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Background. Laparoscopic and robot-assisted resection of the posterior kidney tumors can be performed through retroperitoneal and transperitoneal accesses. Supporters of retroperitoneal partial nephrectomy point to better results for neoplasms in this location. However, most surgeons use transperitoneal access.Aim. To perform comparative analysis of the results of laparoscopic and robot-assisted partial resection of anterior and posterior renal neoplasms.Materials and methods. The results of transperitoneal minimally invasive partial nephrectomy in 156 patients (86 (55.1 %) men and 70 (44.9 %) women) were analyzed. Anterior tumors (1st group) were diagnosed in 96 (61.5 %), posterior (2nd group) in 60 (38.5 %) patients. In the 1st group, mean tumor size was 3.4 ± 1.6 cm; in the 2nd group, 3.2 ± 1.4 cm. In the 1st group, laparoscopic partial nephrectomy was performed in 70 (72.9 %), robot-assisted in 26 (27.1 %) patients; in the 2nd group in 40 (66.7 %) and 20 (33.3 %) patients, respectively. Comparative analysis of operating time, warm ischemia time, complications and glomerular filtration rate was performed.Results. No conversions into nephrectomy or open interventions were performed. Time of laparoscopic partial nephrectomy in the 1st group was shorter than in the 2nd: 108.6 min versus 120.5 min (р >0.05). In robot-assisted partial nephrectomy it was 90.5 and 112.6 min (р >0.05), respectively. For laparoscopic partial nephrectomy, mean warm ischemia time in the 1st group was 15.0 min, in the 2nd group it was 17.5 min (р >0.05); in robot-assisted operation it was 13.2 and 16.0 min (р >0.05), respectively. Blood loss volume was lower in the 1st group compared to the 2nd: 125 ml versus 230 ml (р 0.05). Postoperative complications in transperitoneal resection of anterior tumors were observed less frequently: 16.7 % versus 20.0 % (р >0.05). Grade I complications per the Clavien classification in the 1st and 2nd group were observed in 8 (8.3 %) and 6 (10.0 %) patients, grade II in 6 (6.3 %) and 5 (8.3 %) patients, grade III in 2 (2.1 %) and 1 (1.7 %) patients. After resection, urinary leakage through the drain was observed in 2 (2.1 %) patients of the 1st group and 1 (1.7 %) patient of the 2nd group; they underwent drainage of the upper urinary tract using a stent. Blood transfusion in the postoperative period was performed in 2 patients from each group (2.1 and 3.3 %, respectively). In the 1st group, glomerular filtration rate before and after surgery was 68 and 56 ml/min/1.73 m2, in the 2nd group 70.2 and 58.2 ml/min/1.73 m2, respectively; no significant difference was observed (р >0.05).Conclusion. Transperitoneal access allows to safely perform minimally invasive resection of the anterior and posterior kidney tumors with results comparable to the perioperative results of retroperitoneal partial nephrectomy.

Introduction In patients with long ureteral strictures, bowel substitution of the ureter or kidney autotransplantation can be performed, which are technically demanding. For recurrent uretero-pelvic junction obstruction (UPJO) and proximal ureteral strictures, substitution of the ureter using buccal graft may be an alternative. Aim to study the results of laparoscopic ureteral substitution in patients with long proximal ureteral strictures using buccal graft. Material and methods Laparoscopic ureteral substitution of the ureter using buccal graft was performed in 10 patients with long proximal ureteral strictures, 7 of them were men. The average age was 43.5 years. In 6 patients there was a recurrence after previous pyeloplasty, while 3 patients had ureteroscopy due to upper ureteral stone and one patient had ureteral trauma during laparoscopic excision of the kidney cyst. Three patients were admitted to the hospital with nephrostomy tube, seven with a ureteral stent. Using a laparoscopic approach, an affected part of the ureter was dissected along its length, then a stent was placed antegrade and the ureter was substituted with buccal graft using the onlay technique. Results All patients underwent laparoscopic intervention. There were no intraoperative complications. The duration of the procedure ranged from 170 to 340 minutes. There were no cases of anastomotic leakage. Fever was observed in one patient without nephrostomy drainage (Clavien grade I). On intravenous pyelography and computed tomography, the neoureter was wide and patent. In patients with PUJO, a severity of dilation of the collecting system was decreased over time. Clinically, all procedures were successful, as patients were free of nephrostomy tube and symptoms of upper urinary tract obstruction. Conclusion Ureteral substitution using buccal graft may be the method of choice in patients with long proximal ureteral strictures. It is relatively easy, since it does not require extensive dissection of the ureter and provides for the possibility of using buccal graft of the desired length.

