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An analysis of domestic and foreign literature on the predictors of prostate cancer recurrence are presented in the article. A deep analysis of both pathological and histological risk factors for progression was provided, as well as of laboratory and clinical predictors.

Introduction surgical treatment of urinary stone disease plays an important role in urological practice. Stone fragmentation can be performed using various lithotripters, from which Holmium fiber laser (Ho: YAG) has currently taken the main place. According to the current literature, a superpulsed thulium fiber laser with a wavelength of 1.94 m and a maximum power output of 40 W showed in vitro higher efficiency compared to Ho: YAG, while having the same safety profile. The use of a thulium fiber laser with a pulse energy of 0.025-6 J and a high repetition rate (up to 1600 Hz) allows to most effectively perform stone dusting during retrograde intrarenal surgery (RIRS). Aim to improve the performance of RIRS using the 1.94m superpulsed thulium fiber laser. Materials and methods a total of 152 patients with renal stones who were treated during the period from February 2018 to July 2019 were included in the study. The analysis of the laser settings, their effect on retropulsion and visibility when performing RIRS using a superpulsed thulium fiber laser with a wavelength of 1.94 m and a maximum power output of 40 W, a peak power of 500 W, as well as an assessment of the stone-free rate the first postoperative day and 3 months after the procedure was done. Results The most frequently used settings were as following: 0.5 J, 30 Hz, 15 W (No. 1), 0.15 J, 200 Hz, 30 W (No. 2), 0.8 J, 31.25 Hz, 25 W (No. 3), 0.8 J, 37.5 Hz, 30 W (No. 4). The statistical analysis of the influence of the settings on the quality of endoscopic imaging and retropulsion was carried out. In addition, the features of each settings were analyzed. The stone-free rate on the first postoperative day was evaluated using low-dose CT. Conclusion A superpulsed thulium fiber laser with a wavelength of 1.94 m and a maximum power of 500 W has shown high efficiency in clinical practice when performing RIRS, since it allows to have good endoscopic imaging, minimal retropulsion, and to perform stone dusting, which had a positive effect on the stone-free rate. Optimization of the settings of thulium fiber lithotripsy may improve the results of surgical treatment of urinary stone disease.

Introduction. Urethral transposition remains the most popular operation for postcoital cystitis, however, traumatism and complications, especially such as pudendal neuropathies, dyspareunia and anorgasmia, make us continue to search for effective, but safer techniques.The study objective is to evaluate the efficacy and safety of the proposed treatment of postcoital cystitis, including removal of urethrogymenal adhesions and subsequent paraurethral filler implantation, in comparison with isolated hymenoplasty.Materials and methods. Since 2013, 75 patients with postcoital cystitis have been treated. Patients were divided into two groups: main group – hymenoplasty (removal of urethral adhesions) with paraurethral filler implantation (n = 45), control group – hymenoplasty (n = 30). The gel was injected paraurethrically, fan-shaped, in the volume of 1–2 ml, from a point on the 6-hour conditional dial, creating a gel cushion and thus raising the meautus and distal urethra. To assess the quality of treatment, profile questionnaires were used.Results. In the main group of patient, the quality of life improved in 35 (78 %); in 5 patients, due to the process of biodegradation of the gel during 1 year, the cystitis recidivated, which required the filler reimplantation. In 5 patients, the operation was not effective. In the control group the efficiency of isolated hymenoplasty was noted in 3 (10 %) patients, relapse of cystitis occurred in 27 (90 %) patients, which later required the implantation of a filler. No complications were observed.Conclusions. The suggested combined technique allows to improve the results of treatment of patients with postcoital cystitis. The operation does not carry the risk of damage to the sprigs of the genital nerve, can serve as an alternative to traditional urethral transposition. The main disadvantage is the natural biodegradation of the gel, which may create the need for its reintroduction.

