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The article presents a clinical observation demonstrating the functional results of orthotopic bladder plastic surgery according to Studer after radical cystectomy, which demonstrates the progression of chronic kidney disease (CKD) 2.5 years after surgery. According to the literature, patients who survived the early postoperative period with muscle-invasive bladder cancer and no lymph node involvement have a high probability of relapse-free and cancer-specific life expectancy of more than 15 years, but the probability of developing severe renal failure reaches 20%, which reduces the quality and duration of life of such patients. Progression of CKD in patients after orthotopic bladder plastic surgery according to Studer is possible against the background of high intravesical pressure in the emptying phase. According to clinical guidelines, intermittent autocatheterization is indicated for patients with neurogenic bladder dysfunction such as detrusor hypotension and high intravesical pressure during the voiding phase, minimizing the risk of upper urinary tract damage. Standards for managing patients with an orthotopic bladder do not provide such recommendations. Additional studies are needed to determine the advisability of persistent catheterization of an artificial bladder in the absence of residual urine but high intravesical pressure during urination.

Introduction: Transurethral resection is the main method for diagnosing and staging bladder cancer, which allows to determine treatment tactics. Tumors located in the area of the ureteric orifice is an important clinical problem., Aim: To describe our experience in the treatment of ureteral obliterations after transurethral resection of the bladder tumors., Materials and Methods: From 2021 to 2023 in the CDC "Zdorovie" in Rostov-on-Don, a total of 6 patients underwent endoscopic recanalization of the obliteration of the ureteral orifice after transurethral resection of bladder cancer., Results: The average follow-up period for patients was 6 months. The average duration of the operation was 42 minutes, bladder catheterization 2 days. One of the main criteria for the efficiency of treatment was the absence of upper urinary tract obstruction 3 months after stent removal. In 3 patients, ureteral stents were removed. In two cases, the absence of stricture recurrence was confirmed; in one patient with a stricture of 1 cm in length, a relapse was detected., Discussion: In this article, we describe a technique for endoscopic treatment of iatrogenic obliteration of the ureteral orifice and intramural part of the ureter, in which a combination of antegrade and retrograde access (Rendez-vous) or "cut-to-the-light" technique allows to restore ureteral patency., Conclusions: The endoscopic approach in patients with obliteration of the ureteral orifice after transurethral resection of a bladder tumor is an alternative to open or laparoscopic ureteral reimplantation and provides high efficiency with a low percentage of complications.

Bladder cancer (BC) is a severe, and in some cases disabling disease for which no active detection strategy has been developed. It requires careful differential diagnosis, and is associated with a high risk for recurrence and progression. The choice of optimal treatment of non-muscle-invasive bladder Cancer (NMIBC) can reduce the rate of recurrence and improve oncologic outcomes. The development of the Vesical Imaging Reporting and Data System (VI-RADS) protocol, which has high sensitivity and specificity for assessing the degree of tumor invasion into the detrusor, has been changing the paradigm for primary surgical treatment. The use of new protocol VI-RADS for MRI and intraoperative protocols DEpth of Endoscopic Perforation (DEEP) determine the treatment tactics. Frequency of detrusor presence after en bloc resection is 96-100%. The absence of circulating tumor cells in the peripheral bloodstream during en bloc resection compared to classic transurethral resection (TUR) has been proven. Safety profile and morphologic specimen are better with use of laser energy. Repeat TUR after en bloc resection if there was a negative surgical margin and detrusor was present in the specimen is left to the discretion of the physician. The pathomorphological study after en bloc resection of the bladder allows a more precise staging and may influence on treatment tactics for bladder cancer. En bloc transurethral resection can be recommended as a standard procedure for diagnosis and treatment of NMIBC.

Aim: To evaluate the efficacy and safety of NefroBest-N in patients undergoing to the radical cystectomy with neobladder formation., Materials and Methods: A total of 60 patients with invasive bladder cancer aged 56 to 75 years, treated at A.I. Burnazyan SRC FMBC and at the M.A. Podgorbunsky Kuzbass linical Hospital of Emergency Medical Care in 2022, were included in randomized multicenter parallel group study. All patients underwent radical cystectomy with a formation of Studer neobladder. The main group included those who received the drug NefroBest-N, 1 capsule 2 times a day for 90 days. In the control group, only symptomatic therapy according to current standards was administered. The study consisted of a screening period of up to 4 days (Visit 1) and a period of 90+2 days to evaluate the efficiency of therapy, including 3 visits: day 14 (Visit 2), 30+2 days (Visit 3) and 90+2 days (Visit 4). Laboratory examination and imaging studies included biochemistry panel (urea, creatinine, K, Na, CRP), urinalysis (presence of mucus, leukocytes), urine culture (bacteriuria), physical examination, renal and neobladder ultrasound with determination of postvoid residual volume. In addition, evaluation of the quality of life was also performed., Results: Evaluation of efficacy and safety of NefroBest-N was carried out. Administration of NefroBest-N resulted in a more rapid improvement of urinalysis, including a significant decrease in severity of leukocyturia and amount of mucus. In addition, degree of bacteriuria was reduced according to the urine culture. The quality of life was also improved., Conclusion: NefroBest-N has a favorable efficacy and safety profile. According to our experience, NefroBest-N significantly reduces recovery time and improves the quality of life of patients who have undergone radical cystectomy with a neobladder formation.

