[Use of tamsulosin for a prevention of acute urinary retention in the perioperative period in patients undergoing to surgical procedures]

The perioperative management of patients involves multiple aspects. Acute urinary retention (AUR) is one of the possible postoperative complications. Alpha-adrenoblockers are commonly used for treatment and prevention of AUR. Tamsulosin is the most often prescribed drug; there are a lot of studies devoted to its use in different patient subgroups. The aim of our study was to evaluate the efficiency of perioperative use of tamsulosin for the prevention of postoperative AUR. A literature review from January 2013 to June 2023 in Scopus and PubMed databases was carried out. According to the results, tamsulosin results in a significant reduction in the risk of postoperative AUR. A personalized approach allows to overcome difficulties in the perioperative management of patients and significantly improve their quality of life/satisfaction from treatment.

[HIFU therapy of localized prostate cancer using image-guided robotic HIFU Focal One]

INTRODUCTION

Prostate cancer (PCa) is the second most commonly diagnosed malignant tumor in men after lung cancer and is the fifth leading cause of death worldwide. In November 2019, the spectrum of alternative treatment for PCa was added by a novel minimally invasive method, namely high-intensity focused ultrasound (HIFU) using the latest Focal One machine (with the possibility of combining intraoperative ultrasound and preoperative MRI data).

MATERIALS AND METHODS

During the period from November 2019 to November 2021, HIFU using Focal One device (manufactured by EDAP, France) was performed in 75 patients with PCa. Total ablation was done in 45 cases, while 30 patients undergone to focal prostate ablation. The average age of the patients was 62.7 (51-80) years, the total PSA level was 9.3 (3.2-15.5) ng/ml and the prostate volume was 32.0 (11-35) cc. The maximum urinary rate was 13.3 (6.3-36) ml/s, IPSS score was 7 (3-25) points, IIEF-5 score was 18 (4-25). Clinical stage c1N0M0 was diagnosed in 60 patients, 1bN0M0 in 4 patients, 2N0M0 in 11 patients. In 21 cases, transurethral resection of the prostate was performed within 4-6 weeks prior to total ablation. Before surgery, all patients underwent magnetic resonance imaging (MRI) of the pelvis with intravenous contrast and PIRADS V2 assessment. MRI data were used intraoperatively for precision planning of the procedure.

RESULTS

In all patients, the procedure was performed under endotracheal anesthesia in accordance with the technical recommendations of the manufacturer. Prior to surgery, a silicone urethral catheter of 16 or 18 Ch was placed. The average duration of the intervention was 101 (56-147) minutes. The postoperative period was uneventful in all cases.Patients received antibiotic therapy via parenteral route for 4 days, followed by oral administration for another 10 days, as well as alpha-blockers (at least 1 month after procedure). After removal of urethral catheter on the 4th day, all patients started to void. In 9 cases there was acute urinary retention in the evening and in 4 patients in the next morning, requiring temporary bladder catheterization. A year after the procedure, 53 patients were fully examined: the average total PSA level in patients who underwent total ablation (n=53) was 0.96+/-0.11 ng/ml, the IPSS score was 6.9+/-0,6 points (no difference compared to baseline). Follow-up biopsy revealed PCa in 6 patients; in other cases, prostate fibrosis was determined.

CONCLUSIONS

HIFU in patients with localized PCa using image-guided robotic HIFU (Focal One) is promising and feasible. This method has shown good oncological results with a short follow-up period. It is advisable to carry out further prospective analysis.

[Biofilm control in urological practice]

Urinary tract infections (UTIs) have long been among the most common diseases. In the structure of the general infectious morbidity, UTIs rank second after acute respiratory viral infection. Every year, researchers note an increasing number of mutations in the genomes of bacteria that cause infectious diseases, which leads to the formation of more and more aggressive forms of pathogens. Patients with infectious diseases of the urinary system have the highest risk of biofilm formation, the frequency of which is directly proportional to the length of time the urethral catheter is located and accounts for more than half of all nosocomial infections. The presence of resistant strains of pathogenic bacteria and the development of bacterial biofilms are major problems in the treatment of urinary tract infections. The increasing number of nosocomial bacterial strains in the hospital increases the postoperative bed-day, the frequency of readmission and the number of antibacterial drugs used. In light of increasing antibacterial resistance, the use of medical resources is dramatically increasing, which ultimately leads to an increase in the cost of treatment. Along with this, the selection of resistant strains brings to the fore both the rational use of antibacterial drugs and the search for alternative methods of therapy. This review of publications on the problem of bacterial biofilm formation in urological practice demonstrates updated information on the role of enzymes, probiotics, and bacteriophages in preventing biofilm formation on various medical biomaterials, such as urethral catheters.

Actual aspects of the use of thulium laser as a promising method in the treatment of prostatic hyperplasia

Lower urinary tract symptoms caused by benign prostatic hyperplasia are the most widespread and frequent urological problem among men, affecting about a third of the male population of Russia over 50 years of age. Surgical intervention is the most effective method of treating benign prostatic hyperplasia, and about 75,000 surgical interventions are performed annually in Russia. Today, of all available surgical treatments, monopolar transurethral resection of the prostate (TURP), in which enlarged prostate tissue is resected with a monopolar electrode, has been the preferred surgical method since the 1970s. This method of therapy can significantly improve the maximum urinary flow rate (Qmax), reduce obstructive symptoms assessed on the basis of the international questionnaire on the severity (IPSS) and improve the quality of life of patients. However, monopolar TURP is a rather risky procedure due to the possibility of developing serious complications such as massive bleeding or TURP syndrome (water intoxication syndrome of the body). Consequently, practicing urologists all over the world are faced with the urgent task of developing minimally invasive surgical methods of treatment, the results of which would be at least similar to those after monopolar TURP, while with fewer intra- and postoperative complications, side effects and a shorter recovery period for the patient.

