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BACKGROUND: Neoadjuvant chemotherapy followed by radical cystectomy is the standard treat-dement for cisplatin-eligible patients with muscle-invasive bladder cancer. Adding perioperative immunotherapy may improve outcomes. METHODS: In this phase 3, open-label, randomized trial, we assigned, in a 1:1 ratio, cisplatin eligible patients with muscle-invasive bladder cancer to receive neoadjuvant dur-valumab plus gemcitabine-cisplatin every 3 weeks for four cycles, followed by radical cystectomy and adjuvant durvalumab every 4 weeks for eight cycles (durvalumab group), or to receive neoadjuvant gemcitabine-cisplatin followed by radical cystectonly alone (comparison group). Event-free survival was one of two primary end points. Overall survival was the key secondary end point. RESULTS: In total, 533 patients were assigned to the durvalumab group and 530 to the comparison group. The estimated event-free survival at 24 months was 67.8% (95% confidence interval [CI], 63.6 to 71.7) in the durvalumab group and 59.8°/0 (95°/0 CI, 55.4 to 64.0) in the comparison group (hazard ratio for progression, recurrence, not undergoing radical cystectomy, or death from any cause, 0.68; 95% CI, 0.56 to 0.82; P<0.001 by stratified log-rank test). The estimated overall survival at 24 months was 82.2% (95% CI, 78.7 to 85.2) in the durvalumab group and 75.2°/o (95% CI, 71.3 to 78.8) in the comparison group (hazard ratio for death, 0.75; 95% CI, 0.59 to 0.93; P=0.01 by stratified log-rank test). Treatment-related adverse events of grade 3 or 4 in severity occurred in 40.6% of the patients in the durvalumab group and in 40.9% of those in the comparison group; treatment-related adverse events leading to death occurred in 0.6°/0 in each group. Radical cystectomy was performed in 88.0% of the patients in the durvalumab group and in 83.2% of those in the comparison group. CONCLUSIONS: Perioperative durvalumab plus neoadjuvant chemotherapy led to significant improvements in event-free survival and overall survival as compared with neoadjuvant chemotherapy alone. [ABSTRACT FROM AUTHOR]

Background: First-line pembrolizumab monotherapy is a standard of care for platinum-ineligible patients with advanced urothelial carcinoma (UC). No global standardized definition of platinum ineligibility exists. This study aimed to evaluate the efficacy and safety of pembrolizumab monotherapy in patients with UC who met various criteria for platinum ineligibility., Methods: Patients from KEYNOTE-052 and LEAP-011 deemed potentially platinum ineligible were pooled for this post hoc exploratory analysis as follows: group 1: Eastern Cooperative Oncology Group performance status (ECOG PS) 2; group 2: ECOG PS 2 and age ≥80 years, renal dysfunction, or visceral disease; and group 3: any two other factors regardless of ECOG PS. Patients received pembrolizumab 200 mg intravenously every 3 weeks. End points included objective response rate (ORR), progression-free survival (PFS) per Response Evaluation Criteria in Solid Tumors, version 1.1, by blinded independent central review, overall survival (OS), and safety., Results: A total of 612 patients treated with pembrolizumab from KEYNOTE-052 (n = 370) and LEAP-011 (n = 242) were included; the median (range) follow-up was 56.3 months (51.2-65.3 months) and 12.8 months (0.2-25.1 months), respectively. For group 1, ORR was 26.2%, median PFS was 2.7 months, and median OS was 10.1 months. For group 2, ORR ranged from 23.5% to 33.3%, median PFS ranged from 2.1 to 4.4 months, and median OS ranged from 9.1 to 10.1 months. For group 3, ORR ranged from 25.7% to 27.9%, median PFS ranged from 2.1 to 2.8 months, and median OS ranged from 9.0 to 10.6 months. Treatment-related adverse event rates were consistent across groups., Conclusions: Frontline pembrolizumab has consistent antitumor activity and safety in patients with advanced UC categorized as potentially ineligible for platinum-based chemotherapy, regardless of the variable definitions of platinum ineligibility used., (© 2024 The Author(s). Cancer published by Wiley Periodicals LLC on behalf of American Cancer Society.)