Introduction: Robot-assisted radical cystectomy (RARC) with intracorporeal orthotopic neobladder creation is a complex surgical procedure, which is gradually becoming an alternative to open surgery., Aim: To compare the perioperative, functional and oncological outcomes of open radical cystectomy (ORC) and RARC., Materials and Methods: RARC with ileocystoplasty was performed in 25 patients, including 24 men. The average age was 65.5 years. ORC was done in 30 patients (28 men; control group) with the mean age of 67.2 years. In RARC, the ureters were isolated at the level of lower thirds, the bladder was dissected from the rectum on both sides, then the bladder vessels were divided using clips, and the urethra was cut off. After pelvic lymph node dissection, 50 cm of the ileum was resected. Then two distal segments were folded in a U-shape, a 1.5 cm incision was made in the lower part, and an anastomosis with the urethra was carried out. Further, these segments were detubularized and a modified Studer reservoir was created. The ureters were implanted into the tubular part. In ORC, urine diversion was also done using Studer technique. In both groups, the operation time, the volume of blood loss, the number of complications, the duration of hospitalization, the proportion of daytime and nighttime continence were evaluated., Results: The mean time for RARC and ORC was 380 (320-580) and 260 (220-320) min, respectively (p<0.05). In the group of RARC, the volume of blood loss was 85 (50-250) ml and no blood transfusion was performed, while in ORC, the volume of blood loss was 520 (350-1400) ml, an average of 480 (0-840) ml of blood was transfused (p<0.05). After RARC, 30- and 90- complications rate was 32.0% (n=8) and 24.0% (n=6), respectively, compared to 40.0% (n=12) and 30.0% (n=9) in ORC. One patient died due to myocardial infarction during the 90-day follow-up period after RARC (grade V complication according to Clavien). The average number of removed lymph nodes in the RARC group was 15 (10-18). One patient had lymph node metastases. There were no cases of local recurrence. In ORC, the average number of lymph nodes was 16 (11-20), metastases were detected in 2 patients. One of them was subsequently diagnosed with local recurrence. There was no significant difference in the number of lymph nodes removed between two groups. After RARC, 20 (80.0%) patients had complete urinary continence, while 5 patients (20.0%) used 1-2 pads per day. Night continence was preserved in 15 cases (60.0%). After ORC, complete urinary continence was seen in 23 cases (76.7%). Five patients (20.0%) used 1-2 pads per day and two patients (6.7%) used 2-3 pads per day. Night continence after ORC was preserved in 17 cases (56.7%)., Conclusion: RARC is a minimally invasive method of surgical treatment of patients with muscle-invasive bladder cancer. Compared with ORC, a significantly lower rate of complications and blood transfusions is documented, but RARC requires a longer operation time. Both interventions provide the equivalent oncological and functional outcomes, which are in line with published data.

Introduction: Despite considerable progress during last decade, laparoscopic radical cystectomy (LRC) still remains a complex and time-demanding procedure. The number of patients with baseline chronic kidney diseases has gradually increased., Aim: to compare the results of our novel technique of LRC with late dividing of the ureters with conventional procedure., Materials and Methods: A total of 50 patients with bladder cancer, who underwent to LRC in a single clinic between April 2013 and January 2017, were included in the study. A conventional LRC was performed in 25 patients, while in other 25 cases, a novel technique of LRC was used. In all cases, LRC was done with fully intracorporeal urinary diversion. Statistical analysis was performed using the Shapiro-Wilk test for parametric testing. In order to compare two groups, Student t-test was used for independent samples., Results: There were no significant differences between two groups in average length of procedure, blood loss volume and length of hospital stay. Major intraoperative complications (injury of the rectum) occurred in two patients, one in each group. Both cases were successfully managed intraoperatively. In addition, there were two postoperative complications in each group that required repeat intervention. The mean serum creatinine level on the 2nd day after surgery was significantly higher after conventional LRC (171.6 and 147.7 mol/L), while glomerular filtration rate was significantly lower (58 and 72 ml/min/1.73 m2), compared to group of novel technique of LRC with late dividing of the ureters. A total of four patients in group of conventional LRC and two patients in group of novel technique had cancer progression. Two patients (one in each group) died because of cancer progression after 15 and 34 months after surgery. The mean follow-up was 25.6 (12-39) months after LRC with late dividing of the ureters and 33.2 (18-48) months in group of standard LRC., Conclusion: LRC with late dividing of the ureters allow to prevent prolonged contact of hyperosmolar and, in some cases, non-sterile urine with peritoneum and decrease inflammation and risk of postoperative adhesions. Using of novel technique may decrease rate of perioperative nephropathy, which is especially important in patients with decreased renal function (single functioning kidney, hydronephrosis, diabetes, renal failure, adjuvant chemotherapy). However, more procedures and longer follow-up period are necessary in order to evaluate ontological results of the novel technique.

Bladder cancer ranks 7th in the world among all malignant tumors in men and 11th in both sexes. Radical cystectomy is the gold standard of muscle-invasive bladder cancer treatment in most countries of the world. A large number of fundamentally different options for urine derivation is developed. Therefore the choice of the method of urine derivation is one of the most important and difficult in the treatment of such patients. This review covers current international articles on this topic for 2015-2018.