Aim To present the technical features and results of intestinal and appendicular ureteral replacement. Material and methods From 1998 to 2020, a total of 196 patients aged 18 to 77 years (mean age 49.5 +/- 1.2 years) were undergone to intestinal and appendicular ureteral reconstruction in our clinic. There were 123 women (62.8%). The most frequent indications for surgery were complications of open and endoscopic ureteral procedures, radiation-induced ureteral stricture, and iatrogenic injuries of the ureters during gynecological and surgical interventions (81.6%). In 165 (84.2%) patients, for ureteral replacement the ileal segment was used, while in 4 (2.0%) and 27 (13.8%) cases the colon segment and the appendix were chosen, respectively. Unilateral ileal ureteral replacement was performed in 131 (79.4%) cases, while in 34 (26.6%) patients a bilateral procedure was done. Partial and complete ureteral replacement was performed in 107 (81.7%) and 24 (18.3%) cases, respectively. Laparoscopic intestinal and appendicular ureteral replacement was performed in 44 (22.4%) patients, while two patients were undergone to robot-assisted procedure (1.0%). Results Early postoperative complications were noted in 17 (8.7%) cases. The most severe included acute bowel obstruction, leakage of entero-ureteral anastomoses, necrosis of the ileal graft and bleeding in 10 (5.1%) patients. In all cases, repeat intervention was performed. There were no lethal complications. Late postoperative complications developed in 24 (14.3%) patients. Conclusion Today our clinic has the worlds largest experience in intestinal and appendicular ureteral reconstruction, including original procedures, confirmed by 5 patents for inventions. The minimum number of postoperative complications, the absence of deaths and good long-term results provide the basis for the introduction of ileal and appendicular ureteral replacement into clinical practice.

A description of the successful surgical treatment of a patient with irreversible changes in both ureters and bladder resulting from a severe form of Ormond's disease and interstitial cystitis, resulting in contracted bladder, is presented. For the first time in clinical practice, a one-stage cystectomy, a bilateral ureterectomy with complete replacement of both ureters and the bladder with two isoperistaltic small bowel segment was performed. The postoperative course was uneventful. Follow-up contrast-enhanced computed tomography of the kidneys and newly formed urinary tract revealed good excretory function. The patient was discharged in a satisfactory condition on the 22nd day after the procedure with recommendations for taking 10 g of an aqueous solution of soda daily. At the follow-up after 3 months, she had complaints of slight weakness and voided voluntary up to 8 times a day; clinical and biochemical blood tests were normal. This clinical observation indicates the presence of two different diseases in one patient, namely interstitial cystitis and Ormond's disease. The possibility of one-stage complete replacement of both ureters and the bladder with a good immediate result is shown.