Background: Pembrolizumab plus lenvatinib has shown antitumor activity and acceptable safety in patients with platinum-refractory urothelial carcinoma (UC)., Objective: To evaluate pembrolizumab plus either lenvatinib or placebo as first-line therapy for advanced UC in the phase 3 LEAP-011 study., Design, Setting, and Participants: Patients with advanced UC who were ineligible for cisplatin-based therapy or any platinum-based chemotherapy were enrolled., Intervention: Patients were randomly assigned (1:1) to pembrolizumab 200 mg intravenously every 3 wk plus either lenvatinib 20 mg or placebo orally once daily., Outcome Measurements and Statistical Analysis: Dual primary endpoints were progression-free survival (PFS) and overall survival (OS). An external data monitoring committee (DMC) regularly reviewed safety and efficacy data every 3 mo., Results and Limitations: Between June 25, 2019 and July 21, 2021, 487 patients were allocated to receive lenvatinib plus pembrolizumab (n = 245) or placebo plus pembrolizumab (n = 242). The median time from randomization to the data cutoff date (July 26, 2021) was 12.8 mo (interquartile range, 6.9-19.3). The median PFS was 4.5 mo in the combination arm and 4.0 mo in the pembrolizumab arm (hazard ratio [HR] 0.90 [95% confidence interval {CI} 0.72-1.14]). The median OS was 11.8 mo for the combination arm and 12.9 mo for the pembrolizumab arm (HR 1.14 [95% CI 0.87-1.48]). Grade 3-5 adverse events attributed to trial treatment occurred in 123 of 241 patients (51%) treated with lenvatinib plus pembrolizumab and in 66 of 242 patients (27%) treated with placebo plus pembrolizumab. This trial was terminated earlier than initially planned based on recommendation from the DMC., Conclusions: The benefit-to-risk ratio for first-line lenvatinib plus pembrolizumab was not considered favorable versus pembrolizumab plus placebo as first-line therapy in patients with advanced UC., Patient Summary: Lenvatinib plus pembrolizumab was not more effective than pembrolizumab plus placebo in patients with advanced urothelial carcinoma., (Copyright © 2023 Merck Sharp & Dohme LLC., a subsidiary of Merck & Co., Inc., Rahway, NJ, USA, The Authors. Published by Elsevier B.V. All rights reserved.)

Background: Immunotherapy-based combinations including pembrolizumab plus lenvatinib are the standard of care for patients with first-line clear-cell renal cell carcinoma, but these combinations are not well characterised in non-clear-cell renal cell carcinoma. We aimed to assess the activity and safety of pembrolizumab plus lenvatinib as a first-line treatment for patients with advanced non-clear-cell renal cell carcinoma., Methods: KEYNOTE-B61 is a single-arm, phase 2 trial being conducted at 48 sites (hospitals and cancer centres) in 14 countries (Australia, Canada, France, Hungary, Ireland, Italy, Poland, South Korea, Russia, Spain, Türkiye, Ukraine, the UK, and the USA). Adult patients (aged ≥18 years) with previously untreated stage IV non-clear-cell renal cell carcinoma and a Karnofsky performance status of 70% or higher were eligible for enrolment. All enrolled patients received pembrolizumab 400 mg intravenously every 6 weeks for up to 18 cycles (2 years) plus lenvatinib 20 mg orally once daily or until disease progression, unacceptable toxicity, or withdrawal; lenvatinib could be continued beyond 2 years. The primary endpoint was the proportion of patients with a confirmed objective response as per adjusted Response Evaluation Criteria in Solid Tumours (version 1.1) assessed by independent central review. Activity and safety were analysed in all patients who received at least one dose of study treatment (the as-treated population). This trial is registered with ClinicalTrials.gov (NCT04704219) and is no longer recruiting participants but is ongoing., Findings: Between Feb 23, 2021, and Jan 21, 2022, 215 patients were screened; 158 were enrolled and received treatment. Median age at baseline was 60 years (IQR 52-69), 112 (71%) of 158 patients were male, 46 (29%) were female, 128 (81%) were White, 12 (8%) were Asian, three (2%) were Black or African American, and 15 (9%) were missing data on race. As of data cutoff (Nov 7, 2022), median study follow-up was 14·9 months (IQR 11·1-17·4). 