Aim: to carry out a multicenter prospective analysis of the results of the ERAS protocol in patients undergoing radical cystectomy in real-life clinical practice. The aims of the study were to assess the complication and mortality rate after radical cystectomy using the ERAS protocol and to assess how often ERAS protocol was imple- mented., Materials and Methods: a multicenter study was carried out in 4 clinics in Russia. A total of 134 patients who underwent radical cystectomy in 2017 were prospectively analyzed. Open and laparoscopic radical cystectomy was performed in 35 (26.1%) and 99 (73.9%) patients, respectively. Bricker procedure prevailed as a method for urine derivation (91.7%). Complication and mortality rate, and each principle of ERAS protocol was analyzed both in the general sample of patients and separately for open and laparoscopic radical cystectomy., Results: length of hospitalization before the radical cystectomy was 1 (1-2) day. The median duration of surgery was 260 (205-300) minutes, median blood loss was 300 (200-400) ml. The median of the patients time in ICU was 1 (0-2) day. A total of 95 (70%) complications were recorded in the 90-day period after the surgery, including Clavien I-II category in 52 (38.8%) cases and Clavien III-IV in 43 (32%) cases. Of these, gastrointestinal tract complications were predominated. Gastroparesis requiring a nasogastric tube was observed in 16 (11.9%) patients. Ileus developed in 43 (32.1%) cases, and 22 patients (16.4 %) were managed conservatively; however, 21 patients (15.7%) undergone to reoperation. A 90-days mortality reached 5.2% and the main causes included multiple organ failure as a complication of peritonitis, acute heart failure after myocardial infarction and massive bleeding. Re-hospitalization rate was 9.7% (n=13). Length of stay was 12 (9-16) days. According to univariate and multivariate analysis, an absence of antibacterial prophylaxis, a history of coronary heart disease and the patients age more than 75 years were predictors of an increased complication rate. A 30-days mortality rate is 5.2%, and re-hospitalization was required in 9.7% (n=13) cases. An average length of stay was 12 (9-16) days. Frequency of implementation of ERAS protocol in each of the participating clinic varied. Open and laparoscopic radical cystectomy have insignificant differences in some intra- and postoperative parameters, but, in general, both approaches are comparable in terms of complications, mortality, and length of stay., Conclusion: 1. Despite the use of the ERAS protocol, radical cystectomy has a high frequency of complications (up to 70%); most of them are Clavien I-II. A 30-days mortality rate is 5.2%, and re-hospitalization is required in 9.7% cases. 2. Univariate and multivariate analysis showed that an absence of antibacterial prophylaxis, a coronary heart disease and the patients age more than 75 years are predictors of an increased complication rate. 3. Open and laparoscopic radical cystectomy have insignificant differences in some intra- and postoperative parameters, but, in general, both approaches are comparable in terms of complications, mortality, and length of stay. 4. To obtain more convincing data on the ERAS protocol after radical cystectomy, long-term studies are required.

Introduction: The aim of the study is to compare the results and complications of muscle- invasive bladder cancer treatment using endovideo - surgical radical cycstectomy with orthotopic reservoir formation., Materials and Methods: Between 2013 and 2016 years, 49 patients with muscle -invasive bladder cancer underwent endovideo-surgical treatment with orthotopic reservoir formation. 38 patients underwent laparoscopic radical cystectomy with extracorporeal ileal conduit urinary diversioon [ men - 28 (74%), women - 10 (26%)], intracorporeal reservoir were perfomed in 11 cases [men - 8 (73%) and women - 3 (27%)]. The Modified Studer Ileal Neobladder (1st group) was performed in 32 ( 84%) cases, The Hautmann neobladder in 6 (16%) cases. During intracorporeal neobladder formation (2nd group) in all 11 cases Ileal Neobladder was created according to the methods of Karolinska Institutet, ( Sweden)., Results: In the first group 7 (18%) patients had early postoperative complications: in 1 case - Anastomosis failure, 3 patients - Defect of ureteroileal anastomosis and in other 3 cases - Adhesive intestinal obstruction. There was an incidence of late postoperative complications in 6 (15%) cases: 1 patient had exacerbation of chronic pyelonephritis, other 5 patients had stenosis of uretero-ileal anastomosis. Stenosis treatment methods were: in 3 cases - Laser endoureterotomy, and 2 patients underwent Intestinal plastic surgery of the ureter. In the second group 5 (45%) patients had early postoperative complications: in 2 cases - Defect of ureteroileal anastomosis, 2 patients had acute postoperative intestinal obstruction and in 1 case neobladder defect (multiple defects). In this group 4 (36%) patients had late postoperative complications: in 2 cases Stenosis of uretero-ileal anastomosis and other 2 - Active phase of chronic pyelonephritis., Conclusion: Due to medical technologies development and endovideo-surgical equipment improving, it became possible to perform high-technological operations, such as a laparoscopic radical cystectomy with neobladder formation using different parts of intestine. To imptove the results technical difficulties, postoperative complications and durations of operations were appraised, and we reccomend to perform laparoscopic radical cystectomy with extracorporeal neobladder formation.

The main goal of the research was to study echinococcosis liver cyst laparoscopic treatment's effectiveness. The retrospective analysis of liver echinococcosis cyst surgical treatment in the period from 2003 to 2013 years was conducted. 348 patients underwent surgical treatment, among them 283 patients - laparoscopic procedure, 65 - open surgery. Medial age was 42,3±7,9 years. Female - 214, male - 134. 249 patients underwent laparoscopic partial (conservative) cystectomy, 34 - laparoscopic radical cystectomy with liver resection, 3 (1%) - conversion. 47 patients underwent partial (conservative) cystectomy using open approach. 18 - radical cystectomy using either typical or atypical hemihepatectomy. A long term analysis of 226 (79,8%) patients in a period from 6 month to 7 years was conducted. Comparison of the results revealed the advantage of laparoscopic operations. It was manifested in less blood loss, duration of the procedure, pain syndrome, and a smaller number of bed-days. Infections of the residual cavity after open surgery were twice as much comparing to ones after laparoscopic surgery. Complications after open surgery were significantly higher than after laparoscopic procedures due to postoperative wound infections. After open surgery frequency of echinococcosis recurrence was higher than after laparoscopic one (8,5% vs 2,5%) (р<0,05). Nowadays it is possible to say that treatment of choice of noncomplicated liver echinococceal cysts is laparoscopic one. Correctly made laparoscopical procedure has a good long term results, few postoperative compications, less frequent recurrences and the excellent cosmetic effect. From the principles of radical surgical treatment's point of view laparoscopic approach is the same as an open surgery.