[Alpha1-adrenergic blockers therapy and sexual function]

An increase in life expectancy and the number of older and elderly men, an improvement in the quality of medical care and socio-economic factors in most countries contributed to an increase in the number of patients with benign prostatic hyperplasia (BPH). Currently, improvement of the quality of life is the mainstay of strategy for managing patients with BPH, as well as prevention of complications and the need for surgery. In this regard, the pharmacotherapy with 1-adrenergic blockers (1-AB) is widely used as an effective method for improving lower urinary tract symptoms and reducing the risk of BPH progression. Given that the quality of life is becoming increasingly important in evaluating the efficiency of BPH treatment, including therapy in elderly patients, it is necessary to take into account its effect on sexual function, when choosing a particular drug. The use of 1-AB can be accompanied by side effects manifested by various sexual disorders. Alfuzosin does not adversely affect sexual function in men with BPH, may improve erectile and ejaculatory function and should be considered as the drug of choice, especially in sexually active men and patients who already suffer from worsening ejaculatory function while using another 1-AB.

Identification of Clinically Significant Prostate Cancer by Combined PCA3 and AMACR mRNA Detection in Urine Samples

Purpose

Preclinical evaluation of PCA3 and AMACR transcript simultaneous detection in urine to diagnose clinical significant prostate cancer (prostate cancer with Gleason score ≥7) in a Russian cohort.

Patients and Methods

We analyzed urine samples of patients with a total serum PSA ≥2 ng/mL: 31 men with prostate cancer scheduled for radical prostatectomy, 128 men scheduled for first diagnostic biopsy (prebiopsy cohort). PCA3, AMACR, PSA and GPI transcripts were detected by multiplex reverse transcription quantitative polymerase chain reaction, and the results were used for scores for calculation and statistical analysis.

Results

There was no significant difference between clinically significant and nonsignificant prostate cancer PCA3 scores. However, there was a significant difference in the AMACR score (patients scheduled for radical prostatectomy p=0.0088, prebiopsy cohort p=0.029). We estimated AUCs, optimal cutoffs, sensitivities and specificities for PCa and csPCa detection in the prebiopsy cohort by tPSA, PCA3 score, PCPT Risk Calculator and classification models based on tPSA, PCA3 score and AMACR score. In the clinically significant prostate cancer ROC analysis, the PCA3 score AUC was 0.632 (95%CI: 0.511–0.752), the AMACR score AUC was 0.711 (95%CI: 0.617–0.806) and AUC of classification model based on the PCA3 score, the AMACR score and total PSA was 0.72 (95%CI: 0.58–0.83). In addition, the correlation of the AMACR score with the ratio of total RNA and RNA of prostate cells in urine was shown (tau=0.347, p=6.542e–09). Significant amounts of nonprostate RNA in urine may be a limitation for the AMACR score use.

Conclusion

The AMACR score is a good predictor of clinically significant prostate cancer. Significant amounts of nonprostate RNA in urine may be a limitation for the AMACR score use. Evaluation of the AMACR score and classification models based on it for clinically significant prostate cancer detection with larger samples and a follow-up analysis is promising.

[Evaluation of the clinical efficacy of urethroplasty after failed hypospadias repair]

BACKGROUND

Evaluation of surgical treatment of hypospadias is one of the most controversial problem in urology, considering a lack of continuity in the management of these patients between pediatric andrologists and general urologists. Patients who undergone to multiple hypospadias repairs remain one of the most difficult categories for reconstructive urethral surgery and urology in general.

MATERIALS AND METHODS

The treatment results of 112 adult patients who had complications of previously performed hypospadias repairs were evaluated. The results of repeated procedures were compared in patients, in whom modified balloon urethral catheter (group 1; n=50) or standard Foley catheter (group 2; n=62) was used, respectively.

RESULTS

Most patients after surgery assessed the appearance of the penis as "good" (92% in group 1, 77.4% in group 2). In group 1, satisfactory results was seen in 8% of cases and there were no unsatisfactory results, while in group 2, where standard Foley catheter was used, these values were 19.4% and 3.2%, respectively. In group 1, complication rate was lower than in group 2 (10% versus 41.9%; p<0.05). In group 1, there was a significantly higher proportion of patients with a Qmax score of more or equal 18 ml/s (90% versus 74.2%; p<0.05).

CONCLUSIONS

Repeated procedures in adult men with late complications of surgical treatment of hypospadias are quite effective, although they are accompanied by a rather high complications rate. The use of a new model of the urethral catheter with dilating cuff and an irrigation canal allows to improve treatment results in this category of patients.