Introduction. Rapidly developing highly specialized medical care and the emergence of new medical technologies determine the trend in surgical, minimally invasive treatment of patients with lower urinary tract symptoms due to prostatic hyperplasia. Drug therapy in elderly patients with somatic diseases poses a problem of poor compliance due to pronounced side effects caused by a drug. In this group of patients, surgical treatment of prostate hyperplasia is the most preferred solution. A doctors task is to choose the optimal method of surgery which will not only provide a long-term clinical effect, but also will minimize the economic costs of both surgical intervention and the postoperative period. The emergence of various types of energies for enucleating the prostate gland in urological practice has become an attractive alternative to transurethral resection of the prostate (TURP). However, when choosing surgical endoscopic intervention, it is important to consider the economic factor, which is considered to be a crucial problem in the medical care in Russia. Modern treatment options can not only prevent serious complications, and additional surgical interventions, but also improve the quality of patients lives. However, the introduction of new technologies is impossible without taking into account data on their cost-effectiveness. Purpose. To compare the results and evaluate cost-effectiveness of two types of BPH endoscopic surgical treatment (bTURP, HOLEP) in elderly patients (60 years old). Materials and methods. The study includes patients who underwent two different methods of endoscopic treatment of HPV (bTURP, HOLEP) from October 2017 to September 2018. The inclusion criteria were the presence of moderate or severe obstructive symptoms of the lower urinary tract, prostate volume 40 cm3, maximum urine flow 15 ml/sec. The exclusion criteria were the presence of cystostomy drainage, oncological process of the urinary system, active inflammatory process of the genitourinary system, previous surgical interventions on the organs of the urinary system, and symptoms of an overactive bladder. In each group of the patients the following indicators were evaluated the international system for the total assessment of prostate diseases (IPSS and QoL), the international index of erectile function, the dynamics of postoperative changes in prostate-specific antigen, the maximum urine flow, the residual volume, safety of the operation, intraoperative and postoperative economic expenses as well as socio-economic consequences. Cost-effectiveness analysis was carried out by calculating the indicators cost-effectiveness, cost-utility, net monetary benefit. 20-year prediction of the results was carried out by building the Markov chain model. Results. 150 patients operated within a year were examined. HOLEP has showed its clinical efficacy before bTURP in terms of the duration of surgery, the volume of tissue removed, the time of postoperative catheterization and the length of hospital stay which was significantly lower in the HOLEP group. However, the economic expenses associated with HOLEP were also higher compared to the bTURP group. Conclusions. Holmium laser enucleation is the preferred method for surgical treatment of prostatic hyperplasia in the prostate of more than 40 cm3, from the point of view of surgical safety, effectiveness, and also the length of the patients recovery period in elderly patients. Moreover, laser operations are considered to be economically reasonable in comorbid patients associated with a minimal risk of complications.

Introduction Robot-assisted radical cystectomy (RARC) with intracorporeal neobladder formation is a complex surgical procedure. Aim To describe the main stages of RARC and to analyze its short-term results. Materials and methods RARC with ileocystoplasty was performed in 16 patients, most of whom were men (n=14). In 15 patients, the indication for surgery was bladder cancer (BCa), while one patient has radiation-induced sigmoid fistula with a formation of small, contracted bladder. During radical cystectomy (RC), the lower ureters were dissected, followed by posterior dissection of the bladder with mobilization from both sides to the pelvic fascia, clipping and transection of the vesical pedicles, and suturing of the dorsal venous complex with urethral dissection. After pelvic lymph node dissection, 40 cm of the ileum was resected, after that two distal segments of 15 cm were U-shaped, and a 1.5 cm incision was made in the lower part of the bowel, followed by a formation of the urethral anastomosis. Then bowel segments were detubularized, and continuous suture on the posterior and anterior walls of the neobladder was done. Ureters were implanted in the proximal tubular part of the resected colon according to the Nesbit technique. Results The mean operation time was 380 minutes. The blood loss ranged from 80 to 200 ml; however, blood transfusion was not performed. Complications during 30-days after RARC were observed in 7 (43.7%) patients, including 4 (25%) of class I-II according to Clavien - Dindo, and 3 (18.7%) of class III-IV. In patients with leakage at the uretero- intestinal anastomosis (n=2) and urethro-neobladder anastomosis (n=1), percutaneous drainage was performed, which allowed to resolve these complications. There were no cases of bowel obstruction. One patient with gastrointestinal bleeding required blood transfusion. The 90-day late complications occurred in 6 (37.5%) patients, including 2 cases of upper urinary tract infection. One patient died of acute myocardial infarction. Conclusion RARC is a contemporary minimally invasive method for muscle-invasive BCa. Stepwise approach to RARC with intracorporeal neobladder formation may reduce the operation time and the rate of complications.