In surgical treatment of non-muscle-invasive bladder cancer (BC) the en bloc resection technique – removal of tumour in a single piece with the subjacent muscle (detrusor) – is becoming more widely used. The objective of this review was to assess the oncological efficacy (relapse incidence) and safety (of peri- and post-operative complications) of this technique for various tumour sizes. This systematic review was written in accordance with the PRISMA criteria. The relevant literature published over the past 20 years was chosen in two databases (Medline and Scopus) with the use of the search query “en bloc” and “bladder cancer”. We selected publications that assessed the efficacy and safety of en bloc resection of the bladder wall with non-muscle-invasive tumour, and also publications comparing the efficacy of en bloc резекции resection with that of transurethral resection (TUR) of the bladder. Based on analysis of 18 studies (1592 patients after en bloc resection), the following conclusions were made: the incidence of BC relapses after en bloc resection of the bladder wall (with non-muscle-invasive tumour) is significantly lower than after conventional TUR of the bladder; a practically 100-percent presence of muscle fibers is found in the histological tumour specimen; the frequency of peri- and post-operative complications in en bloc resection is significantly lower as compared with classical TUR; the choice of a power source does not influence the oncological outcomes, but laser en bloc resection is safer than electrical; extraction of tumours with sizes up to 2-3 cm is possible in one piece; tumours of larger diameters should be preliminary fragmented in the bladder cavity; comparison of tumours of various diameters did not reveal any statistical differences between the oncological outcomes of patients. The technique of en bloc resection of the bladder wall with non-muscle-invasive tumour is effective and safe for removal of smaller tumours (~ to 2 cm); as some authors point out, it is also effective in larger tumours but there are no literature evidence sufficient for such an. Key words: systematic review, en bloc resection, non-muscle-invasive bladder cancer

The COVID-19 pandemic had an unprecedented effect on health systems around the world. The current situation has left its mark on all medical organisations. The principles of management of patients with various diseases have changed, and patients of urological clinics have not become an exclusion. On the whole, specialist recommend to postpone any interventions as late as possible, except for life-threatening situations that require urgent medical care In all other cases, remote consultation and treatment of patients are proposed. We prepared a review of the recommendations of the European Association of Urology (EAU) on treatment, diagnosis and follow-up of such patients during the COVID-19 pandemic.

An analysis of national and foreign literature dedicated to recurrence of prostate cancer, is presented in the article. The diagnostic utility of positronic emission tomography, fused with computer tomography and magnetic resonance tomography in case of biochemical recurrences of prostate cancer is discussed.

Multidisciplinary studies in urology is becoming a new global trend which is associated with an emerging of omix technology, big data, the development of IT and other technologies. The concept of "multidisciplinary approach" as well as a brief historical analysis of the development of urologic science are discussed in the article, based on the international Scopus database. An example of a multidisciplinary approach implemented in the Science and Technology Park for Biomedicine of Sechenov University is given. The stages of the creation and implantation of the tissue-engineering urethral wall are described. For the successful development of urologic researches, the active involvement of specialists from various fields of knowledge is required. Such a combination of competencies has already allowed to solve problems of an extremely high level of complexity now, and not in the distant future.

Laser technology has taken a place among the methods of treatment of various urological diseases. The new laser devices are being developed in addition to commonly used. Physicists of the russian NTO "IRE Polus" in collaboration with doctors from Sechenov University have developed a new generation laser device - thulium fiber laser. It has been actively used since 2017 for laser enucleation of prostate. Later the laser was used for treatment of bladder tumor, lithotripsy. The device has already managed to prove its efficacy in in-vitro experiments and clinical practice surpassing foreign analogues.