78 of 158 patients had a confirmed objective response (49%; 95% CI 41-57), including nine (6%) patients with a confirmed complete response and 69 (44%) with a confirmed partial response. Grade 3-4 treatment-related adverse events occurred in 81 (51%) of 158 patients, the most common of which were hypertension (37 [23%] of 158), proteinuria (seven [4%]), and stomatitis (six [4%]). Serious treatment-related adverse events occurred in 31 (20%) of 158 patients. Eight (5%) patients died due to adverse events, none of which was considered related to the treatment by the investigators (one each of cardiac failure, peritonitis, pneumonia, sepsis, cerebrovascular accident, suicide, pneumothorax, and pulmonary embolism)., Interpretation: Pembrolizumab plus lenvatinib has durable antitumour activity in patients with previously untreated advanced non-clear-cell renal cell carcinoma, with a safety profile consistent with that of previous studies. Results from KEYNOTE-B61 support the use of pembrolizumab plus lenvatinib as a first-line treatment option for these patients., Funding: Merck Sharp & Dohme (a subsidiary of Merck & Co, NJ, USA), and Eisai., Competing Interests: Declaration of interests LA reports consulting fees (paid to their institution) from Astellas, Bristol Myers Squibb, Ipsen, Janssen, Merck, MSD, Pfizer, Eisai, and Roche; and travel expenses from Bristol Myers Squibb, MSD, and Ipsen. HG has received honoraria from Pfizer and MSD; and participated on advisory boards for Pfizer, Merck Serono, MSD, Ipsen, Bristol Myers Squibb, and Astellas. CS has received research support from Ipsen; honoraria from Bristol Myers Squibb, Pfizer, Roche, Astellas, Ipsen, Sanofi, Bayer, and MSD; and travel support from Bristol Myers Squibb, Pfizer, Roche, Astellas, Ipsen, Sanofi, Bayer, and MSD. MAC has received honoraria from Bristol Myers Squibb, Roche, MSD, Ipsen, EUSA, AstraZeneca, Merck, Pfizer, Astellas, Janssen, and Bayer; and travel support from Astellas, Janssen, Bayer, Roche, MSD, Merck, and Pfizer. DP has received honoraria from Bayer and Merck/Pfizer; travel support from Merck/Pfizer and Janssen, and participated in advisory boards for Merck/Pfizer, Bristol Myers Squibb, and MSD. PB has received research support from MSD, Bristol Myers Squibb, Ipsen, Pfizer, Merck, AstraZeneca, and Janssen; consulting fees from Bristol Myers Squibb, Ipsen, MSD, Merck, Pfizer, Janssen-Cilag, Astellas, Amgen, Gilead, Eisai, and AstraZeneca; honoraria from Bristol Myers Squibb, Ipsen, MSD, Merck, Pfizer, Janssen-Cilag, Astellas, Bayer, Novartis, Eisai, and AstraZeneca; travel support from Bristol Myers Squibb, Ipsen, MSD, Merck, Pfizer, Janssen-Cilag, and Astellas; and participated on a data safety monitoring board or advisory board for Orion. JLL has received research support (paid to their institution) from Pfizer, Ipsen, Bristol Myers Squibb, MSD, Merck, Roche, Genentech, AstraZeneca, Amgen, SeaGen, and GI Innovation; participated on a data safety monitoring board or advisory board for Pfizer Korea, Astellas Korea, Bristol Myers Squibb, Merck, MSD, AstraZeneca, Amgen, and GI Innovation; and has stocks in Amgen, Johnson and Johnson, and Merck. VS has received research support from Merck Sharp & Dohme (a subsidiary of Merck & Co, Rahway, NJ, USA); honoraria from Pfizer Export BV, Stada-Ukraine, Kyiv Vitamin Plant, Astellas Pharma, PrJSC Pharmaceutical firm Darnytsia, and Pharma Personal Group Bionorica. TF has received research support from MSD; and travel support from Bayer and MSD. PW has received consulting fees and honoraria from Astellas Pharma and