Introduction. The pharmacological market, which is rapidly developing, as well as the appearance of combined forms of drugs, determine the trend in the conservative treatment of patients with symptoms of the lower urinary tract due to benign prostatic hyperplasia (BPH). However, simultaneous administration of drugs from several drug groups, by the patients, who are burdened with concomitant diseases (cardiovascular disease, diabetes) in certain cases, makes surgical treatment of BPH preferable and sometimes the only possible option. In this instance, the doctor’s task is to choose the optimal method of surgery that minimizes the risks of complications and provides a long-term clinical effect. The actively developing technique of endoscopic enucleation of prostate corresponds to the current needs. Various types of energies, which have appeared lately in urological practice for enucleation of the prostate, have become an attractive alternative to transurethral resection of the prostate (TURP). The introduction of a bipolar technology into clinical practice has allowed to significantly expand the use of operations among elderly patients with comorbidities. Laser endourology has gone further in reducing the risks of possible complications. Currently we are witnessing a lack of research, which compares the use of modern methods with bipolar TURP (B-TURP) in elderly patients, i.e. groups with a high risk of intraoperative & postoperative complications.Purpose of the study. To compare the results of various types of BPH endoscopic surgical treatment in elderly patients (> 60 years old).Materials and methods. The study included patients who underwent three different operations treating BPH (B-TURP, B-TUEP, HoLEP) from October 2017 to September 2018. The criteria for inclusion in the study were as follows: the presence of moderate or severe obstructive symptoms of the lower urinary tract, prostate volume > 40 cm3, maximum urine flow Results. 190 patients operated during the year were examined in the current study. Duration of operation, extent of resection, time of postoperative catheterization and duration of hospital stay rates were significantly lower in the HoLEP group. There have been no cases of complications above the 3 level by the Clavien‒Dindo scale.Conclusions. HoLEP is the preferred method of surgical treatment of prostatic hyperplasia over 40 cm3 in terms of surgical safety, efficacy, and the duration of the patient’s recovery period. This method can serve as an alternative to electrosurgical techniques in elderly patients.

Background. Radical cystectomy uses laparoscopic and robotic approaches along with the open ones.Objective: to study immediate results of robot-assisted radical cystectomy with intracorporeal orthotopic cystoplasty.Materials and methods. Robot-assisted radical cystectomy with intracorporeal orthotopic cystoplasty was performed in 15 patients (13 male, 2 female), aged 64–76 years. Fourteen patients had bladder cancer, 1 female – a postradiation bladder fistula and microcystis. T2 stage was detected in 8 (57.1 %) patients, T3 – in 6 (42.9 %). After the operation we evaluated operation time, blood loss volume, hospital stay, functional and oncological results.Results. Average operation time was 380 (320–560) minutes, blood loss volume – 80–200 ml, blood transfusion was not performed. Early complications (up to 30 days) were observed in 7 patients (46.7 %), late ones (90‑days) – in 6 (40.0 %). There were no cases of intestinal obstruction. Patients with ureteral-intestinal (n = 2) and reservoir-urethral (n = 1) anastomosis failure underwent percutaneous renal drainage. One patient died of acute myocardial infarction. Daytime continence was 80.0 %, nocturnal – 53.3 %. One patient died of disease progression within 7.6 observation months.Conclusion. Robot-assisted radical cystectomy with intracorporeal urine diversion is a modern and minimally invasive method for patients with muscle-invasive bladder cancer. More experience in this field will allow to reduce surgery time and number of complications.