The article presents a rare case of urinary bladder reconstruction using thoracodorsal revascularized autograft in a patient with a bladder injury resulting from a road traffic accident. The area and size of the thoracodorsal flap (2215 cm) were determined using a 500 ml latex model of the bladder. The autograft was revascularized through external iliac vessels. From the thoracodorsal autograft, the dome was formed with the dermal part inward, which was fixed along its circumference to the bladder edges with 3/0 prolene sutures. The muscular part of the thoracodorsal flap was fixed along the perimeter to the remaining aponeurosis and covered by a free expanded cutaneous autograft. The surgery resulted in a newly constructed neobladder of sufficient volume (250-300 ml) with elements of the patients own bladder (posterior wall and neck) while sparing the patient from a cystostomy and improving his quality of life.

Introduction Prostate cancer is one of the most common types of cancer in men. The gold standard for the detection of prostate cancer is ultrasound guided transrectal prostate biopsy. The detectability of cancer using this method is from 30 to 50%. As a result, many men undergo multiple repeat biopsies for suspected prostate cancer. The European Association of Urology does not give any recommendations on this matter. A revolutionary new method in the diagnosis of prostate cancer is a targeted prostate biopsy using a fusion of multiparametric magnetic resonance imaging (MRI) and ultrasound. Materials and methods At the R.M. Fronstein Clinic of Urology, 55 patients with suspected prostate cancer from September 2017 to January 2018 underwent fusion prostate biopsy. Of them, 21 patients had negative primary biopsies. Two patients had verified prostate cancer. 32 patients did not undergo primary biopsies. Results The findings of the study suggest that using MRI-ultrasound fusion for guidance of targeted prostate biopsy improves the quality of the histological material, allows patients to avoid unnecessary biopsy, reduces the number of punctures, thereby offering higher diagnostic performance in detecting prostate cancer. MRI-ultrasound fusion targeted biopsy has a high sensitivity in detecting clinically significant cancer and low for clinically insignificant cancers. Conclusion The technique affords accurate detection of the location and extent of pathological lesions in the prostate thus allowing focal therapy for prostate cancer.

Background. There is a category of patients with renal masses, due to severe concomitant diseases, can not perform the operation or may be associated with a threat to life. In addition, many patients with small tumor sites are extremely concerned about their disease and are negative about the tactics of active observation and insist on treatment. These patients can be offered alternative methods of treatment of renal cell carcinoma (RCC), the leading of which is cryoablation.Objective: to evaluate the effectiveness and safety of percutaneous cryoablation of the kidney tumor under ultrasound control.Materials and methods. In the Urology Clinic of the I.M. Sechenov First Moscow State Medical University during the period from 2015 to 2017 performed 23 percutaneous cryoablation of RCC, 7 (men – 4, women – 3) of which were performed under local anesthesia. In 4 patients due to severe concomitant diseases, general anesthesia was associated with an extremely high risk. Three patients refused from dynamic observation and from traditional surgical treatment; preferred an alternative treatment in the form of a percutaneous cryoablation under local anesthesia. In 4 cases, the formations were located in the lower segment along the posterior surface of the kidney, in 3 – along the lateral surface in the middle segment. The size of the formations was not used 4 cm (T1a). The age of the patients was 62.3 years (51 to 83 years). Right-sided localization of the tumor was noted in 3 patients, left-sided – in 4. One patient had a single kidney.At the preoperative stage and 6 months after the operation, all patients underwent ultrasound with dopplerography, multislice computerized tomography with contrast, and computer 3D modeling, which helped to clearly assess the size of the tumor, clarify the prevalence of the tumor process and the spatial ratio of the internal surface of the tumor node to the elements of the bowl-and-pelvis system. In all the observations, the formations were located along the posterior or lateral surface of the kidney; in the lower or middle segment; without invasion of the sine. We used a 3rd generation cryomash machine SeedNet gold (Galil Medical), cryoprobes IceSeed and IceRod. Intraoperative, immediately before cryoablation, a tumor biopsy was performed, the presence of RCC in all patients was confirmed morphologically.Results. According to the ultrasound examination with echodopplerography at 6 months after the operation, the size of the tumor node’s formations decreased on average by 6–8 mm, while there was no blood flow in them. When multislice computerized tomography with 3D modeling was performed, the formation was reduced and the accumulation of the contrast preparation was completely absent or their accumulation gradient did not exceed 10 HU (initially it was about 200 HU). There were no intraoperative complications. In 1 observation, a postoperative hematoma measuring 7 × 3 cm was resolved conservatively and did not require surgical treatment.Conclusions. Percutaneous cryodestruction under local anesthesia using ultrasound guidance seems to be an effective and safe technique for treating patients with stage T1a RCC with localization in the posterior or lateral surface in the lower or middle segments without invasion of the renal sinus and surrounding tissues. It is planned to continue monitoring patients to assess the long-term effectiveness of cryoablation.