MSD, Bayer, Janssen Cilag, Ipsen, Pfizer, and Merck; travel support from Pfizer; and has participated on advisory boards for Astellas Pharma, MSD, Bayer, Janssen Cilag, Ipsen, Pfizer, and Merck. EG has received honoraria from Eli Lilly, Roche, Pfizer, Novartis, Janssen Oncology, Astellas Pharma, Amgen, AstraZeneca, Bristol Myers Squibb, Gilead Sciences, Sandoz-Novartis, Abdi Ibrahim, MSD Oncology, and Genekor; travel support from Roche, Pfizer, Novartis, Janssen Oncology, Astellas Pharma, AstraZeneca, Bristol Myers Squibb, Sciences, and Abdi Ibrahim; participated on advisory boards for Eli Lilly, Roche, Pfizer, Novartis, AstraZeneca, Bristol Myers Squibb, Gilead Sciences, Sandoz-Novartis, and MSD Oncology; and owns stock in ImmunoGen and MacroGenics. CG has received consulting fees from Cadex Genomics and BCAL Diagnostics, participated on a data safety monitoring board or advisory board for Alloplex Biotherapeutics, and was a member of a scientific advisory committee for Brain Cancer Biobanking Australia, Cooperative Trials Group for Neuro-Oncology, Australian and New Zealand Urogenital and Prostate Cancer Trials Group, Mark Hughes Foundation, and International Kidney Cancer Coalition. RFP, MS, and XP are employees of Merck & Co (Rahway, NJ, USA). C-HL has received research support (paid to institution) from Merck, Eisai, AstraZeneca, Bristol Myers Squibb, Calithera Biosciences, and Exelixis; consulting fees from Aveo, Bristol Myers Squibb, Exelixis, Eisai, Merck, Pfizer, EMD Serono, and Cardinal; honoraria from AiCME, IDEOlogy Health, Intellisphere, MJH Life Sciences, Medscape, and Research to Practice; and is on the medical steering committee for the Kidney Cancer Association. PT, LL, and VA declare no competing interests., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Purpose of the Study: to study the safety and efficacy of using a new method of performing percutaneous nephrolithotripsy under ultrasound and endovisual control., Materials and Methods: A comparative analysis of the results of percutaneous nephrolithotripsy performed under ultrasound and endovisual control in 515 (84.1%) patients (main group) and percutaneous nephrolithotripsy performed under fluoroscopic control in 97 (15.8%) patients (control group) was carried out. The groups did not differ in age, gender, body mass index, the number and location of stones, and the duration of the disease. In the main group, there were more patients with large, staghorn and X-ray negative stones, and there were also more patients with kidney block. To analyze and stratify the complications of percutaneous nephrolithotripsy, we used a modified classification of surgical complications according to the Clavien-Dindo system. Statistical analysis of the material was carried out using the licensed package IBM SPSS Statistics Version 14.0.1., Results: The average duration and number of stages of operations in the main and control groups was the same. Almost all operations in groups (93,8% 91,8%) were performed in one step (=0,55). In the main group, in the vast majority of cases95,1%; <0,001), percutaneous nephrolithotripsy was performed through one puncture access, with the degree of complete elimination of stones statistically the same as in the control group (80.6% in the main group and 70.1% in the control group, p=0.158). The degree of decrease in hemoglobin in the postoperative period in the groups did not differ (=0,271). The frequency of postoperative complications in both groups did not differ statistically: in the control - 33.0%; in the main group - 29.3% (p=0.469). The severity of complications according to Clavien-Dindo did not differ in the groups either (p=0.17)., Conclusion: Percutaneous nephrolithotripsy under ultrasound and endovisual control is a safe and effective operation. The results of the operation and the frequency of early complications are comparable with the traditional X-ray control technique.

