortality included ascites, preoperati
{"title":"Technique and short-term outcomes of surgical treatment in patients with renal cell carcinoma and tumor venous thrombosis: experience of the Urology Clinic, N.N. Blokhin National Medical Research Center of Oncology","authors":"V. Matveev, M. Volkova, N. Vashakmadze, I. Stilidi","doi":"10.17650/1726-9776-2021-17-2-17-32","DOIUrl":"https://doi.org/10.17650/1726-9776-2021-17-2-17-32","url":null,"abstract":"Objective: to describe the technique of nephrectomy and thrombectomy used in patients with renal cell carcinoma (RCC) and tumor venous thrombosis of various levels, and to identify risk factors of in-hospital death among operated patients.Materials and methods. This study included 768 patients with RCC and tumor venous thrombosis who have undergone surgical treatment. Median age was 58 years (range: 16-82 years); the male to female ratio was 2.3:1. The symptoms of venous tumor thrombosis were identified in 199 patients (25.9 %). In the majority of patients (n = 509; 66.3 %), the tumor thrombus originated from the right renal vein. The cranial border of the tumor thrombus was located in the perirenal inferior vena cava (IVC) in 219 patients (28.5 %), subhepatic IVC in 201 patients (26.2 %), intrahepatic IVC in 171 patients (22.3 %), and above the diaphragm in 177 patients (23.0 %). We used an individual approach to choose an optimal method of vascular control and to identify indications for circulatory support. Two-thirds of patients (n = 512; 66.7 %) underwent temporary block of the second renal vein; 268 patients (34.9 %) - temporary block of the hepatoduodenal ligament and right heart; 11 patients (3.2 %) were operated on with cardiopulmonary bypass.Results. The median surgery time was 190 ± 63.6 min; median blood loss was 3,000 ± 71.6 mL (≥50 % of circulating blood in 35.1 % of patients). Intraoperative complications were registered in 23 patients (3.0 %); eight patients (1.0 %) died during surgery with 4 of them died due to pulmonary embolism (0.5 %), 3 died due to hemorrhagic shock (0.4 %), and 1 died due to myocardial infarction (0.1 %). One hundred and ninety individuals (25.0 %) developed postoperative complications with Clavien-Dindo grade III-V complications observed in 115 cases (15.1 %). Forty-one patients (5.3 %) died in the early postoperative period. The causes of death included multiple organ dysfunction (n = 21; 2.8 %), pulmonary embolism (n = 7; 0.9 %), sepsis (n = 6; 0.8 %), stroke (n = 4; 0.5 %), myocardial infarction (n = 2; 0.2 %), and RCC progression (n = 1; 0.1 %). We have identified several independent risk factors for in-hospital mortality, including ascites (hazard ratio (HR) 8.3; 95 % confidence interval (CI) 3.2-21.4; p < 0.0001), preoperative pulmonary embolism (HR 3.5; 95 % CI 1.3-9.4; p = 0.013), supradiaphragmatic thrombi (HR 1.5; 95 % CI 1.1-2.0; p = 0.003). The in-hospital mortality rate was 3.5 % (20/575) among patients with no risk factors, 9.8 % (16/163) among those with 1 risk factor, 40.0 % (10/25) among those with 2 risk factors, and 60.0 % (3/5) among those with 3 risk factors (area under the curve (AUC) 0.705; p <0.0001 for all).Conclusion. The incidence of severe complications and postoperative mortality rate in RCC patients with tumor venous thrombosis who have undergone nephrectomy and thrombectomy were 15.1 and 6.4 %, respectively. Risk factors for perioperative mortality included ascites, preoperati","PeriodicalId":42924,"journal":{"name":"Onkourologiya","volume":"1 1","pages":""},"PeriodicalIF":0.1,"publicationDate":"2021-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67765807","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-07-25DOI: 10.17650/1726-9776-2021-17-2-182-194
V. Merabishvili, A. N. Poltorackiy, A. Nosov, A. S. Artem'eva, E. Merabishvili
Background. About 25,000 (2018 - 24,291) new cases of kidney cancer (KC) are registered in Russia annually, in the Northwestern Federal District of Russia in 2018 - 2504.Kidney cancer refers to localizations with a relatively low mortality rate. Mortality in the first year of observation is about 20 %. At the same time, an unfavorable trend in the dynamics of morbidity should be noted. Over the past 10 years, the annual growth rate for both sexes was 3.18%, mortality practically did not change, which indicates certain success in the treatment of patients.Materials and methods. The materials of the research were the monographs of IARC “Cancer on five continents”, reference books of the P.A. Herzen Moscow Oncology Research Institute and the database of the population cancer register of the Northwestern Federal District of the Russia own materials. Standard methods of statistical analysis were used.Results. The study revealed positive trends in the quality of registration of patients with kidney cancer, dynamics of mortality and survival of patients.Conclusion. The positive dynamics of the incidence rate of the population of Russia with kidney cancer has been established, and its place in the world community has been determined. Age-specific levels are close to those in the United States.Particular attention is paid to the need to use the Russian population cancer register database to obtain reliable data for an objective assessment of the activities of the oncological service in relation to kidney cancer.