The latest guideline of the European Association of Urology (2016) for the management of lower urinary tract symptoms has a new term – endoscopic enucleation of the prostate. This term was introduced after the publication of latest meta-analyses showing that both laser enucleation and electroenucleation are effective in the treatment of infravesical obstruction caused by benign prostatic hyperplasia (BPH). Objective : to compare the methods of electroenucleation and laser enucleation (holmium and thulium) of the prostate according to the literature data and own observations. Materials and methods . A total of 624 patients with BPH were included in the study; of them, 459 participants underwent holmium laser enucleation (HoLEP), 35 – monopolar enucleation, and 130 – thulium laser enucleation (ThuLEP). All patients were followed up for one month. We assessed the International Prostate Symptom Score (IPSS), patients’ quality of life (QoL), peak flow rate (Qmax), and residual urine volume prior to surgery and 1 month after it. Results . Functional characteristics have significantly improved by one month post surgery in all three groups. Moreover, the data obtained indicate similar efficacy of different endoscopic enucleation methods. None of the tested parameters demonstrated significant difference across the groups (p >0.05) Conclusions. Our results of HoLEP and ThuLEP suggest high efficacy of these surgical techniques and low number of postoperative complications, which correlates with literature data and guidelines of the European Association of Urology. Monopolar enucleation of the prostate is as effective as ThuLEP or HoLEP; however it has higher frequency of postoperative complications.

AIM To determine the place of laparoscopic pyelolithotomy in surgical management of nephrolithiasis. MATERIALS AND METHODS We analyzed 16 laparoscopic pyelolithotomies performed in our clinic over the last few years for large and stag-horn stones of anomalous kidneys (n=8), the "giant" (>30-40 cc) monolithic stones of the large extrarenal pelvis (n=3), multiple stones of PCS with the stone burden of more or equal 40 cm (n=2) and large recurrent (after PCNL) kidney stones in patients at risk of bacteriotoxic complications of percutaneous nephroscopy (n=3). The age of the patients ranged from 39 to 72 years (mean age 51+/-8 years). The average density of stones was 1012 (160-1483) HU. RESULTS There were no conversions to open surgery. The mean operating time of laparoscopic pyelolithotomy was 137 (96-255) minutes, flexible transabdominal pyelocalycoscopy 31.2 (12-110) min. The stone-free rate was 87%. Residual clinically insignificant stones were found in two (13%) patients with staghorn horseshoe kidney calculi and complex PCS. The preoperative hospital stay was 1 day, postoperative-from 2 to 18 (mean 6) days. DISCUSSION We believe that laparoscopic pyelolithotomy supplemented by transabdominal flexible pyelocalycoscopy may be recommended for surgical management of patients with "giant", multiple and infected kidney stones, because the length of their percutaneous removal is beyond the recommended time intervals and it is accompanied by an increased risk of septic complications.