Background: The PI3K/AKT and androgen-receptor pathways are dysregulated in metastatic castration-resistant prostate cancers (mCRPCs); tumours with functional PTEN-loss status have hyperactivated AKT signalling. Dual pathway inhibition with AKT inhibitor ipatasertib plus abiraterone might have greater benefit than abiraterone alone. We aimed to compare ipatasertib plus abiraterone with placebo plus abiraterone in patients with previously untreated mCRPC with or without tumour PTEN loss., Methods: We did a randomised, double-blind, phase 3 trial at 200 sites across 26 countries or regions. Patients aged 18 years or older with previously untreated asymptomatic or mildly symptomatic mCRPC who had progressive disease and Eastern Collaborative Oncology Group performance status of 0 or 1 were randomly assigned (1:1; permuted block method) to receive ipatasertib (400 mg once daily orally) plus abiraterone (1000 mg once daily orally) and prednisolone (5 mg twice a day orally) or placebo plus abiraterone and prednisolone (with the same dosing schedule). Patients received study treatment until disease progression, intolerable toxicity, withdrawal from the study, or study completion. Stratification factors were previous taxane-based therapy for hormone-sensitive prostate cancer, type of progression, presence of visceral metastasis, and tumour PTEN-loss status by immunohistochemistry. Patients, investigators, and the study sponsor were masked to the treatment allocation. The coprimary endpoints were investigator-assessed radiographical progression-free survival in the PTEN-loss-by-immunohistochemistry population and in the intention-to-treat population. This study is ongoing and is registered with ClinicalTrials.gov, NCT03072238., Findings: Between June 30, 2017, and Jan 17, 2019, 1611 patients were screened for eligibility and 1101 (68%) were enrolled; 554 (50%) were assigned to the placebo-abiraterone group and 547 (50%) to the ipatasertib-abiraterone group. At data cutoff (March 16, 2020), median follow-up duration was 19 months (range 0-33). In the 521 (47%) patients who had tumours with PTEN loss by immunohistochemistry (261 in the placebo-abiraterone group and 260 in the ipatasertib-abiraterone group), median radiographical progression-free survival was 16·5 months (95% CI 13·9-17·0) in the placebo-abiraterone group and 18·5 months (16·3-22·1) in the ipatasertib-abiraterone group (hazard ratio [HR] 0·77 [95% CI 0·61-0·98]; p=0·034; significant at α=0·04). In the intention-to-treat population, median progression-free survival was 16·6 months (95% CI 15·6-19·1) in the placebo-abiraterone group and 19·2 months (16·5-22·3) in the ipatasertib-abiraterone group (HR 0·84 [95% CI 0·71-0·99]; p=0·043; not significant at α=0·01). Grade 3 or higher adverse events occurred in 213 (39%) of 546 patients in the placebo-abiraterone group and in 386 (70%) of 551 patients in the ipatasertib-abiraterone group; adverse events leading to discontinuation of placebo or ipatasertib occurred in 28 (5%) in the placebo-abiraterone group and 116 (21%) in the ipatasertib-abiraterone group. Deaths due to adverse events deemed related to treatment occurred in two patients (<1%; acute myocardial infarction [n=1] and lower respiratory tract infection [n=1]) in the placebo-abiraterone group and in two patients (<1%; hyperglycaemia [n=1] and chemical pneumonitis [n=1]) in the ipastasertb-abiraterone group., Interpretation: Ipatasertib plus abiraterone significantly improved radiographical progression-free survival compared with placebo plus abiraterone among patients with mCRPC with PTEN-loss tumours, but there was no significant difference between the groups in the intention-to-treat population. Adverse events were consistent with the known safety profiles of each agent. These data suggest that combined AKT and androgen-receptor signalling pathway inhibition with ipatasertib and abiraterone is a potential treatment for men with PTEN-loss mCRPC, a population with a poor prognosis., Funding: F Hoffmann-La Roche and Genentech., Competing Interests: Declaration of interests All authors report editorial assistance from F Hoffmann-La Roche. CS reports grants or personal fees, or both from Janssen, F Hoffmann-La Roche and Genentech, Sanofi, Astellas, Pfizer, Bayer, and Lilly, during the conduct of the study; and has a patent abiraterone plus cabozantinib issued to Exelixis, a patent parthenolide as treatment for cancer licensed to Indiana University, and a patent dimethylaminoparthenolide as treatment for cancer licensed to Leuchemix, outside of the submitted work. SB reports serving as advisory board member for Astellas, Janssen, Pfizer, BMS, F Hoffmann-La Roche, Ipsen, MSD, Merck, AAA, and AstraZeneca, outside of the submitted work. CNS reports grants and non-financial support from F Hoffmann-La Roche during the conduct of the study; and personal fees