Background. Despite low incidence, malignant urethral neoplasms are among the most aggressive tumours. Prevalence of muscle-invasive and metastatic cancer at diagnosis, as well as a high relapse rate compel adherence to the most radical treatment. At the same time, the high incidence of urethral tumours in elderly and senile patients and high postoperative complication rates warrant the development of organ-preserving treatment.Aim. A case description to verify the organ-preserving treatment applicability in urethral cancer.Materials and methods. We report the treatment experience in a senile patient with concomitant chronic kidney disease at the Volgograd Regional Clinical Oncology Dispensary’s Oncourology Unit. Accounting for the age, concomitant pathology and tumour histology factors, a minimally invasive organ-preserving surgical intervention was performed as laparoscopic urethral resection with ureterocystoneostomy.Results and discussion. Renal function was assessed in postoperative period with dynamic nephroscintigraphy and blood creatinine monitoring. Control cysto-, ureteroscopy and contrast-enhanced CT scanning in areas of interest were performed to rule out relapse and progression.Conclusion. No report of disease relapse or progression at follow-up indicates the oncological safety of organ-preserving surgery in this patient category. Th is approach also gains support from immediate and long-term outcomes of the patient’s improved renal function and sustained good quality of life.
Purpose: to conduct a comparative assessment of the effectiveness and safety of laparoscopic kidney resections for benign and malignant neoplasms with and without vascular isolation of the organ. Materials and methods: the research presents a comparative analysis of the direct results of treatment of 182 patients who underwent laparoscopic kidney resection. Among them there were 94 men (51,7 %) and 88 women (48,3 %). The average age was 61,6 ± 6,2 years. Two main methods were used: kidney resection with vascular isolation and without vascular ischemia. Surgical treatment was performed for malignant neoplasms in 152 cases (86,5 %) and for benign neoplasms in 24 cases (13,6 %). We used the methods of laparoscopic resection of the kidney with total vascular ischemia in 44 cases (24,2 %) and without vascular ischemia in 138 patients (75,8 %). Results: the average duration of surgery was 80 ± 18,5 minutes. The average duration of the operation with the use of vascular ischemia was 122,1 ± 17,5 minutes, without ischemia — 81,7 ± 10,6 minutes. The volume of intraoperative blood loss averaged 174,4 ± 20,1 ml, while this indicator when using the ischemic-free technique was 154,2 ± 15,7 ml, which is 32,9 % less (p> 0,05) than in cases with the use of vascular isolation (230,1 ± 20,8 ml). When using the technique of vascular isolation, the serum creatinine has increased for 16,2 ± 1,7 μmol / L (16,7 %), without vascular isolation 6,5 ± 1,5 μmol / L (6,7 %). Conclusion: laparoscopic kidney resections without vascular isolation are characterized by a lower volume of intraoperative blood loss, a shorter operation time and are not accompanied by an increase in the number of postoperative complications.
Background. Prostate cancer (PCa) is an actual disease and a frequent oncological pathology in men. The main methods of radical treatment of patients with PCa are radical prostatectomy and radiation therapy. Radical prostatectomy s the most commonly used method of therapy in patients with localized PCa. Adjuvant hormone therapy after surgical treatment is the standard method of therapy in patients with the presence of lymph node metastases. At the same time, the standard approach of treatment of patients with metastatic PCa is combination therapy with medical (using of analogues or antagonists of luteinizing hormone-releasing hormone (LHRH) or surgical castration in combination with chemotherapy with docetaxel or new generation antiandrogens (enzalutamide or apalutamide)). Numerous studies have demonstrated the importance of achieving minimum testosterone levels at all stages of drug therapy in patients with PCa. It has also been shown that the use of LHRH analogues may be less effective to the use of LHRH antagonists (degarelix) in relation to the effectiveness of testosterone suppression. Thus, conducting a study aimed at studying the effectiveness of testosterone suppression using LHRH antagonists in various clinical situations and patient populations in real clinical practice is a very actual task.Aim. To evaluate the effectiveness and safety of castration therapy using degarelix in real clinical practice and in various clinical situations.Materials and methods. The object of an observational non-interventional study was 132 patients with PCa from 13 cancer centers of Russian Federation who were treated with LHRH antagonist degarelix. The study was non-interventional (observational), retrospectively-prospective, open multicenter and not randomized. In accordance with the design of the study, depending on the clinical situation, patients were divided into 3 groups: group A (n = 52; 39.4 %) – patients with primary metastatic hormone-sensitive PCa, who were shown to undergo combined drug treatment with castration therapy as one of the components; group B (n = 43; 32.6 %) – patients, who underwent combined hormonal and radiation treatment (ADT + radiation therapy); group C (n = 37; 28 %) – patients who underwent surgical treatment (radical prostatectomy with extended PLND) with the presence of metastases in the lymph nodes identified by the results of a morphological examination (pN1).Results and conclusion. As a result of a non-interventional observational study, high efficacy of androgen-deprivation therapy with the use of degarelix was demonstrated in relation to the suppression of testosterone and PSA in patients with primary metastatic and locally advanced PCa in various clinical situations, as well as low toxicity and satisfactory tolerability of this variant of hormonal treatment.
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