Targeted prostate biopsy in the diagnosis of prostate cancer: results from a prospective cohort study

Background. Detection of prostate cancer by various targeting methods of prostate biopsy is an important problem now. Aim. To improve the detection of prostate cancer (PCa), compare the methods of targeted biopsy – cognitive biopsy guided by MRI with biopsy guided by histos-canning, using a randomized biopsy of the prostate from twelve cores as a control method. Materials and methods. A total of 145 respondents who underwent a randomized biopsy of the prostate in combination with targeted techniques were divided into 3 samples in accordance with the methods of targeted biopsy. In the results, the detectability by targeted methods was compared with each other and with a randomized biopsy as a control method. The results were subjected to statistical processing in order to form the conclusions of the study. Results. The detection rate of prostate cancer in the cognitive biopsy group was 64.4%, in the histofusion group – 51.1%, in the cognitive biopsy with histofusion group – 69% (p<0.05). The detection of PCa when comparing positive targeted biopsies did not differ statistically significantly between the methods (38 and 36%, p=0.05). The percentage of positive biopsies was higher with histofusion biopsy (34.2%) than with cognitive biopsy (29.7%), the incidence of clinically sig-nificant cancer was higher according to the results of targeted methods compared with randomized biopsy (73% vs 37.5%, p<0.05). The highest complication rate with the combined use of the studied targeting techniques was 13.6%, while all complications belonged to the 1st category according to Clavien–Dindo. Conclusion. To optimize the diagnosis of prostate cancer, it is advisable to use a combination of targeted and “randomized” cores. The combination of the targeted methods studied has been shown to be effective and safe. Carrying out a histofusion biopsy using a unified technique allows obtaining information on the clinical and morphological characteristics of prostate adenocarcinoma, which in terms of prognostic value is practically not inferior to the data of a cognitive biopsy performed taking into account the results of MRI. The use of targeted prostate biopsy methods increases the detection of clinically significant prostate cancer without adversely affecting the safety of the procedure in conjunction with standard prostate biopsy.

[Moscow program of early detection and treatment of prostate cancer]

The aim of this study is to improve the results of detection and treatment of patients with prostate cancer (PCa) in the Moscow. For this purpose, we performed our own clinical diagnostic, epidemiological, autopsy, experimental and comparative studies that emphasize the relevance of the stated subject in the study of the diagnosis and treatment of patients with PCa. Urology Department of A. I. Evdokimov Moscow State University of Medicine and Dentistry was at the forefront of the Men's Health program in Moscow and in early 2003 it was the first to have an office for early diagnosis of prostate diseases, as part of the Program. Over 20,000 patients were screened for PCa. For the first time in Russia, methods for the early detection of PCa were investigated on a cohort of Russian men using PCA3 and the Prostate Health Index. The role and significance of prostate saturation biopsy was examined. The investigation of aspects of the morphological assessment of prostate diseases formed the basis for the development of an electronic atlas of PCa images. A series of studies on various prostate visualization methods, including Histoscanning system and MRI, have been performed. A new minimally invasive method for the treatment of prostate cancer has been introduced - a robot-assisted radical prostatectomy and cryoablation. The concept of surgical treatment of localized forms of PCa has been developed and the factors predicting the success of treatment have been determined. This study is reflected in numerous publications both in Russia and abroad, in monographs and dissertations.

[Fusion biopsy of the prostate]

AIM

to compare the prostate cancer (PCa) detection rate, accuracy and safety of prostate image-guided fusion biopsy methods (cognitive fusion, software-fusion and HistoScanning-guided biopsy) on the basis of published studies in patients from 48 to 75 years with suspected prostate cancer during primary or repeat biopsy. To identify the limitations of these methods and improve the efficiency of fusion biopsy of the prostate in a further clinical trial.

MATERIALS AND METHODS

search was carried out in the PubMed, Medline, Web of Science and eLibrary databases using following requests: (prostate cancer OR prostate adenocarcinoma) AND (MRI or magnetic resonance) AND (targeted biopsy); (prostate cancer OR prostate adenocarcinoma) AND (PHS OR Histoscanning) AND (targeted biopsy) and (prostate cancer OR prostate adenocarcinoma) AND (MRI or magnetic resonance) AND (targeted biopsy) AND (cognitive registration), targeted prostate biopsy, prostate histoscanning, histoscanning, cognitive prostate biopsy.

RESULTS

a total of 672 publications were found, of which 25 original scientific papers were included in the analysis (n=4634). According to the results, PCa detection rate in patients with an average age of 62.5 years. (48-75) and an average PSA of 6.3 ng/ml (4.1-10.8), who underwent cognitive fusion biopsy under MRI control (MR-fusion) was 32.5%, compared to 30% and 35% for histoscanning in combination with a systematic biopsy and combination of methods (MR-fusion biopsy and histoscanning-guided biopsy), respectively. The accuracy of cognitive MR-fusion biopsy was 49.8% (20.8%-82%), the accuracy of the software MR-fusion biopsy was 52.5% (26.5%-69.7%), the accuracy of histoscanning-guided targeted biopsy was 46.8% (26%-75.8%). The highest values were observed in the patients undergoing primary biopsy (75.8%).

DISCUSSION

Currently, imaging methods allow us to change the approach to the diagnosis of PCa by improving the efficiency of prostate biopsy, the only formal method for verifying PCa. A common method for PCa diagnosis in 2018 is a systematic prostate biopsy. However, due to the its drawbacks, fusion biopsy under control of MRI or ultrasound has being introduced into clinical practice with superior results. So far, there is a lack of sufficient scientific data to select a specific technique of the fusion biopsy of the prostate. According to the analysis, it was concluded that the incidence of complications didnt increase when performing targeted biopsy in addition to the systematic protocol.

CONCLUSION

The efficiency of cognitive MR-fusion biopsy is comparable to software MR-fusion biopsy. Histoscanning-guided biopsy has lower diagnostic value than MR-guided target biopsy using software. The lack of solid conclusions in favor of a particular prostate fusion biopsy technique stresses on the relevance of further research on this topic.