from Pfizer, MSD, Merck, AstraZeneca, Astellas, Sanofi and Genzyme, F Hoffmann-La Roche and Genentech, Incyte, and Clovis, outside of the submitted work. KNC reports grants from F Hoffmann-La Roche, during the conduct of the study; and grants or personal fees, or both from Astellas, AstraZeneca, Constellation Pharma, Daiichi Sankyo, Janssen, Merck, Novartis, Pfizer, Point Biopharma, F Hoffmann-La Roche, and Sanofi, outside of the submitted work. DO reports grants and non-financial support from F Hoffmann-La Roche, during the conduct of the study; and grants, personal fees, or non-financial support from Astellas Pharma, Bayer, Janssen, AstraZeneca, Clovis Oncology, Astellas Medivation, F Hoffmann-La Roche and Genentech, Pfizer, Tokai Pharmaceuticals, Ipsen, MSD, and Daiichi Sankyo, outside of the submitted work. SS reports grants and non-financial support from F Hoffmann-La Roche, during the conduct of the study; and grants or personal fees, or both from Amgen, MSD, Merck Serono, F Hoffmann-La Roche and Genentech, AstraZeneca, and Novartis, outside of the submitted work. CM reports grants and non-financial support from F Hoffmann-La Roche, during the conduct of the study; and personal fees from Amgen, Astellas Pharma, AstraZeneca, Bayer, BeiGene, Blueprint Medicines, BMS, Celgene, Debiopharm Group, F Hoffmann-La Roche and Genentech, Innate Pharma, Ipsen, Janssen, Lilly, MSD, Novartis, Orion, Pfizer, PharmaMar, Sanofi, and Taiho, outside of the submitted work. NM reports grants and non-financial support from F Hoffmann-La Roche, during the conduct of the study; and grants or personal fees, or both from Janssen, MSD, Chugai, Astellas, Eli Lilly, Taiho, Pfizer, and Sanofi, outside of the submitted work. BA reports grants from F Hoffmann-La Roche, during the conduct of the study; and grants, personal fees, or non-financial support from Astellas, AstraZeneca, Bayer, BMS, Eisai, Ferring, Ipsen, Janssen, MSD, Pfizer, F Hoffmann-La Roche, and Sanofi, outside of the submitted work. RG reports grants from F Hoffmann-La Roche, during the conduct of the study; and grants, personal fees, or non-financial support from Astellas, AstraZeneca, Bayer, BMS, Eisai, Ipsen, Janssen, MSD, Pfizer, F Hoffmann-La Roche, Sanofi, and Pierre Fabre, outside of the submitted work. LC reports grants and non-financial support from F Hoffmann-La Roche, during the conduct of the study. GVA reports grants from MSD, BMS, Merck-Serono, F Hoffmann-La Roche, Pfizer, AstraZeneca, Beigene, Ipsen, and Janssen, outside of the submitted work. EB reports personal fees from Sanofi Aventis, Astellas Pharmaceuticals, Roche Hellas, Bayer, Janssen Pharmaceuticals, GlaxoSmithKline, Pierre Fabre, and Merck, outside of the submitted work. JP reports grants and non-financial support from F Hoffmann-La Roche, during the conduct of the study; and grants or personal fees from Astellas Pharma, AstraZeneca, Bayer, BMS, Eisai, EUSA Pharma, Ipsen, Janssen-Cilag, MSD Oncology, Pierre Fabre, F Hoffmann-La Roche, Sanofi, Clovis Oncology, and MSD, and grants, personal fees, and non-financial support from Pfizer, outside of the submitted work. M-LH-Y, JGal, and JGar are employees of F Hoffmann-La Roche. GC, JH, and MJW are employees of Genentech. JSdB reports personal fees and grants from F Hoffmann-La Roche and Genentech, during the conduct of the study; grants, personal fees, or travel expenses from AstraZeneca, GlaxoSmithKline, Pfizer, Taiho, Daiichi, Bayer, Orion Pharma, F Hoffmann-La Roche and Genentech, Merck Serono, Sierra Oncology, MSD, Astellas, Cellcentric, Sanofi Aventis, and Vertex Pharmaceuticals, and personal fees or travel expenses from Terumo, Menarini and Silicon Biosystems, Bioexcel Therapeutics, Eisai, and Qiagen, outside of the submitted work; and has a patent for DNA damage repair inhibitors for treatment of cancer (patent number WO 2005 053662 licensed to AstraZeneca) and a patent for 17-substituted steroids useful in cancer treatment (patent number US 5604213 licensed to Janssen). All other authors declare no competing interests., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Aim: to study the features of microbiota in patients of urological departments and to optimize the schemes of antibiotic therapy., Materials and Methods: Data of microbiological studies in patients of urological departments in 2017 years were analyzed. Isolation of pathogens was carried out using standard techniques. A disk diffusion test using Mueller-Hinton agar with BioRad disks was used to determine the sensitivity. The statistical analysis was performed using the WHONET 5.4 program. In addition, a comparison with the results of the PCR study was done., Results: A total of 672 etiological pathogens were isolated in whole clinic in 2017 year. From those, 173 pathogens were found in the urological clinic, which accounted for 25.7% of the total number. Gram-negative bacteria