Background. Kidney damage caused by long warm ischemic time is one of the most important factors affecting kidney function. Compression of only the segmental artery leading to the tumor is an alternative to total ischemia. Оbjective: to evaluate the effectiveness of laparoscopic partial nephrectomy (LPN) with selective kidney ischemia. Materials and methods. The results of laparoscopic partial nephrectomy in 68 patients with Т1а (n = 60) and Т1b (n = 8) disease stages and a healthy contralateral kidney were analyzed. Patients with tumors of the solitary kidney weren’t included. The study included 38 (55.9 %) men and 30 (44.1 %) women. Mean age was 58.4 ± 7.8 years. In 36 (52.9 %) patients LPN was performed with compression of the main renal artery (1st group), in 32 (47.1 %) patients the segmental artery was clipped (2 nd group). Mean tumor size in the 1st group was 3.6 ± 1.5 cm (2.5–5.8 cm), in the 2 nd group – 3.2 ± 1.2 cm (2.3–5.2 cm). Surgery duration, warm ischemia time, blood loss volume, and glomerular filtration rate prior to surgical intervention and after it were studies. Results. All LPNs were concluded with laparoscopic access. There were no conversions to open surgery and nephrectomy. However, in 5 of 32 patients in the 2 nd group, the second branch of the renal artery was compressed due to large blood loss after clipping of one small artery. Surgery duration in the 1 st group was 90.0 ± 18.6 min (65–120 min), in the 2 nd group – 100.0 ± 22.0 min (70–135 min) (р >0.05). Warm ischemia time in the 1st group was significantly lower (16.0 ± 4.2 min versus 22.0 ± 4.6 min). Blood loss volume in the 1st group was 160.0 ± 80.6 ml, in the 2 nd group – 240 ± 160 ml. Glomerular filtration rate before the surgery was 42.4 ± 4.2 ml/min in the 1st group and 42.6 ± 4.2 ml/min in the 2 nd group; 3 months after the surgical intervention, it was 30.6 ± 3.4 and 35.8 ± 3.6 ml/min, respectively (р

In case of stricture of the lower third of ureter in patients with duplex kidney, ureteroneocystostomy or transureteroureterostomy can be used. Anastomosis of the injured ureter of the upper pole with the pelvis of the lower pole is considered nontypical. In this clinical observation, a 46-year-old patient with iatrogenic trauma of the pelvic part of the upper pole of a duplex kidney successfully undergone laparoscopic ureteropyelostomy. There were no complications; the stent was removed after 4 weeks. During the follow-up examination, the function of both kidneys was within normal range and there were no disturbances in the urine passage in the upper urinary tract. Thus, laparoscopic ureteropyelostomy provided an adequate urine passage from the duplex system kidney through the healthy ureter.

Aim To analyze the results of laparoscopic adrenalectomy (LAE) in patients with adrenal gland tumors. Materials and methods From 2011 to 2016, 24 patients (15 men, 9 women), mean age 49.6 +/- 8.2 years, underwent LAE. The right, left and bilateral LAE was performed in 12, 10 and 2 patients, respectively. Indications for surgery were mainly primary and metastatic adrenal tumors. The operations were performed using a transperitoneal 4-port approach. Results Twenty six LAE were successfully performed in 24 patients. There were no conversions. Blood transfusion was used only in 1 patient, who had a history of the laparoscopic left nephrectomy for the renal cell carcinoma 2 years earlier. She had bleeding due to a spleen injury during the left LAE. She also developed acute postoperative pancreatitis, resolved by conservative therapy. The mean intra- and postoperative blood loss was 160 (120-750) ml, the operative time was 135 (100-205) min, and the length of hospital stay was 4 (3-5) days. Histological examination revealed adenocarcinoma and adenoma in 20 (73.1%) and 6 (26.9%) removed adrenal glands, respectively. Conclusion Laparoscopic adrenalectomy is an effective and safe surgical modality to treat patients with adrenal tumors.

The article presents a case of laparoscopic antevasal correction of the retrocaval ureter in a 16 year old patient, who was admitted to the hospital with complaints of aching pain in the right lower back. His history was noteworthy of early age onset of intermittent fever accompanied by abdominal and lumbar pain. Blood count and urinalysis were within normal limits, and he was treated symptomatically. However, no renal ultrasound scan was done. Intravenous urography and MSCT showed a retrocaval ureter. The diagnosis was confirmed by retrograde ureteropyelography. With the patient placed in the lateral position, the right ureter was mobilized by transperitoneal access, transected and mobilized from under the inferior vena cava. Anterior uretero-ureteral anastomosis on the stent was performed, drainage was established. The operating time was 90 minutes, blood loss was 60 ml. There were no postoperative complications. Drainage was removed 2 days after surgery and the patient was discharged for outpatient treatment. The stent was removed 6 weeks postoperatively. Control urography showed normal function of both kidneys, no urodynamic abnormality of the upper urinary tract was identified.