Introduction The estimated recurrence rate of benign prostatic hyperplasia (BPH) after transurethral resection of the prostate is about 5 to 15%. Laser enucleation of the prostate results in a much lower recurrence rate (not exceeding 1-1.5%). At the same time, laser enucleation of the prostate is still not widely used for recurrent prostatic hyperplasia since it believed to be technically difficult in cases. Aim To describe the distinctive features of thulium and holmium laser enucleations of the prostate in the management of recurrent BPH and show that the technical difficulties are not an obstacle to the wide application of this technique. Materials and methods This was a retrospective study comprising 676 patients aged 54 to 87 years with clinically pronounced infravesical obstruction due to prostatic hyperplasia (IPSS>20, Qmax Results The mean ThuLEP operating time was shorter than that of HoLEP (p=0.02). The mean duration of repeat and primary ThuLEP and HoLEP did not differ statistically significantly (p>0.05). There was no difference in the length of hospitalization and catheterization between the four groups (p>0.05). At six months after surgery, a statistically significant improvement in I-PSS, Qmax, QoL, and RUV was observed in all groups compared with preoperative values (p>0.05)). Conclusion We found that the technical difficulties of the re-operation, such as the difficult separation of adenomatous tissue from the prostate capsule, the multinodular nature of the adenoma, increased tissue density are easy to overcome and do not confer a significant complexity. In turn, better completeness of resection, low complication and recurrence rates and the possibility of surgery, even in elderly patients with multiple comorbidities - these features allow us to conclude that laser enucleation of the prostate is not only an effective treatment for infravesical obstruction due to benign prostatic hyperplasia, but is also a method of choice in the treatment of patients with recurrent BPH.

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 first medical application of lasers dates back to the mid-60s of the XX century. Since then, laser systems have undergone significant changes. No longer a science fiction, lasers are used in many medical fields as an indispensable tool in the hands of the modern physician. The article outlines advances in laser techniques (from the idea of laser radiation to the modern laser systems used as effective surgical tools). We also present our experience in using laser surgical techniques in treating patients with prostatic hyperplasia.

Introduction . Currently, benign prostatic hyperplasia (BPH) is diagnosed in 50 % of men aged 50 and older and in 80 % of men aged 80 and older. The most effective treatment method is surgical removal of prostate adenoma. It allows to quickly remove infravesical urinary tract obstruction, but at the same time it increases the risk of erectile dysfunction, one of the most important possible complications. The rate of this complication was significantly decreased by implementation of modern laser technology in urological practice. The study considers the effect of different methods of endoscopic removal of BPH on erectile function (EF): mono- and bipolar transurethral resection (TUR) of the prostate, holmium (HoLEP) and thulium (ThuLEP) laser enucleation, prostate vaporization. Evolution of modern laser technologies and changes in approaches to preservation of EF in treatment of prostate adenoma are presented. The study objective is to discuss possible mechanisms of EF disorders after endoscopic surgeries for BPH removal, as well as to identify which of the mechanisms is the most probable cause of postoperative erectile dysfunction. Conclusion . According to the available data, such methods as bipolar TUR of the prostate, HoLEP, and ThuLEP do not negatively affect erection in any significant way. Moreover, in some cases its recovery is significantly quicker after ThuLEP; therefore, the last method is recommended for patients interested in quick EF recovery.

The paper discusses the present-day idea on a relationship between atrial fibrillation and chronic kidney dis~ase, the specific features of therapeutic policy, and the place of antithrombotic therapy in particular."Based on the results of population-based studies,the authors set forth the specific features of cardiac arrhythmias concurrent with kidney injury, as well as promising directions to optimize management schemes for this category of patients.В статье обсуждаются современные представления о взаимосвязи фибрилляции предсердий и хронической болезни почек, особенности терапевтической тактики, в частности место антитромботической терапии. На основании результатов популяционных исследований излагаются особенности сочетания нарушений ритма сердца с поражением почек, а также перспективные направления оптимизации схем ведения пациентов данной категории.