predominated and its proportion was 59.23%. Gram-positive bacteria were isolated in 24.4%, and fungi were found in 16.37% of cases. The structure of pathogens isolated from stoma or obtained by catheterization was not significantly different. Most frequently isolated pathogens included @K. pneumonia (22.8%), @E. coli (21.2%), @C. albicans (17%), @P. aeruginosa (11%), @E. aerogenes (6%) and @S. aureus (3 %). @K. pneumonia usually had an unfavorable resistance pattern. E. coli isolated from urine samples had more favorable resistance pattern in comparison to pathogens obtained from stoma. The bacteria which were found in intensive care unit had the increased level of resistance., Conclusion: Gram-negative bacteria predominate in the urological clinic with a relatively high proportion of extended-spectrum beta-lactamase-producing organisms. Risk factors for the emergence of multi-resistant pathogens are the treatment in the intensive care unit and the presence of stomas or catheters. The PCR method, carried out in parallel with routine microbiological studies and regular analysis of the overall bacterial spectrum, allows to optimize the starting antibiotic therapy from the first day of the disease. The use of cephalosporins is not justified in the most cases. Aminoglycosides and fluoroquinolones remain effective. The use of either -Lactamase-protected penicillins or fosfomycin is possible only after obtaining the results of bacteriological study. When prescribing carbapenems, the risk of inefficiency is especially high in patients with stomas/catheters and transferred from the intensive care unit.

The ultrasound pattern of hepatic and renal changes after different types of resection is depicted. Ultrasound studies were performed in 335 patients operated on for focal hepatic masses and in 72 patients operated on for focal renal masses. The authors identified 3 patient groups after hepatic resection (segment-oriented liver resection (99 patients), portal hemihepatectomy (n=163), and extended hemihepatectomy (n=73)) and 3 patient groups after renal resection (planar (n = 83), wedge (n = 104), and frontal (n = 66)). It has been established that the number and location of hepatic veins in the liver stump, which the authors have designated as a hepatic vein rule, are of basic value in defining the type of hepatic resection. To determine the type of renal resection, it is essential to assess the shape of the organ and the area of its resection. The found echosemiotic patterns allow the type of performed resection of parenchymatous organs to be correctly determined in the majority of cases.

Results of treatment of 32 patients after nephrectomy with thrombectomy for renal cell carci-noma complicated by tumor thrombosis of the inferior vena cava were analyzed. The study in-cluded patients only with II - IV clot levels: 26 patients with T3b - the length of the thrombus 5.1 +/- 1.75 cm, 6 patients with T3c - the length of a thrombus - 14.8 +/- 0.98 cm. One patient (3.1%) died due to pulmonary artery thromboembolia in immediate postoperative period. 1-2 degrees Clavier Complications were observed in 11 patients, 3-4 degree - in two (6.2%) patients. 90.4% of patients had metastases in distant organs and (or) in the regional lymph nodes, which nega-tively affected the survival rates of patients - 5-year survival rate was 36%. The presence of lymphogenous metastases, MSKCC criteria were factors affecting survival rate. Survival rates of patients with T3b and T3C levels were not statistically different. The results of postoperative systemic targeted therapy were significantly statistically better than the results of immunotherapy.

Using 60 outbred albino male rats, the changes of colonic mucosa were studied after rectal infusion of urine for 1, 3 and 5 months. In response to prolonged exposure to urine, the mucosa was found to undergo gradual atrophic changes, including the reduction of its thickness and crypt depth. Moreover, the number of goblet cells was significantly decreased. Oral correction by weak solution of sodium hydrocarbonate could slow down the progression of atrophic processes in colonic mucosa.

An original method of kidney resection with the use of ultrasonic surgical destructor-aspirator is proposed. The method was applied in the treatment of 19 patients (20 renal resections and 1 tumor enucleation). No complications occurred. The use of ultrasonic destructoraspirator in renal resection enabled isolation of all the intraparenchymatous tubal structures of the kidney, each of them could be ligated and cut if visualization is adequate. This provided a complete hemostasis on the wound surface of the kidney and hemostatic suturing of the kidney wound became unnecessary. This method of renal resection reduced hospital stay of the patients because they had no hemorrhages, purulent complications and urinary fistulas.