AIM To present the results and technical features of forming the ureterointestinal anastomoses in intestinal ureteral substitution. MATERIAL AND METHODS From 1998 to December 2016, 168 patients (mean age 51 +/- 8.7 years) underwent ureteral substitution using intestinal segments at the Urology Clinic of the I.I. Mechnikov NWSMU. Of them, 76 (45.2%) were males. In 119 (70.8%) patients, intestinal segments were used to replace various parts of the ureters (iliac in 92, colonic in 4, appendix in 23), and in 49 (29.2%) patients ureteroplasty was combined with orthotopic ileocystoplasty. 96 patients underwent isolated ureteral substitution with segments of the small and large bowel. RESULTS Among the 96 patients, early postoperative complications occurred in 8 (8.3%) patients, whereof 5 (5.2%) required reoperations. Among them, 2 (2.1%) had a proximal anastomotic failure. Late postoperative complications occurred in 7 (7.3%) patients whereof 4 (4.2%) required surgical treatment. These patients developed strictures of the proximal ureter-intestinal anastomoses over 3 or more months after the operation. The urinary flow was restored by antegrade dilation. Vesicoureteral reflux occurred in 2 (2.1%) patients. However, it was not clinically evident and was not accompanied by hydroureteronephrosis and recurrent urinary tract infection. CONCLUSION A perfect ureterointestinal anastomoses should be easy to create and have a low risk of stenosis and reflux. These requirements are met by direct anastomosis, which is associated with a minimal risk of stricture, and with isoperistaltic positioning and sufficient length (not less than 15 cm) of the graft provides antireflux protection. It should be noted that proximal (ureterointestinal) anastomoses are vulnerable in these operations and prone to the stricture formation. Unlike proximal, the distal anastomosis of the graft with the bladder is always wider, and therefore the risk of its narrowing is minimal. Isoperistaltic positioning of the graft prevents reflux formation.

Aim To present the results and technical features of different methods of simultaneous ileal ureteral and bladder substitution. Materials and methods From 2001 to 2016, 154 patients (mean age 52+/-9.2 years) underwent ileal and appendicular ureteroplasty. Of them, 70 (45.4%) were men and 84 (54.6%) women. Among them, 49 (31.8%) patients underwent ureteroplasty concurrently with orthotopic ileocystoplasty. The Studers ileal-ureter cystoplasty and Y-shaped bladder and ureteral reconstruction were performed in 38 (77.5%) and 11 (24.5%) cases, respectively. Results Early postoperative complications occurred in 8 (16.3%) patients: 4 of them suffered recurrent bouts of pyelonephritis, 3 experienced an acute adhesive intestinal obstruction, and another one had a failure the right-sided pouch-ureteral anastomosis. Late postoperative complications occurred in 7 (14.3%) patients. Of them, 3 suffered recurrent bouts of chronic pyelonephritis, 2 developed a pouch-ureteral-pelvic reflux, and 2 had strictures of ileoureteral anastomosis, requiring antegrade dilation with ureteral stenting. Conclusion Simultaneous ureteral and bladder substitution is one of the most challenging and traumatic surgical interventions. Sometimes, due to severe comorbidities, disorders of upper tract urodynamics and decreased renal function, two-stage surgery may be necessary. At the first stage, cystectomy with cutaneous ureterostomy should be performed, and then, after the patients stabilization ileal substitution of the bladder and pelvic parts of ureters may be done.