{"title":"The state of oncology care in Russia. Kidney cancer (morbidity, mortality, index of accuracy, one-year and year-by-year mortality, histological structure). Part 1","authors":"V. Merabishvili, A. N. Poltorackiy, A. Nosov, A. S. Artem'eva, E. Merabishvili","doi":"10.17650/1726-9776-2021-17-2-182-194","DOIUrl":"https://doi.org/10.17650/1726-9776-2021-17-2-182-194","url":null,"abstract":"Background. About 25,000 (2018 - 24,291) new cases of kidney cancer (KC) are registered in Russia annually, in the Northwestern Federal District of Russia in 2018 - 2504.Kidney cancer refers to localizations with a relatively low mortality rate. Mortality in the first year of observation is about 20 %. At the same time, an unfavorable trend in the dynamics of morbidity should be noted. Over the past 10 years, the annual growth rate for both sexes was 3.18%, mortality practically did not change, which indicates certain success in the treatment of patients.Materials and methods. The materials of the research were the monographs of IARC “Cancer on five continents”, reference books of the P.A. Herzen Moscow Oncology Research Institute and the database of the population cancer register of the Northwestern Federal District of the Russia own materials. Standard methods of statistical analysis were used.Results. The study revealed positive trends in the quality of registration of patients with kidney cancer, dynamics of mortality and survival of patients.Conclusion. The positive dynamics of the incidence rate of the population of Russia with kidney cancer has been established, and its place in the world community has been determined. Age-specific levels are close to those in the United States.Particular attention is paid to the need to use the Russian population cancer register database to obtain reliable data for an objective assessment of the activities of the oncological service in relation to kidney cancer.","PeriodicalId":42924,"journal":{"name":"Onkourologiya","volume":"57 1","pages":""},"PeriodicalIF":0.1,"publicationDate":"2021-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67765871","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-07-25DOI: 10.17650/1726-9776-2021-17-2-53
Александр Зырянов
Целью проспективного исследования, результаты которого опубликованы в данной статье, явилось изучение возможности сокращения использования антибактериальных препаратов для проведения трансперинеальной биопсии предстательной железы в амбулаторных условиях. В последнее время специалистами активно обсуждается необходимость поиска и изучения оптимальных режимов антибиотикопрофилактики перед биопсией ПЖ в связи со стремительно растущей резистентностью флоры кишки к фторхинолонам и запретом их использования для антибиотикопрофилактики. Первые публикации по профилактике инфекционных осложнений при биопсии простаты относятся к в 1982 году, когда Thompson и соавторы выявили 100% бактериемию после ТР биопсии простаты. В 87% случаев авторы констатировали развитие инфекции мочевой системы, отметив наличие широкого спектра микроорганизмов от аэробной грам-позитивной и грам-негативной до анаэробной флоры в крови и моче после ТР биопсии простаты. В этом же 1982 году Crawford и соавторы опубликовали данные рандомизированного двойного слепого исследования у 63 пациентов, посвященного эффективности антибиотикопрофилактики инфекции мочевого тракта и сепсиса. Двухдневная терапия карбенициллином позволила снизить бактериурию с 36% до 9% по сравнению с контрольной группой без антибиотиков.В последующие годы проводилось довольно много исследований, посвященных антибактериальной профилактике осложнений ТР биопсии простаты. Результаты этих исследований как правило автоматически распространялись и на перинеальную методику. Не могу не согласиться с логическим рассуждением авторов статьи о том, что промежностный доступ при выполнении биопсии простаты менее опасен в отношении инфекционных осложнений по сравнению с трансректальным. Также интересны полученные данные об отсутствии достоверных различий в частоте возникновения инфекционных осложнений (инфекция мочевых путей, инфекция мягких тканей промежности, простатит, лихорадка, сепсис) между группами. Однако, ряд ограничений в отборе пациентов в исследование (наличие уретрального катетера или цистостомического дренажа, патология кожи промежности, контаминация мочи микроорганизмами) не позволяют пока совсем отказаться от антибактериальной профилактики при перинеальной биопсии и требуют продолжения изучения данной очень актуальной темы.
