Dynamics of inflammatory reaction markers in patients under endourological interventions

Introduction. Urolithiasis is one of the most widespread urological diseases and infectious complications remain one of the most common adverse events after surgical interventions for urolithiasis. Currently, in routine clinical practice in most clinics in the country, for the purpose of postoperative control and detection of infectious complications is used: a clinical blood test with assessment of the dynamics of the blood leukocyte count. Unfortunately, the current edition of the clinical guidelines does not contain recommendations on what indicators of postoperative follow-up examinations the clinician should focus on in order to identify infectious and inflammatory complications. For this reason, the study of the value of other markers of the inflammatory response appears to be an actual task.Objective. To assess the relationship between the dynamics of laboratory markers of infectious-inflammatory complications and the incidence of infectious-inflammatory response after endoscopic stone removal.Materials & methods. The prospective cohort study included 217 patients diagnosed with urolithiasis and underwent surgical removal of stones by endoscopic method. Of total patient numbers, 43 patients underwent ureteroscopy (URS) with lithotripsy, 152 patients underwent percutaneous nephrolithotripsy (PNL), and 22 patients underwent flexible ureterolithotripsy with lithotripsy. An analysis of demographics, clinical parameters and postoperative complications was performed as a descriptive analysis. Patients underwent a standard list of laboratory and instrumental examination methods. The mandatory control of body temperature was carried out t.i.d. daily. Before surgical treatment, indicators of WBC, LYMP, CRP, and ESR content were recorded on the first and second days after surgical treatment.Results. Postoperative fever was recorded in 40 (18.5%) patients. During the postoperative period, an increase in CRP and ESR was observed in both the fever and the normal temperature group, exceeding the reference values on the first day. At the same time, in the fever group (in 40 patients — 18.5%), a significantly higher increase in CRP and ESR was observed (685% vs 323%) for CRP and (146% vs 80%) for ESR. According to the results obtained in our study, CRP and ESR indicators demonstrate the most clinically significant dynamics in patients with postoperative fever, increasing by more than 500% and 100%, respectively.Conclusions. Endoscopic removal of urinary stones is a safe treatment option in patients with sterile urine cultures. After endoscopic stone removal, all patients experience such reactive changes in peripheral blood parameters as: an increase in the level of leukocytes, lymphopenia, an increase in ESR and CRP levels. Indicators of CRP and ESR demonstrate the most clinically indicative dynamics

ПРИМЕНЕНИЕ ТАДАЛАФИЛА ДЛЯ ЛЕЧЕНИЯ ЭРЕКТИЛЬНОЙ ДИСФУНКЦИИ У ПАЦИЕНТОВ, ПЕРЕНЕСШИХ РАДИКАЛЬНУЮ ПРОСТАТЭКТОМИЮ

Erectile dysfunction is a frequent complication of radical prostatectomy despite numerous modifications in surgical technique. The term «penile rehabilitation» refers usually to treatments intended to restore functional penile erection after radical prostatectomy. Selective phosphodiesterase type 5 inhibitors are the mainstay of this rehabilitation at present. Tadalafil seems a logical choice for recovering of erectile functionafter radical prostatectomy given its prolonged duration of action. The once-daily dose of tadalafil has the theoretical benefit in terms of safety and separation of medication from sexual activity. In this paper we review the published clinical and basic science research studies on the role of tadalafil in patients with postprostatectomy erectile dysfunction.Несмотря на постоянное усовершенствование техники радикальной простатэктомии (РПЭ), эректильная дисфункция остается нередким осложнением операции. Термином «пенильная реабилитация» обычно обозначают различные виды терапии, направленные на восстановление эректильной функции после РПЭ. Большинство программ реабилитации включает назначение селективных ингибиторов фосфодиэстеразы 5-го типа (иФДЭ-5). В настоящее время тадалафил имеет преимущество перед другими иФДЭ-5 вследствие длительного периода полувыведения, а также наличия формы препарата для ежедневного приема, позволяющей исключить взаимосвязь сексуальной активности с приемом лекарства и благодаря уменьшенной дозировке теоретически меньшую вероятность побочных эффектов лечения. В данном обзоре литературы проанализированы клинические и фундаментальные исследования роли тадалафила в терапии эректильной дисфункции после РПЭ