From 2010 to 2016 years we obsreved 8 patients with ureteral avulsion after endoscopic surgeries. All patients were men, their age ranged from 50 to 71 years. In all patients the ureter was damaged during ureteroscopy with lithotripsy and lithoextraction. Of the 8 patients, two had proximal ureteral avulsion between upper and middle thirds, four had ureteral avulsion 4 cm away from the pyeloureteral junction , two had had complete pyeloureteral junction avulsion. In 7 cases trauma of ureter occured at other hospitals. These patients were underwent revision of retroperitoneal space and drain for kidney by nephrostomy (6) and ureterocutaneostomy (1). One case occurred at our department and this patient was underwent laparoscopic nephrectomy with autotransplantation. The patient with ureterocutaneostomy was treated by nephrovesical bypass. In 6 patients with extended ureteral strictures we performed ileoureteroplasty. Results of reconstructive surgeries and nephrovesical bypass were successful in all patients. No intra- and postoperative complications. Mean operative time during uleoureteroplasty was 180 min, laparoscopic nephrectomy with autotransplantation – 210 min, nephrovesical bypass – 110 min. Ureteral avulsion often associated with ureterosopy in patients with large impacted proximal ureteral stones. In most cases after these injuries were diagnosed extended ureteral stricture that requires performing for autotransplantation or ileoureteroplasty.

Objective: to investigate survival in patients with bladder cancer (BC) after radical cystectomy (RCE). Subjects and methods. Our clinic performed RCE using different urine derivations in 375 patients with BC. There were 324 (86.4%) men and 51 (13.6%) women. All the patients underwent clinical, laboratory, ultrasound, X-ray, and radiation studies. Results. The 10-year overall and cancer-specific survival rates were 43.4 and 47.2%, respectively. In patients without regional lymph node (LN) metastases, the 2- and 3-year overall survival rates were 81.2 and 67.2%. In those with regional LN metastases, the 2- and 5-year overall survival rates were 46.9 and 13.9%. In the negative LN group, the 2- and 5-year cancer-specific survival rates were 83.6% and 70.7%, respectively. In the positive LN group, these were 51.0 and 15.1%. The overall and cancer-specific survival rates also declined with higher tumor stage and grade. Conclusion. Tumor stage, regional LN metastases, and histopathological grade have a considerable independent impact on the overall and cancer-specific survival rates of patients with BC following RCE.

Introduction Renal hematomas (RH) are a rare complication of retrograde endoscopic lithotripsy (REL). This study aimed to investigate the incidence and causes of RH after REL in patients with ureteral stones of different locations. Materials and methods From 2001 to 2016, 1214 REL were performed at the Urology Clinic of the Mechnikov NWSMU. The analyzes of patients who had RH after REL included the following parameters: age, gender, history of upper urinary tract (UUT) surgery and concomitant diseases (diabetes mellitus, hypertension), the baseline kidney function, the stone characteristics and the degree of hydronephrosis observed in the postoperative period, results of laboratory tests, ultrasound and spiral computed tomography (SCT) of the kidneys. Results Renal hematomas were diagnosed in 4 (0.3%) of 1214 patients aged 36 to 50 years who had obstructive upper ureteral stones measuring from 0.8 to 1.2 cm in diameter. Three of them previously had UUT surgery: two had REL, and one female patient with a solitary left kidney twice underwent percutaneous nephro- and ureterolithotripsy. All four patients had a triad of symptoms: side flank pain, fever, and anemia. In three patients hematomas were diagnosed on day 2-3 and in one it was found two weeks after the surgery. Two of them were managed with conservative therapy, including bed rest and antibiotics. One patient underwent an ultrasound guided puncture and drainage of the hematoma. In the patient with a solitary kidney, laparoscopic drainage of RH was performed due to growing hematoma and aggravating renal insufficiency. Two patients received blood transfusions. Follow-up kidney SCT showed complete resolution of hematomas in all patients. Conclusion Renal hematomas are a rare but serious complication of REL. The presence of side flank pain, fever and anemia may be indicative of REL and requires a kidney ultrasound. Management of RH should be patient specific, depending on the severity of the patients condition.