Data on somatic mutations obtained by whole exome sequencing of FFPE tissue samples from Russian patients with prostate cancer

Prostate cancer (PCa) is the most frequently diagnosed among men malignant disease that remains poorly characterized at the molecular level. Advanced PCa is not curable, and the current treatment methods can only increase the life expectancy by several months. Identification of the genetic aberrations in tumor cells provides clues to understanding the mechanisms of PCa pathogenesis and the basis for developing new therapeutic approaches. Here we present data on somatic mutations, namely single nucleotide variations (SNVs), small insertions and deletions, detected in prostate tumor tissue obtained from Russian patients with PCa. Moreover, we provide a raw dataset on the whole exome and targeted DNA sequencing of tumor and non-tumor prostate tissue obtained from Russian patients with PCa and benign prostatic hyperplasia (BPH). This data is available at NCBI Sequence Read Archive under Accession No. PRJNA506922.

[One-stage cryoablation of two renal tumors]

The progressive development of medical technologies allowed the introduction of alternative methods of treatment of localized renal cell carcinoma with a tendency to organ-sparing approach. Cryoablation, radiofrequency ablation, and some experimental methods of treatment (microwave and laser ablation, therapy with high-intensity focused ultrasound) are referred to minimally invasive treatment of renal cell carcinoma. Cryoablation is highly effective alternative method of treatment of renal cell carcinoma. The main advantages of this technique are tumor visualization and formation of 'ice ball' in real time, fewer complications compared with other methods, as well as the possibility of cryotherapy in critically ill patients. Compared to other ablative technologies, cryoablation is followed by low percentage of redo treatment and good intermediate oncological results. We described the experience of one-stage cryoablation of two kidney tumors in this report.

[Evaluation bacteriological analysis of urine in patients with long-term bladder drainage]

INTRODUCTION

The experience of comparative evaluation of the effectiveness of various types of urethral catheters in prevention of catheter-associated infection is described in this article.

MATERIALS AND METHODS

The study included 69 patients treated at the CCH n.a. S.I. Spasokukotsky in the period from December 2017 to March 2018. The average age of patients was 67.5 years. In all patients, the bladder was drained by a two-way Foley catheter No. 16-18 Ch (100% silicone). In the 1st group (n=18), the bladder was drained with a standard urethral uncoated catheter, in the 2nd (n=16) - with a silver impregnated urethral catheter, in the 3rd (n=15) - with an urethral catheter coated with nitrofuran, in the 4th (n=20) urethral catheter with the possibility of controlled irrigation of the bladder and urethra with antiseptic solutions and (a new model of the urethral catheter developed during cooperative work of the Moscow State University of Medicine and Dentistry n.a. A.I. Evdokimov Urology Department and National Medical Research Center of Obstetrics, Gynecology and Perinatology n.a. V.I. Kulakov).

RESULTS

The bladder was drained by Foley urethral catheter for more or equal 15 days. A microbiological study of urine (on the example of clinical isolates of conditionally pathogenic microorganisms) with preparation of an inoculum, inoculation of nutrient media, counting cultures of pathogenic bacteria and determining the sensitivity of pathogenic bacteria to antibiotics was carried out. The study showed the effectiveness of the new urethral catheter model in patients with long-term bladder drainage.

CONCLUSIONS

Conducting multicenter studies evaluating the effectiveness of the proposed urethral catheter model with the inclusion of a larger number of patients will reduce the economic costs, associated with treating patients with prolonged bladder drainage in the long term by reducing the number of nosocomial infection cases and reducing postoperative day.

[The role of the uretral catheter in the development of catheter- related urinary tract infection]

The most common source of nosocomial infection is the urinary tract, especially if they it is drained with a urethral catheter. Catheter-associated urinary tract infections account for at least 80% of all complicated urinary tract infections and are the most common type of hospital-acquired infection. Intestinal microflora plays the leading role in the pathogenesis of catheter-associated urinary tract infections, whereas the most important risk factor for their development is the long duration of urinary catheter drainage. In the case of short-term and intermittent catheterization, routine antibiotic prophylaxis is not required, but if a patient develops clinically significant infection, antibiotic therapy is required followed by definitive therapy based on culture. Urethral catheters coated with antimicrobial substances and anti-inflammatory agents can significantly reduce the adhesion and migration of bacteria, thereby reducing the incidence of urinary tract infections. Despite this, the incidence of catheter-associated infection remains high. We have reviewed recent literature related to catheter-associated urinary tract infections and the best means of preventing this condition.

[Current methods of early diagnosis of prostate cancer]

Prostate cancer is the most common cancer among men, except for lung cancer. Therefore, it is imperative to identify diagnostic methods for early detection of prostate cancer to determine patients from healthy populations, which helps guide a timely treatment at an initial stage of the disease. The article provides an in-depth review of the most current diagnostic biomarkers of prostate cancer, their role in clinical practice as a means of the early detection and screening for prostate cancer.

[Efficacy of tamsulosin for treating lower urinary tract symptoms in patients with advanced prostate cancer]

RELEVANCE

From the moment of their first use to the present day, -adrenoblockers remain the most popular medication in urology. Indications for their clinical use for various pathological conditions are constantly expanding.

AIM

To compare the efficacy of androgen deprivation therapy (ADT) alone and ADT with concomitant use of tamsulosin in treating lower urinary tract symptoms (LUTS), and to estimate the efficacy and safety of tamsulosin in relieving voiding dysfunction symptoms in patients with advanced PCa treated for 6 months.

MATERIALS AND METHODS

This paper presents data from a randomized, open, single-center trial that evaluated the efficacy and safety of tamsulosin co-administered with ADT for LUTS in patients with advanced prostate cancer. The study comprised 50 people aged below 75 years. In the first group of patients (n=25), ADT was used as a monotherapy, in the second group (n=25) ADT with concurrent administration of the -adrenoblocker. The duration of treatment was 6 months.