КРИОАБЛЯЦИЯ ПРЕДСТАТЕЛЬНОЙ ЖЕЛЕЗЫ

Prostate cryoablation is an effective mini-invasive treatment for prostate cancer (PC), which may be used in case of both primary and postradiotherapy recurrent tumor. Due to continuous improvements of cryoablation equipment, the number of treatment-induced complications is small. The studies oflong-term cryotherapy outcomes, such as cancer-specific, metastasis-free, and other survival rates, are presently under way. Focal cryoablation of the prostate remains an experimental therapy option.Криоабляция предстательной железы является эффективным, минимально инвазивным методом лечения рака предстательной железы (РПЖ), который может применяться как первично, так и в случае рецидива опухоли после лучевой терапии. Благодаря постоянному усовершенствованию оборудования для криоабляции число осложнений лечения невелико. Изучение отдаленных результатов криотерапии РПЖ – раковоспецифической выживаемости, выживаемости без метастазов и др. – продолжается в настоящее время. Фокальная криоабляция предстательной железы остается экспериментальным видом терапии

Robot-assisted technologies for targeted prostate biopsy: a literature review

One key aspect in treating any cancer is timely diagnosis and treatment. Obtaining the right diagnosis depends mainly on running the biopsy algorithm. Most studies show a significant increase in sensitivity and specificity in the targeted tissue sampling method compared to standard biopsy. The human factor can result in more medical errors. This can be solved by replacing the standard biopsy method with a more advanced one. The human factor is excluded from the biopsy sampling process using the semi-automatic robotic biopsy needle guidance. This paper presents a literature review development in robot assisted prostate biopsy. A literature review was performed using PubMed and Scopus databases. Papers reporting on experiments using semi-automatic robotic systems were included. Using the literature, we described the prerequisites for the development the software for semi-automatic targeted biopsy to increase the sensitivity and specificity of prostate cancer diagnosis

POLYPOID CYSTITIS: A FINDING AND DIFFERENTIAL DIAGNOSIS

Background. Polypoid cystitis may simulate urothelial neoplasias cystoscopically and histologically. The frequency of polypoid cystitis is 0.38%; that among patients undergoing bladder catheterization is 6 %.Subjects and methods. The authors estimated the frequency of polypoid cystitis among chronic cystitis patients admitted to City Clinical Hospital Fifty, a base of the Clinic of Urology, Moscow State University of Medicine and Dentistry, in the period from February 2008 to February 2010. Out of 819 patients followed up, 3 who had diagnosed as having polypoid cystitis complained of pollakiuria, imperative micturate urges, and macrohematuria. They underwent ultrasonography, computed tomography, and cystoscopy; bladder masses measured 1.0, 7.0, and 11.5 cm, respectively; extensive growth was verified in 2 cases. Endoscopic studies identified procumbent rough-villous masses without well-defined outlines with the signs of bullous edema, decay, hemorrhages, and urinary salt encrustations. By taking into account the clinical picture and laboratory and instrumental findings, the authors suspected stage T3bNхMх bladder tumor in 2 patients and T1NхMх stage in 1. According to the European Association of Urology guidelines for management of bladder cancer, the patients underwent transurethral bladder resection. The patients were diagnosed as having polypoid cystitis on the basis of postmortem evidence.Results. In this study the frequency of polypoid cystitis was 37 %. Polypoid cystitis, a benign mass without a risk for malignancy, had signs of invasive transitional cell carcinoma.Conclusion. Such cases that rarely occur in practice are of clinical value and interest to urologists, pathologists, and oncologists.</p

Risk factors for urinary incontinence in patients undergoing radical robot-assisted prostatectomy

Introduction. Prostate cancer (PCa) is one of the most common cancers among men, and the tactic to treat this disease stage-depends directly. The “gold” standard for localized PCa is radical robot-assisted prostatectomy (RARP). Patients often have excessive surgery requirements and are concerned about the development of postoperative complications. One of the most frequent functional complications after this operation is urinary incontinence (UI), whose formation mechanism is not fully understood. Clinical studies have described many UI predisposing factors, but the results obtained are often contradictory, which requires a repeated and deeper study of the issue.Objective. To identify predisposing factors for urinary incontinence in patients undergoing radical robot-assisted prostatectomy.Materials &amp; methods. The search results for the scientific databases PubMed, Medline, Web of Science, Embase, Cochrane Library and PEDro, Wang-fang Database and CNKI, Edline were analyzed for the queries "robot-assisted prostatectomy", "radical prostatectomy", "incontinence", "predictors", "urinary incontinence".Results. The predisposing factors to UI after RARP were studied. The review discusses and illustrates in detail all known predisposing factors for UI and shows the inconsistency of the data obtained by different researchers, which once again emphasizes the need for further study of this issue.Conclusion. Despite the long history of studying postoperative complications of RARP, reliable and consistent data on all the risks of UI after RARP have not yet been obtained. Therefore, this literature review summarizes and analyzes the results of the latest research in recent years