Introduction: Radical cystectomy remains the gold-standard treatment for muscle-invasive bladder cancer. To combine the advantages of minimally invasive interventions and the well-established open surgery, we attempted to reproduce as accurately as possible the technique of open radical cystectomy using a laparoscopic procedure., Materials and Methods: The study comprised 35 patients (27 men and 8 women) with invasive bladder cancer who underwent laparoscopic radical cystectomy (LRC) between April 2013 and March 2016. The study included only patients with fully intra-corporal ileum conduits., Results: The operating time averaged 378 min., the mean blood loss was 285 ml, the mean postoperative hospital stay was 12.4 days. Only 20% of patients needed postoperative opioid analgesia. Postoperative complications occurred in 11.4% of patients. The vast majority of them were successfully managed by minimally invasive methods., Conclusion: Laparoscopic radical cystectomy is a safe and effective treatment modality for invasive bladder cancer. However, more patients and a longer observation period are needed to recommend the method as a standard of care.

There are numerous options for forming an orthotopic bladder by the source tissue and the shape of the urinary reservoir. In our practice, we use the technique reported by Karolinska Institute (Sweden). This technique allows us to form a neobladder most resembling the natural urinary bladder in the shape and volume. The article presents a clinical observation describing this technique in a 63 year old patient who was initially diagnosed with bladder cancer pT2N0M0G3 and underwent transurethral resection of the bladder wall with the tumor. Thereafter, the patient underwent laparoscopic cystoprostatvesicleectomy with extended pelvic lymph node dissection and orthotopic ileal bladder substitution. His upper urinary tract on both sides was drained by ureteral stents with external diversion. The eccentric suturing technique makes it possible to form an oval-shaped urinary reservoir that is anatomically and functionally most comparable to a healthy man's bladder.

The article reports a case of a robot-assisted cystprostatectomy in a 36 y.o. patient with a malignant bladder neoplasm (highly differentiated infiltrative urothelial bladder cancer, Gr 2, invading the bladder wall mucosa, the multicentric growth type, with the focal tumor growth in the urethral mucosa and prostate). The ileal neobladder was constructed using intracorporeal access. Operating time was 6 hours, intraoperative blood loss was 150 ml. There was no intra - or postoperative complications. Voiding function was restored at day 10 postoperatively.

Introduction: We conducted a meta-analysis assessing the effect of photodynamic diagnosis (PDD) -guided transurethral resection of the bladder tumor (TURB) on the recurrence-free survival in patients with non-muscle invasive bladder cancer within prospective randomised trials that used 5-aminolevulinic acid as a photosensitizer., Matherial and Methods: Medical literature search was performed up to February 2016. Recurrence hazard ratios (HRs) and its 95% confidence intervals (CI) were calculated for each selected study with direct and indirect methods and the pooled estimates were obtained with random-effects model., Results: Data from 5 prospective randomized trials with inclusion of 1089 patients were selected. Pooled estimate of recurrence HR was 0.71 (95% CI 0.48-1.04, p=0.08) with significant heterogeneity across selected publications: p=0,001; I2=78%. The subgroup analysis substantially reduced the heterogeneity: in subgroup comprising single/two-center studies or with moderate to high risk of bias or with long follow-up there was significant benefit of PDD-assisted TURBT (HR 0.51, 95% CI 0.38-0.69; p<0.0001), while in multicenter studies or those with low risk of bias or short follow-up the effect size was within the statistical error limits (HR 1.04, 95% CI 0.77-1.42, p=0.78)., Conclusions: Statistically significant benefit of PDD-guided TURBT over the white-light TURBT was limited to single/two-center studies or with moderate to high risk of bias or with long follow-up. True meaning of these finding it is not clear due to possibility of alternative explanations of identified differences. Generally there was low quality of evidence from significant proportion of studies and risk of publication bias.

The article introduces a clinical example of a patient who was first diagnosed with bladder cancer, which contributed to the development of end-stage renal failure. Initially, given the significant upper urinary tract retention and post renal acute renal failure, the patient underwent bilateral percutaneous nephrostomy. Taking into account periodic gross hematuria, cystoscopy and transurethral electrocoagulation and biopsy of bladder tumor were performed and bladder cancer was identified. Despite adequate functioning of nephrostome drainage and daily urine output up to 3000 ml, kidney failure was not resolved. After creation of an arteriovenous fistula, a hemodialysis program was launched. The patient continued to experience persistent gross hematuria, he had a hectic fever, which was estimated as a symptom of acute pyelonephritis. The patient was scheduled for bilateral nephroureterectomy, cystoprostatectomy as the only option to remove the source of bleeding and infection. The operation was carried out without complications. The patient is currently maintained on chronic hemodialysis and followed by an oncologist at the place of residence; there are no data of bladder

Radical cystectomy is the standard method for treatment of muscle-invasive and locally advanced bladder cancer. Several less invasive approaches have been suggested recently, including totally laparoscopic radical cystectomy and robotic cystectomy. However despite significant improvements in surgical techniques the overall occurrence of perioperative complications is still high. Analysis of the literature data and comparison of these data with the results of our study was performed with respect to perioperative complications after radical cystectomy and oncological outcomes. In most of the studies, operating time during laparoscopic cystectomy was longer than that of open approach. Despite that, there was no influence of type of surgery on intraoperative complications. Major complication rates were similar between all groups. However laparoscopic cystectomy had lower rate of minor complications compared to open cystectomy. Laparoscopic cystectomy is safe and associated with lower blood loss, decreased postoperative ileus and lower length of stay compared with open radical cystectomy. Laparoscopic surgery for bladder cancer decreased minor complications (mainly due to lower bleeding and gastrointestinal complication rate) and had no impact on major complications. Moreover, if performed following the oncologic principles of open surgery, our results and literature data suggest that LRC is safe and determines non-inferior long-term cancer control compared with open surgery.