{"title":"Review of the article “The first experience of transperineal prostate biopsy without antibiotic prophylaxis”","authors":"Александр Зырянов","doi":"10.17650/1726-9776-2021-17-2-53","DOIUrl":"https://doi.org/10.17650/1726-9776-2021-17-2-53","url":null,"abstract":"Целью проспективного исследования, результаты которого опубликованы в данной статье, явилось изучение возможности сокращения использования антибактериальных препаратов для проведения трансперинеальной биопсии предстательной железы в амбулаторных условиях. В последнее время специалистами активно обсуждается необходимость поиска и изучения оптимальных режимов антибиотикопрофилактики перед биопсией ПЖ в связи со стремительно растущей резистентностью флоры кишки к фторхинолонам и запретом их использования для антибиотикопрофилактики. Первые публикации по профилактике инфекционных осложнений при биопсии простаты относятся к в 1982 году, когда Thompson и соавторы выявили 100% бактериемию после ТР биопсии простаты. В 87% случаев авторы констатировали развитие инфекции мочевой системы, отметив наличие широкого спектра микроорганизмов от аэробной грам-позитивной и грам-негативной до анаэробной флоры в крови и моче после ТР биопсии простаты. В этом же 1982 году Crawford и соавторы опубликовали данные рандомизированного двойного слепого исследования у 63 пациентов, посвященного эффективности антибиотикопрофилактики инфекции мочевого тракта и сепсиса. Двухдневная терапия карбенициллином позволила снизить бактериурию с 36% до 9% по сравнению с контрольной группой без антибиотиков.В последующие годы проводилось довольно много исследований, посвященных антибактериальной профилактике осложнений ТР биопсии простаты. Результаты этих исследований как правило автоматически распространялись и на перинеальную методику. Не могу не согласиться с логическим рассуждением авторов статьи о том, что промежностный доступ при выполнении биопсии простаты менее опасен в отношении инфекционных осложнений по сравнению с трансректальным. Также интересны полученные данные об отсутствии достоверных различий в частоте возникновения инфекционных осложнений (инфекция мочевых путей, инфекция мягких тканей промежности, простатит, лихорадка, сепсис) между группами. Однако, ряд ограничений в отборе пациентов в исследование (наличие уретрального катетера или цистостомического дренажа, патология кожи промежности, контаминация мочи микроорганизмами) не позволяют пока совсем отказаться от антибактериальной профилактики при перинеальной биопсии и требуют продолжения изучения данной очень актуальной темы.","PeriodicalId":42924,"journal":{"name":"Onkourologiya","volume":"1 1","pages":""},"PeriodicalIF":0.1,"publicationDate":"2021-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67766207","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-07-25DOI: 10.17650/1726-9776-2021-17-2-62-68
V. Mager, A. S. Orlov, T. R. Gilmutdinov, A. A. Veshkina, D. Kovalenko, A. V. Zamyatin
Background. Nowadays there is no consensus on application of cytoreductive prostatectomy in a complex therapy in patients with oligo-metastatic prostate cancer.Study objective: assessment of short-term results of neoadjuvant chemohormonotherapy followed by cytoreductive prostatectomy in patients with oligo-metastatic prostate cancer.Materials and methods. Cytoreductive prostatectomy was performed in 7 patients with oligometastatic prostate cancer.Results. Postoperative complications in 3 (42.9 %) out of 7 treated patients were classified as grade IIIb according to Clavien-Dindo scale. Post-surgical analysis of prostate tissue samples showed therapeutic pathomorphism of grade II in 3 patients (42.9 %), grade III in 1 patient (14.3 %) and grade IV in another patient (14.3 %). Urinary continence regained in all the patients. Average postoperative supervision period took 12 months. Disease progression was diagnosed in 1 patient (14.3 %).Conclusion. Combined application of neoadjuvant chemohormonotherapy followed by cytoreductive prostatectomy can be considered as an alternative method of treatment in a properly selected group of patients with oligo-metastatic prostate cancer.
{"title":"First experiment study in cytoreductive prostatectomy in patients with oligo-metastatic prostate cancer following neoadjuvant chemohormonotherapy","authors":"V. Mager, A. S. Orlov, T. R. Gilmutdinov, A. A. Veshkina, D. Kovalenko, A. V. Zamyatin","doi":"10.17650/1726-9776-2021-17-2-62-68","DOIUrl":"https://doi.org/10.17650/1726-9776-2021-17-2-62-68","url":null,"abstract":"Background. Nowadays there is no consensus on application of cytoreductive prostatectomy in a complex therapy in patients with oligo-metastatic prostate cancer.Study objective: assessment of short-term results of neoadjuvant chemohormonotherapy followed by cytoreductive prostatectomy in patients with oligo-metastatic prostate cancer.Materials and methods. Cytoreductive prostatectomy was performed in 7 patients with oligometastatic prostate cancer.Results. Postoperative complications in 3 (42.9 %) out of 7 treated patients were classified as grade IIIb according to Clavien-Dindo scale. Post-surgical analysis of prostate tissue samples showed therapeutic pathomorphism of grade II in 3 patients (42.9 %), grade III in 1 patient (14.3 %) and grade IV in another patient (14.3 %). Urinary continence regained in all the patients. Average postoperative supervision period took 12 months. Disease progression was diagnosed in 1 patient (14.3 %).Conclusion. Combined application of neoadjuvant chemohormonotherapy followed by cytoreductive prostatectomy can be considered as an alternative method of treatment in a properly selected group of patients with oligo-metastatic prostate cancer.","PeriodicalId":42924,"journal":{"name":"Onkourologiya","volume":"1 1","pages":""},"PeriodicalIF":0.1,"publicationDate":"2021-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67766737","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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