RESULTS

Both groups showed an improvement in the severity of LUTS, decrease in the total I-PSS score and residual urine volume and increase in the urinary flow rate. At the same time, co-administration of ADT and -adrenoblocker resulted in greater and faster relief of LUTS than using ADT alone. There were no significant side effects in any of the groups.

CONCLUSIONS

Co-administration of ADT and the -blocker is an effective and safe treatment for advanced prostate cancer in patients with LUTS.

[Conservative management of benign prostatic hyperplasia: are urologists satisfied?]

The author presents his point of view on the conservative management of benign prostatic hyperplasia and the role of combination therapy (co-administration of -blockers and 5-reductase inhibitors) in the treatment of voiding symptoms. The latest evidence for combination therapy of prostatic hyperplasia published in 2017 is also presented.

[Results of urethral reconstruction in adults after multiple hypospadias repairs]

AIM

To improve treatment results in patients after multiple hypospadias repairs by optimizing the postoperative management.

MATERIALS AND METHODS

Eighty-two patients (mean age 48.1+/-15.3 years) with urethral strictures secondary to failed hypospadias repairs underwent staged graft urethroplasty using oral mucosa (cheek, lip, tongue) as a grafting material. In 62 patients, at the end of surgery the bladder was drained with a standard Foley catheter. In twenty patients the bladder was drained with a modified silicone urethral catheter, which had an additional channel for delivering drugs and removing the urethral wound effluent, and a second additional channel for inflating a balloon fixed to the catheter tube at different parts of the catheter.

RESULTS

The mean length of the stricture was 5.4+/-1.2 cm (from 1 to 16 cm). Twenty-eight patients had postoperative complications. Using the modified catheter resulted in statistically significantly (p<0.05) smaller percentage of complications (10% vs 41.9%) compared to standard Foley catheter. Urinalysis and sperm test on the follow up examination at 12 months showed that only 9 (10.9%) patients had signs of the inflammatory process. Seventy-five patients (91.5%) rated the appearance of the penis as "good"; only 5 (6.1%) and 2 (2.4%) patients considered the result as "satisfactory" and "unsatisfactory", respectively. Eighty patient (97.6%) regarded the treatment result as "good" for the quality of urination and only two (2.4%) considered it "satisfactory". When assessing the strength of urinary stream, 64 (78.1%), 13 (15.8%) and 5 (6.1%) patients rated it as "good", "satisfactory", and "unsatisfactory", respectively.

CONCLUSION

The study findings shows that staged urethroplasty using the oral mucosa restores the urethral patency, reduces the severity of the inflammatory process, thus improving the quality of life of patients after failed hypospadias repair. The proposed modification of the catheter ensures the timely delivery of drugs to the surgical site, evacuation the wound effluent from the urethra and helps prevent strictures by periodically inflating the adjustable balloon-dilator.

[GSTP1, APC and RASSF1 gene methylation in prostate cancer samples: comparative analysis of MS-HRM method and Infinium HumanMethylation450 BeadChip beadchiparray diagnostic value]

There is a clear need in molecular markers for prostate cancer (PC) risk stratification. Alteration of DNA methylation is one of processes that occur during ÐÑ progression. Methylation-sensitive PCR with high resolution melting curve analysis (MS-HRM) can be used for gene methylation analysis in routine laboratory practice. This method requires very small amounts of DNA for analysis. Numerous results have been accumulated on DNA methylation in PC samples analyzed by the Infinium HumanMethylation450 BeadChip (HM450). However, the consistency of MS-HRM results with chip hybridization results has not been examined yet. The aim of this study was to assess the consistency of results of GSTP1, APC and RASSF1 gene methylation analysis in ÐÑ biopsy samples obtained by MS-HRM and chip hybridization. The methylation levels of each gene determined by MS-HRM were statistically different in the group of PC tissue samples and the samples without signs of tumor growth. Chip hybridization data analysis confirmed the results obtained with the MS-HRM. Differences in methylation levels between tumor tissue and histologically intact tissue of each sample determined by MS-HRM and chip hybridization, were consistent with each other. Thus, we showed that the assessment of GSTP1, APC and RASSF1 gene methylation analysis using MS-HRM is suitable for the design of laboratory assays that will differentiate the PC tissue from the tissue without signs of tumor growth.

[Effectiveness and safety of degarelix in treating hormone-sensitive prostate cancer: review of the recent literature]

Since their first clinical use in 1990 and up to the present time, the luteinizing hormone-releasing hormone (LHRH) analogues have formed the mainstay of androgen deprivation therapy of patients with hormone-sensitive prostate cancer. The transient testosterone surge inherent in this group of hormonal therapy medications might contribute to cardiovascular complications, limiting to some extent their use. Conversely, LHRH antagonists have a minimal adverse effect profile and their use in clinical practice is seen as more promising. The most extensively studied and widely available LHRH antagonist is degarelix. It should be noted that degarelix is currently only available as a depot formulation given as a monthly injection which may be viewed as a disadvantage.

[Alternative approaches to prevention and treatment of postoperative complications by introduction of new models urinary catheter]

RELEVANCE

and goals. The evaluation of the results of the primary introduction into clinical practice of two new models of the urethral catheter. Considering the advisability was evaluated the efficiency of using new models of urinary catheter for the prevention and treatment of postoperative complications after radical prostatectomy, as well as in the treatment of major pathological conditions accompanied by the infectious-inflammatory complications MATERIALS AND METHODS: The study included 25 patients who underwent radical prostatectomy (the first group) or transurethral resection of the bladder / prostate (the second group). After surgery, the bladder was installed specially designed urethral catheter with controlled filling the balloon is located in the area formed by the anastomosis (the first group) and urinary catheter irrigation urethra drugs (the second group). In the control group (n=22) in the bladder has been established a standard two-way silicone Foley urinary catheter.