Exstrophy of bladder in adults is extremely rare, since such anomalies are usually underwent surgery in early childhood. Difficulties in the treatment of adult patients are associated with severe long-term changes of the mucosa and surrounding tissues, chronic urinary infection, as well as a large diastasis between pubic bones and inefficiency of osteotomy. The article describes the methodology and results of the surgery in a patient 33 years old with exstrophy-epispadias after failed previous interventions. During the follow-up period of more than 5 years, there were no complications related to continent reservoir, reconstruction of the anterior abdominal wall, and urinary infection. Decrease in renal function was not observed. Thus, the cystectomy with formation of continent reservoir from the ileum is accompanied by a good functional and cosmetic results. Resection of vesical plate is justified due to severe long-term changes of the mucosa and the surrounding skin, as well as a high risk of malignancy. The use of polypropylene ? allows to reconstruct the anterior abdominal wall without osteotomy and provides a sufficient degree of its strengthening.

Results of treatment of 204 elderly and senile patients who underwent cystprostatectomy or anterior pelvic exenteration are analyzed. A comparative analysis of two groups of patients whose operation ended with the traditional drainage through the anterior abdominal wall (n = 100), and bilateral perineal drainage (n = 104) is presented. Bilateral perineal drainage after operations on the pelvic organs, accompanied by cystectomy and extended lymphadenectomy in conjunction with the restoration of the peritoneum lateral pelvic walls, improves postoperative recovery of intestinal peristalsis, promotes an earlier reduction in the intensity of pain and morbidity in the early postoperative period. Perineal installation of drains is a simple in design and safe procedure. We recommend bilateral perineal drainage after operations on the pelvic organs, accompanied by cystectomy and extended lymphadenectomy.

This article presents the results of experience of application of a technique fluorescent in situ hybridization (FISH) in early diagnostics of relapses of a superficial bladder cancer in 103 middle-aged, old and senile persons who had transurethral resection of the bladder.

The present study is devoted to improving quality of life of patients in elderly and senile age after operation of Bricker by finding the optimal method of forming ureterointestinal anastomosis. From 2007 to 2009 103 patients of elderly and senile age with diseases requiring removal of the bladder were treated in the Lenigrad Regional Oncology Centre. All the patients were made cystectomy. Patients were divided into two groups: In 1st group, the ureterointestinal anastomosis was formed a classical way "end to side" described Bricker, in the 2nd group ureterointestinal anastomosis was performed by the method of Wallace - "common area". Pathological conditions developed in patients in late postoperative period were as follows: hydronephrosis in early and later stages, obstructive pyelonephritis, frequent attacks of chronic pyelonephritis, chronic renal failure, urinary fistula. Formation of ureterointestinal anastomosis by Wallace during surgery reduces the amount of later postoperative complications. Quality of life was better after the formation of ureterointestinal anastomosis by Wallace.

Contractile activity of the iliac and sigmoid intestines versus detrusor activity, reabsorption and secretory activity of the iliac and sigmoid intestinal mucosa in contact with urine were studied in 30 rats. It was found that isolated segments of the iliac and sigmoid intestines have spontaneous contractile activity (stronger in the iliac intestine) while bladder segment contracted only in response to electric stimulation. A contraction-stimulating effect of acetylcholine and a relaxing effect of noradrenaline in experiments with the iliac intestine were close to their effects on the detrusor. The sigmoid intestine responded weaker to the above mediators. The iliac mucosa actively reabsorbed urinary urea, creatinin, glucose causing elevation of their concentrations in blood as well as K, Na, Ca, CI, P and secreted protein in urine leading to hypoproteinemia. The sigmoid mucosa showed weaker metabolic activity. The results of the study demonstrate importance of consideration of biological properties of different intestinal regions for choice of a cystoplasty method after cystectomy.

A procedure was evolved and tested for forming a urinary bladder from the sigmoid in the course of radical cystectomy carried out for invasive bladder cancer (20). A sigmo-sigmoid anastomosis ("end-to-side") was used by means of an apparatus suture.

Treatment results were analysed for 27 patients (mean age 53 +/- 7 years) after orthotopic urinary diversion (by the method of Studer, Hautmann) following radical cystectomy. Radical cystectomy was performed without nerve preservation in all the patients. Overcontinence was detected in 4 (26.6%) of 15 patients who had undergone urinary diversion by a conventional method. At the average, residual urine was 220 ml. The modified operation for prevention of urine retention was made in 12 subsequent cystectomies. Neobladder topography was studied with MR imaging (MRI) of the pelvic organs and videoroentgenoreservoiroscopy, urodynamic examination was combined with electromyography of the pelvic base muscles. MRI has found that in patients without retention the reservoir was above linea pubbo-coccigeus both at rest and voiding. In patients with overcontinence at rest topographic details by MRI did not differ from those in patients without retention but in stress reservoir changed position. The modification proposed allows one to avoid change in reservoir position and to prevent formation of acute urethra-reservoir angle. Thus, the cause of retention (overcontinence) of the continent orthotopic intestinal neobladder is eliminated.

To improve quality of life in postcystectomy patients, we made 150 radical cystectomies with recovery of urethral voiding. Cystectomy was performed by a modified technique in 87 of 135 operated men: transprostatic cystvesiculectomy (n = 11), transprostatic cystectomy (n = 53), supraprostatic cystectomy (n = 23). Indication for this modification was the absence of extravesicular growth of the primary tumor and prostatic cancer. Monitoring of radicalism was carried out by intraoperative urgent histological investigation of the resection line. 74 patients have undergone retrograde cystectomy. Postoperative lethality was 2.3%. 9 month and longer follow up results were studied.