Expert System for Histological Diagnosis of Prostate Cancer

The paper is dedicated to the development of expert system for histological prostate cancer diagnosis. The developed system allows to fill the knowledge base and then to use this knowledge base to support physician decision on the histological diagnosis of prostate disease. Keywords: pattern recognition, prostate cancer diagnosis, decision making, decision support syste

Сальважная лимфаденэктомия у пациентов с рецидивом рака предстательной жедезы после радикальной простатэктомии

A separate group of patients who underwent radical prostatectomy, make patients with isolated recurrence of cancer in the lymph nodes, limited by regional and / or retroperitoneal lymph nodes. Alternatively, treatment of this patient group can be used open or laparoscopic lymphadenectomy (robot-assisted). The analysis of literature indicate an increase in disease-free survival of these patients during lymphadenectomy. Imaging techniques such as multiparametric magnetic resonance imaging and positron emission tomography, allow more accurately identify lymph nodes in patients with biochemical recurrence of prostate cancer after radical prostatectomy. Отдельную группу больных, перенесших радикальную простатэктомию, составляют пациенты с изолированным рецидивом рака в лимфатических узлах, ограниченных регионарными и / или забрюшинными лимфатическими узлами. В качестве одного из вариантов лечения данной группы пациентов может быть применена лимфаденэктомия открытым или лапароскопическим (робот-ассистированным) доступами. Проведенный анализ литературных источников указывает на увеличение общей выживаемости данной группы пациентов при проведении лимфаденэктомии. Доступные методы визуализации, такие как мультипараметрическая магнитно-резонансная томография и позитронно-эмиссионная томография, позволяют более точно идентифицировать поражение лимфатических узлов у пациентов с биохимическим рецидивом рака простаты после радикальной простатэктомии.

СОСТОЯНИЕ ОРГАЗМИЧЕСКОЙ ФУНКЦИИ ПОСЛЕ РАДИКАЛЬНОЙ ПРОСТАТЭКТОМИИ

Objective: to study orgasmic function (OF) in patients undergoing radical prostatectomy (RPE).Subjects and methods. Seventy-nine patients who had undergone RPE for locally advanced prostate cancer without hormone and radiation therapies were examined. The patients’ mean age was 59.3 years. The mean EF-IIEF domain score was 24.4. OF was estimated by IIEF question 10 and the authors’ questionnaire. The Spearman rank correction coefficient and Mann-Whitney U-Wilcoxon tests were used.Results. After RPE, there was a reduction in the mean IIEF question 10 score from 3.9 (confidence interval 3.7–4.1) to 3.3 (3–3.5) (p = 0.000). The following changes were found in orgasm intensity: no changes in 43 %, mild worsening in 42 %, severe worsening in 8 %, and enhancement in 4 %; orgasm could not be achieved in 4 % of the patients. Pain usually of low intensity was reported by 8.8 %. The poor factors for preserving OF were its low baseline level, elderly age, or severe post-RPE erectile dysfunction.Conclusion. There were significant OF changes after RPE, which should be kept in mind while treating this category of patients.Цель исследования – изучение состояния оргазмической функции (ОФ) у больных, перенесших радикальную простатэктомию (РПЭ).Материалы и методы. Обследованы 79 пациентов, которым была выполнена РПЭ по поводу локализованного рака предстательной железы без проведения гормональной и лучевой терапии. Средний возраст больных составил 59,3 года. Средний балл по опроснику EF-IIEF был равен 24,4. Оценку ОФ выполняли по вопросу № 10 IIEF и собственному опроснику. Использовали ранговую корреляцию по Спирмену и -тесты Вилкоксона и Манна–Уитни.Результаты. После осуществления РПЭ отмечено снижение среднего балла по вопросу № 10 IIEF с 3,9 (доверительный интервал 3,7–4,1) до 3,3 (3–3,5), p = 0,000. Выявлены следующие изменения интенсивности оргазма: отсутствие изменений — в 43 %, легкое ухудшение — в 42 %, выраженное ухудшение — в 8 %, усиление — в 4 % случаев; 4 % больных не смогли достичь оргазма. Боли, обычно малой интенсивности, отметили 8,8% пациентов. Неблагоприятными факторами для сохранения ОФ были исходно низкий ее уровень, пожилой возраст, возникшая после РПЭ тяжелая эректильная дисфункция