Urologiya

Effectiveness of hyperthermic intravesical chemotherapy in the combined treatment of patients with high-risk non-muscle-invasive bladder cancer

R.S. Chystiakov — 2024-12-30

The aim of the study was to increase the effectiveness of treatment of patients with high-risk non-muscle-invasive bladder cancer (HR NMIBC) by using hyperthermic intravesical chemotherapy in the adjuvant mode after transurethral resection of the bladder (HIVEC-therapy group; n=53) and to compare the treatment results with patients in which adjuvant therapy was carried out with BCG vaccine (BCG therapy group; n=54). The frequency of recurrence and progression during the 36-month follow-up period differed significantly between the two groups – 22.6 and 42.6% and 7.5 and 20.4%, respectively. The difference between RFS indicators was significantly higher in the HIVEC-therapy group in periods of 12 months. (HR 0.32; p=0.02) and 36 months. (HR 0.48; p=0.04) after the end of the course of induction therapy. The median time to recurrence in patients receiving HIVEC therapy was longer than in patients receiving BCG therapy: 31.5 months. and 26.0 months. respectively (Log Rank test; p=0.034). The expression level of the proliferative activity marker Ki-67 decreased by 6.5 times in recurrent tumors under the influence of HIVEC therapy and by 2.1 times under the influence of BCG therapy (p<0.001). According to the EORTC QLQ-30 and FACT-BL questionnaires, the best level of quality of life in patients with HR NMIBC was when adjuvant chemohyperthermia was performed. When evaluating the level of toxicity of treatment according to the CTCAE scale of adverse events, a significantly higher number of cases of fever, bladder spasms, and non-infectious cystitis were found in the BCG therapy group when comparing the frequency of grade I–II adverse events. The number of grade III-IV adverse events, such as fever and urinary tract infection, was also higher in the BCG group. The implemented method of treatment of patients with high-risk non-muscle-invasive bladder cancer using the method of hyperthermic intravesical chemotherapy demonstrates treatment results comparable to the results of intravesical immunotherapy, while providing patients with a better quality of life during treatment.

New approaches in the treatment of localized kidney cancer. Personal experience

Yu.V. Dumanskiy — 2024-12-30

Aim – to increase the effectiveness of organ-sparing surgical treatment of patients with localized kidney cancer by carefully studying the vascular anatomy of the kidney and its correlation with the tumor, preoperative embolization of segmental kidney vessels, and the use of intraoperative fluorescence angiography. We conducted a clinical prospective comparative (controlled) single-center cross-sectional study involving 65 patients with localized renal cell carcinoma (T1-2vN0M0), The comparison group included 40 patients, and the main group, respectively, included 25 patients. The minimum sufficient number of patients was determined by the standard methodology based on the appropriate statistical power. 25 patients (the main group) underwent retroperitoneoscopic (lumboscopic) kidney resection with preliminary targeted embolization of the renal artery branch supplying the part of the kidney to be resected, 40 patients (the comparison group) underwent laparoscopic or "open" kidney resection according to industry-specific national unified protocols and clinical guidelines. The results of instrumental studies 1 month after surgical treatment in both groups showed that 45% of patients had subclinical signs of postoperative inflammation in the operated kidney. In addition, in the comparison group, according to intravenous enhancement CT, 16 (40%) patients had impaired perfusion of the operated organ. These data confirm that the proposed algorithm for the treatment of patients with localized renal malignancy using preoperative selective renal vascular embolization and fluorescence imaging is safer and more appropriate for widespread implementation compared to the standard method. The proposed method of retroperitoneoscopic resection using preoperative X-ray vascular embolization and intraoperative fluorescence imaging in the infrared spectral region using indocyanine green in patients with localized renal cancer has advantages over the standard method of surgical treatment and can be used in this patient population.

Epidemiological and etiological features and the current state of the problem of treating chronic cystitis (literature review)

V.P. Stus — 2024-12-30

Epidemiological and etiological features and the current state of the problem of treating chronic cystitis (literature review)

Enzyme test – early diagnosis of kidney inflammation

G.V. Bachurin — 2024-12-30

The aim of the work is to improve the results of early diagnosis of acute infectious kidney diseases at the molecular level in urolithiasis (urinary stone disease) through the study of enzymatic test indicators. Enzymatic tests (NGAL, IL-1β, β2-microglobulin) were investigated at the molecular level using the IFA method in the urine of patients with urolithiasis. Comparative and prognostic significance of the conducted treatment was established between the groups of patients, and an algorithm was developed based on the results of kidney damage predictors. It was found that the indicators of general laboratory analysis in patients with urolithiasis within the first 24-48 hours do not reliably indicate the absence of an infectious-inflammatory process in the kidneys and the development of renal failure. It was determined that an increase in the inflammation predictor indicators in more than 50% of patients indicates the development of infectious-inflammatory complications within the first 12-24 hours before the occurrence of general laboratory and clinical changes. The assessment of the effectiveness of conservative therapy in groups IA and II revealed that complications of the inflammatory process in the kidneys were observed five times more frequently in group II (comparison) than in group IA. The use of enzymatic tests as markers for early kidney damage allows for the classification of two main groups of patients: those requiring conservative treatment and those requiring urgent surgical intervention. This significantly reduces the frequency of inflammatory, purulent-septic complications and improves the treatment outcomes for patients with upper urinary tract obstruction in urolithiasis.

Significant and anniversary dates in the history of urology and related areas in 2024

V.P. Stus — 2024-12-30

Significant and anniversary dates in the history of urology and related areas in 2024