Problem of decreasing the complications rate of intestinal urine derivation is very relevant. One of the most important problem is the stricture of urointestinal anastomosis. The problem of the choice of antireflux or direct method of ureters implantanion is not solved. Results of forming of 186 renoureteral units (RUU) according to direct method and 70 RUU according to antireflux method were analyzed by the authors. Straight anastomosis was applied according to Wallace 1 and 2 technique, antireflux--according to Abol-Enein technique or by means of transverse duplicating. Age of the patients ranged from 16 to 76 years (56 years on average); men prevailed in groups. Terms of supervision ranged from 6 to 108 months (54.6 months on average). Strictures and failure of ureteroreservoir anastomosis using Wallace method were not revealed (0%), then using antireflux methods (transverse duplicating or extramural Abol-Enein tunnel) the frequency of complication amounted 2.8% on average. Strictures after antireflux mode in case of their early exposure were successfully corrected using endoscopic methods. In other cases open revision of anastomoses with their repeated apply was carried out. Reno-reservoir reflux was not observed in any cases after antireflux methods. Clinical manifestation of reflux was revealed at 2 RUU. Basing on the data renal radionuclide of image renal function didn't significantly change after direct or antireflux methods of ureters implantation. Wallace method is remarkable for its technical usability. This method ensures low level of complications after as incontinent and continent urine derivation.

The efficacy of radiotherapy and chemoradiotherapy for patients with breast cancer and combined treatment for bladder cancer was evaluated by means of as-blood test (Sbl). It points to magnitude of radiation-induced decay of peripheral blood DNA in vitro prior to therapy. Level of DNA decay was evaluated after exposure to 2Gy and 3-hr incubation. The index in excess of 1.0 (in radiation-sensitive patients) was followed by a relapse-free survival 1.5-2 times longer (5-32 months depending on pathology) than in radiation-resistant patients. Also, a relationship was established between Sbl index and leukopenia level, as an indicator of hematoxic effect of radio- and chemotherapy on patients with bladder cancer and Hodgkin's disease. Hence, Sbl may be used to individualize a therapeutic modality including radiotherapy and, if necessary, to provide for use of hemostimulators.

Urinary bladder cancer relapse was evaluated in 116 patients (stage II--68 (58.6%); stage III--48 (41.3%)). Segmented resection and radiotherapy (STD-- 2 Gy; TTD--40 Gy). Early relapse were registered in 64.0 +/- 7.6% and late one--35.9 +/- 7.6% (stage II early relapse--42.6%; stage III--58.3%). They occurred on primary tumor site in 41.3%; other sites--42.26%. Local relapse was reported in 16.3%. Remission lasted in well-differentiated cell tumors longer than in moderately- or poorly-differentiated ones. Incidence of early relapse in cases of low apoptotic index was relatively higher and vice versa.

The findings of evaluation of complex organ-sparing therapy of 153 patients with invasive bladder cancer are discussed. Transurethral resection of the exophytic end of tumor was followed by two courses of polychemotherapy plus combined treatment. Radiotherapy was carried out by conventional fractionation (group I), hyperfractionation (group II) and accelerated hyperfractionation (group III) (total focal dose--up to 60-66 Gy). Overall and corrected 5-year survival rates were: 47.3 +/- 7.5% and 51.7 +/- 7.5% (group I), 65.6 +/- 1% and 70.4 +/- 8.4% (group II), 53.9% +/- 6.8% and 61.9% +/- 6.8% (group III), respectively. Our tentative results suggest that further efforts be made to improve the efficiency of radiotherapy by introduction of novel techniques.

It is suggested that Scr-index for radiation-induced apoptosis in leukocytes in vitro be determined prior to combined therapy of urinary bladder cancer in order to estimate its efficacy. It was identified by studying leukocytes of peripheral blood from patients in whony white blood cells DNA level decreased after exposure to 2 Gy and 3-hr incubation at 37 degrees C. Values over 1.0 predicted relatively longer relapse-free survival. Scr-index of over 1.20 pointed to an insignificant decrease in leukocyte count during therapy. When it ranged 1.00-0.75, leukocyte count fell by approximately 25%; S(cr)-index below 0.55 indicated grade III blood poisoning.

The authors present a retrospective analysis of the results of transurethral conservative and radical operations in 125 patients with invasive cancer of the urinary bladder (UB) treated in the Research Institute of Urology throughout 1992-2002. Transurethral resection (TUR) of the UB was made in 72 patients. Stages pT2a, pT2b, T3 and T4 were diagnosed in 23 (31.9%), 18 (25%), 14 (19.5%) and 17 (23.6%) cases, respectively. 53 patients with advanced invasive UB cancer have undergone radical cystectomy varying by the method of urine derivation. Stages pT2N0M0, pT3aN0M0, pT3bN0M0, pT4aN0M0 and N1-2 were registered in 4 (7.5%), 13 (25%), 21 (40%), 7 (12.5%) and 8 (15%) patients, respectively. UB cancer recurrences after TUR occurred in 12 (16.7%) patients with stage pT2a, in 8 (11.1%) patients with stage pT2b. Three-year overall and recurrence-free survival after TUR at stage T2 reached 97.5 +/- 3.2 and 47.4 +/- 2.8, respectively, at stage T3 and T4--57.1 +/- 4.3 and 26.6 +/- 3.4%, respectively. Postcystectomy distant metastases to the lungs, bones and iliac lymph nodes after treatment were detected in 3, 2 and 3 patients, respectively. One patient had a local pelvic recurrence. For all 53 patients a 2-year corrected survival made up 68 +/- 12.0%. Thus, transurethral electrosurgery is an effective treatment of invasive UB cancer; the only radical surgical treatment for invasive UB cancer is cystectomy.