Introduction This study examined the dynamics of 24-h electrocardiogram (ECG) monitoring parameters (Holter monitoring) in patients with ischemic heart disease (IHD) before and after conservative or surgical treatment of patients with voiding and storage lower urinary tract symptoms (LTS) due to benign prostatic hyperplasia (BPH). Methods A total of eighty-three 57 to 81-year-old (mean age 70.4 ± 5.75 years) patients with LUTS/BPH and accompanying IHD were examined and treated at the Institute of Urology and Human Reproductive Health and Clinic of Cardiology of Sechenov University. All patients received recommended cardiac therapy at least 6 months before inclusion in the study. Results Our study demonstrated that there is correlation between voiding and storage LUTS/BPH and Holter-detected cardiac impairments in patients with IHD/BPH. These data make it possible to consider LUTS/BPH (voiding and storage) as a factor in the additional functional and psychological load on the activity of patients with ischemic heart disease. Improvement of voiding and storage LUTS due to BPH and objective parameters of urination (Qmax) in patients treated with alpha-1 adrenoceptor blocker tamsulosin correlated with improvement of 24-h ECG monitoring parameters (Holter monitoring) in 72% of patients. Improvement of 24-h ECG monitoring parameters (Holter monitoring) 1 month after transurethral resection of the prostate (TURP) in IHD/BPH patients and indications for surgical treatment was observed in 65.7%. Negative dynamics of the Holter-based ECG was not registered in patients who were operated on. Conclusion Holter monitoring helps to identify groups of patients in whom urinary impairments caused by prostatic hyperplasia negatively affect the course of IHD. Restored urination (either conservatively or operatively) in patients with BPH in 72% of cases decreased the number of fits of angina, thus influencing favourably the course of IHD. Trial Registration ClinicalTrials.gov Identifier: NCT03856242.

Aim. To evaluate the 5-year results of renal denervation (RDN) in patients with resistant arterial hypertension (AH). Materials and methods. The study included 14 patients to whom, during the 2011-2013 period RDN has been completed. Before and after the intervention, office blood pressure, quality of life indicators according to the EQ-5D questionnaire, mass index bodies, indicators of kidney function were duly assessed. Results. Five years after RDN, office BP decreased from 165/110 to 139/95 mm Hg. Art. (p

Introduction: Instrumental methods of examination may alter the course of treatment and patients' management: from minimally invasive nephron-sparing procedures to radical operations. Objective:to present preliminary data on split kidney function assessment (in a kidney volume, e.g. segment) in patients with urological diseases. Materials and methods: A prospective study was launched in aResearch Institute for Uronephrology and Reproductive Health from November, 2015 to February, 2017. 31 patients were enrolled into the study: 15 with stone kidney disease, 2 with kidney anomalies, 14 with renal tumors. Contrast-enhanced CT with 3D-models and mathematical analysis were performed in all patients. Correlation between CT-based and renal scintigraphy-based measures of split renal function was estimated. Results: CT-based methods for the calculation of split renal function with 3D-models showed correlation with renal scintigraphy (p

To compare electro- and laser enucleation (thulium, holmium) of prostate hyperplasia.693 prostate hyperplasia patients were enrolled. 489 patients underwent holmium enucleation (HoLEP), 51 - monopolar enucleation, 153 - thulium enucleation (ThuLEP). Prostate volume was 91.7 (50-250) cmMean time of HoLEP was 97.0±42.2 min, monopolar enucleation - 112.9±36.3 min, ThuLEP duration was significantly less (77.4±36.3 min, p0.01). An efficacy of all methods was confirmed in 6 months after surgery by significant (p0.01) improvement of functional parameters (I-PSS, QoL, Qmax, residual urine volume).High efficiency of thulium and holmium enucleation allows to consider them as 'gold standard' of prostate hyperplasia management. Despite higher incidence of complications an efficacy of monopolar enucleation is comparable to that in laser techniques.Введение. Эндоскопическая энуклеация простаты - новый термин, введенный для описания методов анатомически правильной трансуретральной энуклеации простаты. К нему относятся лазерные методики энуклеации (гольмиевая и тулиевая), а также методики электроэнуклеации. Цель работы - сравнение методик электро- и лазерной энуклеации (тулиевая, гольмиевая) аденомы простаты. Материал и методы. В исследовании приняли участие 693 пациента с гиперплазией простаты: 489 пациентов перенесли гольмиевую энуклеацию (HoLEP), 51 - монополярную энуклеацию, 153 - тулиевую энуклеацию (ThuLEP). Объем простаты 91,7 (50-250) см