RESULTS

Hypersensitive of the new model of the urethral catheter none of the patients were observed. The average period when the urinary catheter in the main and control groups, exactly as the incidence of dysuria did not differ. After removal of the urethral catheter in all patients in the study and control groups restored self urination.

CONCLUSIONS

The preliminary data showed a good tolerability the new models of the urethral catheter. Evaluation of the effectiveness of distant occupy additional time and will require inclusion in the study a larger number of patients.

[Contemporary markers and histological features of prostate cancer]

Increasing prostate cancer incidence rates highlight the importance of more timely diagnosis with the ultimate aim of reducing cancer-specific mortality, while maintaining patients quality of life. Until recently, digital rectal examination and prostate-specific antigen have been used for diagnosis of prostate cancer. Recent advances in medical technologies and laboratory testing have led to introducing new cancer markers into clinical practice. The most highly demanded of them are the PCA-3, -2proPSA and Prostate Health Index. Despite the wide range of laboratory tests, a prostate biopsy with a subsequent morphological examination of biopsy tissue specimens remains the only way to definitively diagnose prostate cancer.

[Possibilities of automated image analysis in pathology]

Pathology is one of the most dynamically developed medical specialties. The wide spread of whole-slide imaging systems has leaded to the development of microscopic image analysis software. This review shows the possibilities of these programs and their role in the routine work of a pathologist.

[Primary candidate rna biomarker screening by RNA-seq for prostate cancer diagnostics]

The RNA-seq approach for prostate cancer candidate RNA biomarkers screening in plasma and urine obtained by minimally invasive or noninvasive methods is proved to be feasible. Significant amount of RNA biomarkers associated with prostate cancer according to the literature were found in plasma and urine samples obtained from patients with benign prostatic hyperplasia (BPH). The number of detected markers was shown to vary in accordance with method of library preparation used for transcriptome profiling. The detection of known RNA biomarkers for prostate cancer in urine and plasma samples shows the feasibility of such method for minimally invasive diagnostics. The fact of presence of the same RNA biomarkers in samples from patients with BPH suggests their possible lack of specificity and confirms the need for further research in this area.

[Genome-wide analysis of DNA methylation in prostate cancer using the technology of Infinium HumanMethylation450 BeadChip (HM450)]

Using the technology of DNA chips Infinium HumanMethylation 450 BeadChip it was analyzed quantitative DNA methylation status in 12 paired samples of prostate adenocarcinoma, and morphologically altered tissues. Analysis of differentially methylated regions of the genome showed an association with abnormal status for 21610 and 3852 hypomethylated hyper-methylated CpG sites. Dominance in the cancer genome hypermethylated sites and their predominant localization in the regulatory regions of genes indicate their possible role in the implementation of mechanisms of gene suppression in the pathogenesis of prostate cancer (PCa). For 14 genes studied were characterized array maximum values hypermethylation in promoter region (> 50% CpG sites) in combination with a high level of methylation differences between treatment groups (> 40%). Role of hypermethylation in some of them: AOX1, KLF8, ZNF154, TMEM106A in the pathogenesis of prostate cancer has been showed previously. Hypermethylation of genes ACSS3, TAC1, TUBA4B, ZSCAN12 not previously been shown for prostate cancer, but is characterized by the association with other cancers. In turn, the differences in the levels of methylation in genes GPRASP1, NKX2-6, ARX, CYBA, EPSTI1, RHCG been documented as a result of a number of genome-research oncology, but has not been studied in detail. To assess the diagnostic potential of epigenetic markers of prostate cancer there was carried out unbiased selection of individual CpG sites most reliably discriminate against tumor samples from a group of no tumor samples. In selected diagnostic model based on logistic regression included 9 CpG sites. Validation of the model was carried out on an independent dataset of methylation of 40 paired samples from the prostate cancer project Atlas of Cancer Genome (TCGA) analyzed on the same version of the DNA chip. Summarized rates of diagnostic informativeness of a model (specificity 95%, sensitivity of 97%, the area under the curve of the diagnostic test (ROC) - 0,96), obtained after validation, allow us to consider these CpG Sites as potential markers for molecular diagnosis of prostate cancer.

[Simulation-based robot-assisted surgical training]

Since the first use of robotic surgical system in 2000, the robot-assisted technology has gained wide popularity throughout the world. Robot-assisted surgical training is a complex issue that requires significant efforts from students and teacher. During the last two decades, simulation-based training had received active development due to wide-spread occurrence and popularization of laparoscopic and robot-assisted surgical techniques. We performed a systematic review to identify the currently available simulators for robot-assisted surgery. We searched the Medline and Pubmed, English sources of literature data, using the following key words and phrases: "robotics", "robotic surgery", "computer assisted surgery", "simulation", "computer simulation", "virtual reality", "surgical training", and "surgical education". There were identified 565 publications, which meet the key words and phrases; 19 publications were selected for the final analysis. It was established that simulation-based training is the most promising teaching tool that can be used in the training of the next generation robotic surgeons. Today the use of simulators to train surgeons is validated. Price of devices is an obvious barrier for inclusion in the program for training of robotic surgeons, but the lack of this tool will result in a sharp increase in the duration of specialists training.