The results of treatment of 850 patients with urinary bladder cancer (UBC) are analysed. Precise staging of the tumor should be made in the following order: suprapubic ultrasonic investigation (USI), cystoscopy and microcystoscopy, transrectal, transurethral USI. Indications for different treatments are outlined: typical and atypical papillary fibroepithelioma, papillary cancer in stage T1 should be managed with TUR after previous electrocoagulation; cancer in stage T2-3--with urinary bladder resection and uni- or bilateral pelvic lymphadenectomy; total papillomatosis, multiple lesions in stage T3, in cases of recurrent cancer--with cystectomy including one-stage or multistage replacement of the urinary bladder by intestinal transplant. The only physiologically sound method of treating patients after cystectomy with ureterocutaneostomy and ureterocolostomy is creation of intraperitoneal intestinal urinary bladder with reestablishment of transurethral urination. Arguments against creation of artificial urinary bladder made of detubularized segments consist in the absence of advantages.

The paper presents the results of 114 radical cystectomies made in 1996-2002. The age of 114 patients (103 males, 11 females) ranged from 37 to 78 years (mean age 57.5 years). Transient cell carcinoma was diagnosed in 81.5% patients. Supravesical urine derivation was conducted by means of ureterocutaneostomy and transureteroureteronephrostomy in 9 (7.9%) patients, ureterosygmoanastomosis--in 43 (37.7%) patients, artificial orthotopic urinary bladder was created in 7 (6.1%) patients of a gastric segment and in 55 (48.2%) patients of the ileum. Postoperative complications were observed in 28 (24.6%) patients, intestinal obstruction being a prevailing complication. Five patients died: 2 of pulmonary artery thromboembolism, 1 of acute cardiac failure, 1 of sepsis and 1 of gastric bleeding. Continent methods of urine derivation were preferred, such as ureterosygmoanastomosis by Mainz-Pouch II and creation of orthotopic urinary bladder of the stomach or of the ileum.

Macroscopic fluorescence which is induced with aminolevulinic acid (ALA) allows visualizing of small flat tumors, carcinoma in situ, true neoplasm margins and dysplasias of the bladder. Following ALA instillation, cystoscopy was performed under both standard and blue light illumination. In a prospective randomized multicenter study, 102 patients underwent TUR of bladder tumor(s) either with white light or ALA-fluorescence. Significant reduction in the number of residual tumours was detected in 59% (p = 0.005) after 8 weeks, 3 months--in 58% (p = 0.002) and 6 months in 38% (p = 0.01) respectively.

The rates of lower bowel cancer morbidity have risen from 10.1 to 13.5%, while those of urinary bladder--from 7.4 to 8.9%--per 100,000 of population in Omsk Region for the past 6 months. The shares of tumors stage III-IV were 64.3 and 46.1%, respectively. Combined surgery in the organs of the small pelvis was carried out in 275. Since 1997, 32 patients have had the lower part of the bowel and/or urinary bladder removed and an isolated ileocecal angle formed turning towards the small pelvis, as a method of choice for surgical rehabilitation. No early postoperative complications have been reported. At a later stage, 7 patients suffered pyelonephritis and one--stricture of ureteroenteric anastomosis. Our modified procedure of cystoplasty offers optimal means for social rehabilitation of the patient and prevention of reflux-pyelonephritis as well as cutting down the risk of immediate postoperative complications development.

Organ preservation has been investigated inmuscle-invasivebladder cancer over the past years as an alternative to standard radical cystectomy. However, the morbidity of radical cystectomy and early reports of good results of radical transuretheral resection of bladder tumors (TURBT) have stimulated interest in combined treatment for muscle-invasive bladder cancer. Organ preservation requires a trimodal schedule, including transuretheral surgery, mega voltage radical external beam radiotherapy (EBRT) and adjuvant chemotherapy (ACT). Our results point to the effectiveness of combined therapy of urinary bladder in old patients with invasive, advanced cancer (stage T2). These results demonstrate the effectness of intra-arterial ACT when used in combination with EBRT.

A total of 102 radical cystectomies have been conducted for 1996-2001 (94 males, 8 females, age 37-78 years, mean age 57.5 years). Most of the patients (81.4%) were diagnosed to have transitional cell carcinoma. Supravesical urine derivation was made by means of ureterocutaneostomy and transureteroureteronephrostomy in 7(6.9) patients, ureterosigmoanastomosis--in 41(40.2%), Sigma-rectumpouch--in 1(0.9%) patients, ileocystoplasty, largely by Hautmann and Studer was carried out in 52(51%) patients. Postoperative complications developed in 25(24.5%) patients who often had adhesive ileus. Four patients died: 2 of pulmonary artery thromboembolism, 1 of acute cardiac failure and 1 of sepsis. Methods of continence urine derivation were preferred, such as ureterosigmoanastomosis by Mainz-Pouch II and creation of orthotopic bladder of the ileum.

Two operative techniques of urinary reservoir creation are described. The techniques preserves urethral urination and urinary reservoir for supravesical urine passage with establishment of "dry" enterostoma. Ureteral implantation is made with establishment of invagination-valvular ureterocystoanastomosis. The above operations were tried on 13 mongrel dogs. The experiments have shown that urinary reservoir, serous-muscular constrictor, invagination valve of the urinary reservoir and invagination-valvular ureterocystoanastomosis retain their shape, structure and functional capacity in different postoperative terms and can be practiced in inpatients after radical cystectomy for muscular-invasive cancer of the bladder or in urinary bladder diseases urging greater capacity of the bladder.