Introduction Surgery remains the gold-standard curative treatment for localized (T1) renal carcinoma. However, recent medical-technological advances have led to the development of new minimally invasive treatment options, one of which is percutaneous cryoablation. Aim To assess the effectiveness and safety of ultrasound-guided percutaneous cryoablation of renal tumors. Materials and methods The study comprised 12 patients aged 52 to 76 years who underwent ultrasound-guided percutaneous cryoablation of renal tumors from 2015 to 2017. In 11 patients, the size of the renal mass was 3.0 cm (T1a), in 1 patient 4.5 cm (T1b). A Doppler ultrasound, contrast-enhanced MSCT and computer 3D modeling were performed in all patients pre-operatively and 6 months after surgery to assess the tumors size and extent and the spatial location of the tumor internal surface to the pelvicalyceal system. In all patients, the tumors were located along the posterior or lateral surface of the kidney, in the lower or middle segment and without sinus invasion. We used a 3rd generation Galil Medicals SeedNet Gold Cryotherapy System and IceSeed and IceRod cryoprobes. Intraoperatively, immediately before cryoablation, the tumor was biopsied. In all patients the diagnosis of renal cell carcinoma was confirmed morphologically. Results Mean duration of cryoablation was 60 minutes. Endotracheal, spinal, local and intravenous anesthesia was used in 1, 6, 5 and 1 patients, respectively. Doppler ultrasound at 6 months after surgery showed that in 11 patients (T1a) the tumor size decreased on average by 8 mm, with no blood flow in the tumors. MSCT with 3D modeling also revealed a decrease in tumor size and total absence of contrast agent accumulation, or accumulation gradient not exceeding 10 HU (initially it was about 200 HU). In the patient with T1b stage renal carcinoma, MSCT showed a decrease in tumor size from 4.5 to 3.7 cm, however, there was a mass up to 1.5 cm with a high gradient of contrast agent accumulation. The patient underwent kidney resection. No intra- and postoperative complications were observed. Conclusion The accumulated experience allows to confirm the effectiveness and safety of ultrasound-guided percutaneous cryoablation and to consider it a method of choice for patients with stage T1a renal carcinoma located along the posterior or lateral surface of the kidney in the lower or middle segment, without sinus invasion.

Chronic renal failure (CRF) is one of the most challenging problems of contemporary medicine. Patients with chronic renal failure usually need renal replacement therapy as either hemodialysis, peritoneal dialysis or a kidney transplant. The latter is the most promising option for end-stage kidney disease. However, the shortage of donor organs, the complexity of their delivery, the difficulty in finding an immunologically compatible donor and the need for lifelong immunosuppression triggered advances in modern tissue engineering. In this field, the primary priority is focused on developing bioengineered scaffolds with subsequent recellularization with autologous cells. Using such constructs would allow for solving both ethical and immunological problems of transplantation. The aim of this pilot study was to develop a new method of renal decellularization using small laboratory animals. Materials and methods The study investigated the morphological structure of the obtained decellularized matrix and quantitatively tested DNA residues in the resulting scaffold. We proposed a new biophysical method for assessing the matrix quality using the EPR spectroscopy and conducted experiments on the matrix recellularization with mesenchymal multipotent stem cells to estimate cytotoxicity, cell viability and metabolic activity. Results The obtained decellularized renal matrix retained the native tissue architecture after a complete removal of the cell material, had no cytotoxic properties and supported cell adhesion and proliferation. Conclusion All the above suggests that the proposed decellularization protocol is a promising method to produce tissue-engineered kidney constructs with possible clinical application in the foreseeable future.