[QUALITY OF LIFE IN PATIENTS UNDERGOING PROSTATE CRYOABLATION]

Not long ago, survival rates were the primary outcome measures of surgical management of prostate cancer. Currently, more attention is paid to the quality of life, because even minor changes in the quality of life can lead to serious alterations in the psycho-emotional status and significantly reduce patients' self-esteem. Most experts believe that the quality of life of patients treated for prostate cancer, is mostly affected by urinary incontinence, erectile dysfunction, urethral stricture, and bowel dysfunction. Thanks to advances in the treatment of prostate cancer, the incidence of complications was reduced to a minimum. To some extent, this was due to the use of novel minimally invasive treatment for prostate cancer, such as cryoablation, interstitial brachytherapy and HIFU-therapy. The quality of life in 65 patients undergoing cryoablation of the prostate was evaluated using EORTC QLQ-C30 questionnaire. Analyzing the findings of the survey enabled us to estimate the patients' quality of life, as well as to identify the various components of the postoperative health problems.

[VALUE OF THE -2PROPSA INDEX AND THE PROSTATE HEALTH INDEX IN PATIENTS WITH PROSTATE CANCER: REVIEW OF LITERATURE AND DATA OF RUSSIAN PROSPECTIVE STUDY]

The article presents the analysis of the fundamental studies on the -2proPSA and prostate health index (PHI) and the determination of their field of use in patients with prostate cancer (PCa). The main aspects of use of the new markers studied include improvement of detection of prostate cancer, increase of specificity and reduction of the number of unnecessary biopsies, identification of aggressive forms of prostate cancer, as well as determination of the progression of the disease. The results of numerous studies, as well as preliminary data of Russian study on the assessment of new indicators are promising and today allow to recommend the use of the test to determine the values of the -2proPSA and prostate health index (PHI) in routine urological practice.

[Treatment of prostate cancer using cryoablation: a prospective study]

Currently, the choice of tactics of treatment of the patient with prostate cancer (PCa) requires to take into account the degree of differentiation and stage of tumor, age of the patient and his somatic diseases, the risk of complications, as well as the patient's desire and physician's experience. Due to the progressive development of medical technology, interest in minimally invasive treatments for prostate cancer, such as cryoablation, interstitial brachytherapy and HIFU-therapy, has grown. Cryoablation of the prostate gland is a tissue ablation by local effects of very low temperatures and is minimally invasive, highly effective treatment for prostate cancer that can be used as the primary treatment, and in the case of tumor recurrence after radiotherapy. Focal cryoablation of the prostate allows to selectively destroy the known tumor with preservation of organ function and without reducing the quality of life of the patient. Focal therapy for prostate cancer is an alternative to radical treatment and active surveillance, occupying an intermediate position between them. Due to the lack of long-term results, focal cryoablation is an experimental type of treatment. First cryoablation of the prostate using modern equipment was carried out in Russia in March 2010, at the Department of Urology MSMSU. Since that time, we performed this procedure in 122 patients with prostate cancer; cryoablation was primary treatment in 110 patients and was used as salvage treatment in 12 patients. In most cases, the operation was performed under epidural or spinal anesthesia. According to the protocol, all the patients underwent 2 cycles of freezing and thawing under transrectal ultrasound guidance. A significant improvement of equipment for cryosurgery, the use of cryoneedles with smaller diameter, and the use of temperature sensors and catheters to warm the urethral mucosa have allowed to minimize the number of complications in comparison with other methods of treatment of prostate cancer and achieve a high disease-free survival. Our prospective study was aimed to analyze our own results cryoablation of the prostate gland.

[Benign mimics of prostatic adenocarcinoma]

Prostate cancer occupies 2nd place on the prevalence and 6th place on mortality among all cancers in men. That is not to deny the social importance of prostate cancer, but attention is drawn to significant advantage of newly detected cases above the cancer-specific mortality. "Gold standard" for diagnosis includes morphological study of tissue fragments after transrectal multifocal prostate biopsy. The importance of the differential diagnosis is particularly relevant when analyzing fragments of prostate tissue obtained from biopsies as a false positive result may cause unnecessary and excessive treatment. This article presents the most common benign processes that can simulate various grade adenocarcinoma. Awareness about the presence of such cancer mimics and careful examination of micropreparations in most cases allows to come to the correct conclusion.

[Perineal saturation biopsy of the prostate]

The effectiveness of perineal biopsy for the detection of prostate cancer (PC) using an array for brachytherapy/cryotherapy was evaluated. It is shown that perineal saturation biopsy provides high detection rate of prostate cancer in patients with suspected cancer after negative transrectal biopsies, does not increase the detection of clinically insignificant cancer and incidence of complications, but requires a lot of time and cost.

[Radical retropubic prostatectomy accompanied with inguinal hernioplasty via preperitoneal approach]

Radical prostatectomy is now widely practiced in the treatment of prostatic cancer (PC). If PC patients have inguinal hernia, hernioplasty can be made simultaneously with radical prostatectomy without one more surgical approach. The article presents pathogenetic rationale of hernioplasty from preperitoneal approach and an original technique of the simultaneous operation. Positive experience with 32 radical prostatectomies with hernioplasty is described.

[Interaction of omnic (tamsulozine) and its generic analogues with alpha-adrenoreceptors]

In current practice of pharmacotherapy of prostatic adenoma alpha1-adrenoblockers are first-line drugs the efficacy and safety of which have been proved in many randomized studies. Because of the appearance of a large amount of generic analogues of tamsulozine on the market we studied the ability of tamsulozine analogues to bind with alpha-adrenoreceptors on rat and human prostate affected by adenoma. Significant differences on the receptor level of interaction were found. Omnik, compared to other generic analogues of tamsulozine, has the highest affinity to alpha1-adrenoreceptors.