Ultrasonic transabdominal and transrectal investigations, computed tomography, endoscopic photodynamic studies, polyfocal biopsy of the urinary bladder were used in examination of 1238 patients which were diagnosed to have urinary bladder cancer. 894 patients underwent transurethral resection of the bladder. Morphologically, cancer of the urinary bladder has an inductory effect on intact parts of the bladder mucosa. This means that even most radical resection does not eliminate grounds for a new tumor growth. Radical cystectomy was performed in diffuse papillomatosis, multiple stage T2 tumors of high-grade malignancy, tumors at stage T3, T4, Nx, MO, in rapid recurrent tumors after conservative or operative treatment.

In 1987-1993 surgical treatment for exstrophy of the bladder was performed in 35 children at the age 8 months--3 years. All the patients underwent one-stage transplantation of the ureters into the semi-isolated segment of the sigmoid colon with antireflux protection of the ostia, bladder extirpation and repair of the anterior abdominal wall. The most difficult stage of the intervention is repair of the abdominal wall defect after removal of the large bladder. Related complications arising in 16% of the surgical patients impose the problem of the technique of safe filling of the abdominal wall defect. In 16 patients with large bladder its demucosation was followed by strengthening of the detrusor muscles with the help of interrupted sutures with fixation to underdeveloped oblique abdominal muscles. The skin defects was filled by raised movable skin flaps on both sides of the divided pubis. The above technique reduced the number of postoperative complications three times. Intestinal eventration was not observed. The wound suppuration and partial defect of the sutures occurred in 1 case. The rest 15 children exhibited healing with minimal scarring and good cosmetic effect.

101 patients with cancer of the bladder were operated in the Moscow Cancer Research Center from 1990 to 1995. Cystectomy with varying urinary bypass was made in 49 patients. 52 patients were subjected to bladder resection. The former developed recurrences in 28.9%, the latter in 62% of the patients. Recurrences after the resections were primarily local. 5-year survival of transient-cell bladder carcinoma patients after cystectomy made up 68.2%, after the resection 80.7%. The authors hold that both operations are applicable, but they have specific indications.

Bladder tumors morphological and treatment efficacy data obtained on 246 relevant patients over 60 years of age support the benefit of surgery in combined treatment of bladder cancer in elderly patients in spite of difficulties caused by concomitant diseases and defective adaptation. High-grade poorly differentiated cancer of the bladder causing more frequent recurrences and metastases occur in patients over 60 two times less often than in younger patients. Transurethral electroresection of the bladder with removal of the tumor followed by intravesical immunoprophylaxis of the recurrences is thought a radical treatment for elderly patients with bladder cancer stage T1 and T2. At stage T3 cystectomy is preferable. Positioning of the ureters into the straight ileocecal angle provides the best results in urine derivation after cystectomy. Transurethral electroresection is optimal in the treatment of elderly patients with bladder cancer stage T1-T2 and prostatic adenoma. Indications to transurethral adenomectomy in the presence of bladder cancer must be maximally extended as adenomatous nodes provoke infravesical obstruction and speed up the recurrence of bladder cancer.

The authors present long-term results of surgical treatment with the use of CO2 laser of 104 patients suffering from bladder cancer stage T1-4 of different location. It is shown that high antiblastic effect of laser radiation results in reduced number of cancer recurrences, postoperative complications and lethal outcomes. Laser resection of the bladder wall with the tumor as deep as adventitious layer and paravesical fat ensures preservation of the organ on the one side and efficiency of surgery on the other side. Laser surgery of bladder cancer proved more effective than conventional methods, including transurethral resection.

The authors practiced pubectomy and resection in surgical treatment of bladder cancer located in the cervical region. The experiments on animals started in the 1970s. Clinically, 32 patients were operated. Maximal efficacy of the surgery was demonstrated in omental closing of the file or in use of muscular pedicle graft from the musculus rectus abdominis. The transpubic approach allows radical removal of cancer-affected part of the bladder in intact urination. Persistent orthopedic defects were not registered.

Transurethral resection (TUR) is now widely used in combined treatment of urinary bladder cancer, but the procedure may be compromised if applied without evaluation of infiltration and malignancy degree and metastases responsible for frequent recurrences. The aim of this study was design of effective measures to prevent TUR complications. For 8 years the surgeons from the Moscow Medical Academy urological clinic made 824 TURs for bladder tumors in 322 patients (mean age 57.5 years, 72.6% of males, 27.4% of females). At the stage T3-4 TUR was conducted in contraindications to cystectomy or absence of distant metastases. The following intra- or postoperative complications were observed: hemorrhages (4.6%), intraperitoneal perforations (0.3%), extraperitoneal perforations (0.9%), vesicoureteral reflux (2.8%), enuresis (1.2%). The emergence and severity of the complications were dependent on the bladder tumor stage and degree of infiltration of the muscular layer. Positive TUR results are more feasible in more strict approach to the indications for surgery, adequate surgical skills and technique, high-quality anesthesia, early arrest of hemorrhage, low pressure of the washing liquid in the course of operation.

Modified cystectomy with formation of colonic urine reservoir and dry abdominal urostomy was performed in 12 patients with transitional cell carcinoma of the bladder T1-2NO-1M0. Four patients were previously treated surgically, received drugs or radiation. 8 patients were untreated. Early after surgery 1 patient died of hypostatic bronchopneumonia, 2 patients died 14-17 months after discharge from hospital of cardiovascular disorder, 4 patients were lost for follow-up, the rest 5 patients are alive and socially fit. It is inferred that the above cystectomy is functionally and rehabilitatively appropriate for bladder cancer patients. Modification of some operative stages improves treatment outcomes.

The authors describe the method of operation on cystectomy and plasty of the urinary bladder. Results of operations on 46 patients and the following complications are described.