Introduction Tissue engineering has become a new promising strategy for repairing damaged organs of the urinary system, including the bladder. The basic idea of tissue engineering is to integrate cellular technology and advanced bio-compatible materials to replace or repair tissues and organs. Aim of the study is the objective reflection of the current trends and advances in tissue engineering of the bladder using acellular matrix through a systematic search of preclinical and clinical studies of interest. Materials and methods Relevant studies, including those on methods of tissue engineering of urinary bladder, was retrieved from multiple databases, including Scopus, Web of Science, PubMed, Embase. The reference lists of the retrieved review articles were analyzed for the presence of the missing relevant publications. In addition, a manual search for registered clinical trials was conducted in clinicaltrials.gov. Results and discussion Following the above search strategy, a total of 77 eligible studies were selected for further analysis. Studies differed in the types of animal models, supporting structures, cells and growth factors. Among those, studies using cell-free matrix were selected for a more detailed analysis. Conclusion Partial restoration of urothelium layer was observed in most studies where acellular grafts were used for cystoplasty, but no the growth of the muscle layer was observed. This is the main reason why cellular structures are more commonly used in clinical practice.

Small variations of electric impedance (bioimpedance) of human penis were examined in healthy volunteers and in patients with vascular erectile dysfunction (ED). The harmonic analysis revealed rhythmic oscillations of penile bioimpedance at frequencies corresponding to the heart and respiration rates and Mayer wave (0.1 Hz) and to multiple frequencies (harmonics) of the respiratory and cardiac oscillations. In normal penile bioimpedance spectrum, the Mayer and respiratory peaks were several times higher than the first cardiac (pulsatile) harmonic indicating neurogenic origin of rhythmic bioimpedance variations in the whole penis. The most of healthy individuals (78%) demonstrated the cardiac harmonics at the frequency range of 4-7 Hz that violated the monotone decrement of the pulsatile harmonic series suggesting the resonant character of oscillations of the penile arteries at this "near" frequency range. In contrast to stable 1-4 cardiac harmonics, the amplitudes of the near-range resonant harmonics could vary during few minutes suggesting a causal relation of the corresponding bioimpedance oscillations with the varying vascular tone in penile arteries. The most patients (89%) with vascular ED demonstrated not only the first 1-4 monotonically decrementing harmonics and the near-resonant ones, but also the stable cardiac harmonics at the "far" frequency range of 8-14 Hz that also disturbed the monotonic character of the cardiac harmonic series indicating the sclerotic alterations in regional arteries. In ED patients, insignificant decrease of the initial cardiac harmonics C1-C3 in comparison with the norm was accompanied by pronounced and significant decrease of the respiratory R1 and Mayer M1 peaks. The study showed that the far-frequency bioimpedance resonances at the range of 8-14 Hz and dramatic drop of Mayer and respiratory peaks are the diagnostic signs of vascular ED independent on the accompanying hormonal or neurogenic disorders.

The paper discusses the specific features of the current course of acute glomerulonephritis, the spectrum of its etiological factors, and clinical manifestations. The factors influencing the course and outcomes of acute glomerulonephritis, including the risk of its progression to chronic kidney disease, are specially depicted.Обсуждаются особенности современного течения острого гломерулонефрита, спектр его этиологических факторов и клинических проявлений. Специально представлены факторы, влияющие на течение и исходы острого гломерулонефрита, в том числе на риск его трансформации в хроническую болезнь почек.

The paper discusses current approaches to organizing a diagnostic process in health care facilities. It describes approaches to improving patient examinations in multidisciplinary hospitals.Обсуждаются современные подходы к организации диагностического процесса в медицинских организациях. Представлены подходы к совершенствованию организации обследования пациентов в условиях многопрофильных стационарных медицинских организаций.