The epidemiology of bladder cancer in Russia

This study assessed the epidemiology of bladder cancer in Russia. The available publications in Russian were analysed, as well as information from the database of N. N. Blokhin Cancer Research Center, accumulating non-uniform data from different cities and regions of Russia. In 2006 there were 68 129 patients with bladder cancer in Russia, accounting for 2.8% of all cancer cases, with unknown proportions of males and females. In the same year 11 973 new bladder cancer cases were diagnosed, with morphological confirmation in 82.3% of cases. From 1999 to 2004 the incidence of bladder carcinoma increased by 5.3% in males and by 12.5% in females. In 2006 57.4% of patients with newly diagnosed disease were staged as T1 and T2, 26.8% as T3 and 11.4% as T4 bladder cancer cases. The mortality rate of patients with bladder carcinoma increased by 10.9% in males from 1999 to 2004 and did not change in females. In conclusion, over the past 10 years both the prevalence and incidence of bladder carcinoma have increased in Russia. There was a trend towards detecting less advanced cases of the disease, and stages T3 and T4 are diagnosed less frequently today than in 1996. As a result the mortality rate of bladder cancer patients within the first year from diagnosis has decreased, although the overall mortality rate in males has risen.

[Effects of parallel ultrasonic visualization of the prostate in sagittal and cross projections in transrectal biopsy on detectability of prostatic cancer]

The results of 526 transrectal prostatic biopsies are available. Mean age of the patients was 64.6 years, mean level of PSA--10.4 ng/ml, mean size of the prostate--56 cm3. Biopsy was made in visualization of the prostate in the sagittal projection (ultrasound devices Bruel & Kjaer 1846 and Kretz Voluson 730). Application of Bruel & Kjaer Medical 2102 Hawk provides visualization of the prostate during biopsy both in sagittal and cross projection. Double visualization significantly improved detectability of prostatic cancer in patients with PSA 4-10 ng/ml. In biopsy of the top and peripheral zone there was lengthening of prostatic tissue fragments, reduced fragmentation of the columns, less frequent blank shots of the biopsy gun. The data obtained supports the importance of isolated placement and marking of prostatic tissue fragments in biopsy and allow to recommend wide clinical use of ultrasonic facilities with biplanic sensors providing online sagittal and cross visualization of the prostate.

[Complications of transrectal biopsy of the prostate]

The aim of the study was to assess frequency of various complications of transrectal multifocal biopsy of the prostate (TMBP), to specify prophylactic measures against such complications. Primary TMBP under US guidance was made in 612 patients (mean age 65.8 years, mean level of PSA 12.6 ng/ml). TMBP complications include: hematuria (220 patients, 35.9%), hemospermia (166 patients, 27.1%), pain in the perineum and the rectum (189, 30.9%), acute prostatitis (21 patients, 3.4%), acute orchiepididymitis (7 patients, 1.1%), acute urine retention (9 patients, 1.5%), long-term rectal hemorrhage (13 patients, 2.1%), loss of consciousness during the biopsy (7 patients, 1.1%). The analysis of TMBP complications leads to the conclusion that adequate preparation of the patients and accurate conduction of the prostatic biopsy technique under US guidance make this invasive manipulation diagnostically effective and safe.

[An expanded technique of transrectal prostatic biopsy]

To compare diagnostic value of transrectal prostatic biopsy in obtaining samples of tissue from different sites in patients with various levels of prostate-specific antigen (PSA) and prostate size, we made primary transrectal biopsy of the prostate in 486 patients. The patients were divided into 7 groups by the number of punctures at biopsy (from 6 to 18). Among the patients with PSA under 20 ng/ml in the number of tissue biopsy samples 18, a rise in prostatic cancer detection rate (PCDR) was 16.6%. In PSA above 20 ng/ml, a statistically significant maximal rise in PCDR occurred in the increase of biopsy number from 6 to 12 (by 9.3%). The number of local cancer forms in patients with PSA < 20 ng/ml among all the detected cases rose from 70% (biopsy from 6 sites) to 92.3% (biopsy from 18 sites). Among the patients with PSA < 20 ng/ml and the size of the prostate > 50 sm3, a significant rise of PCDR increased from 20 to 33.3% in an increase of the puncture number from 6 to 12. In the group of patients with the same PSA level and prostate > 50 cm3 PCDR improves in biopsy from 14, 16 and 18 sites (from 12.1 to 27.7%, 28.5 to 33.3%, respectively). Standard biopsy is insufficient for adequate PCDR, it is necessary to obtain samples of tissue from a large number of sites with puncture of peripheral zone of the prostate. Transrectal biopsy of the prostate according to the extended method improves PCDR, primarily, in local cancer.

[Screening for prostatic cancer]

The discussion covers different aspects of application of programs of early prostatic cancer diagnosis. Arguments for and against the screening are presented. The existing methods of early prostatic cancer diagnosis are reviewed. How to improve the technique of taking prostatic biopsy is shown.

[Experience in long term use of tamsulosin (Omnik) in patients with chronic prostatitis]

Tamsulosin (omnik), a selective adrenoreceptor blocker-alpha 1A/D, was used in a long-term regimen of chronic prostatitis (CP) treatment conducted in 39 patients. Tamsulosin was given in a standard dose of 0.4 mg once a day for 1 year. The IPSS total scores, quality of life (Qol, Q max) and size of the prostate were assessed. Tamsulosin proved highly effective in symptoms of the lower urinary tracts (SLUT) and CP. In patients with exacerbation of CP and with SLUT combination of tamsulosin with antibacterial, antiinflammatory, immunomodulating and symptomatic therapy raises the treatment efficiency. Tamsulosin monotherapy can be recommended for treatment of micturition disorders in patients with nonaggravated CP.