Background. The most difficult is to determine medical tactics in patients with renal cell carcinoma (RCC) with intraparenchimal and central localization in the single, the only functioning kidney, as well as with a combination of tumor and other illnesses in contralateral kidney. Partial nephrectomy leading to renal replacement therapy results in life-threatening complications and poor prognosis. The priority is to develop organ-preserving treatment: from minimally invasive endoscopic surgery to ex vivo kidney resection. Aim: to develop a technique of extracorporeal partial nephrectomy in terms of pharmaco-cold ischemia without crossing the ureter with renal vessels orthotopic replantation in patients with RCC. Materials and methods. The study included 37 patients with pT1a-T3vN0M0-1G1-3 RCC with intraparenchymal and central tumor location. The average age of the patients was 55.32 ± 13.1 years. The ratio of men and women - 2.7:1. Bilateral renal tumors were observed in 3 (8.1%) patients, and the RCC of the single functioning kidney in 6 (16.2%) patients. One patient (2.7%) was diagnosed RCC of a single kidney with intraluminal invasion (cava-renal form). Results. The mean operation time was 413.97 ± 89.14 minutes. The mean warm ischemia time – 8.39 ± 4.75 minutes. Cold ischemia lasted from 70 to 240 minutes, on the average 151.41 ± 41.29 min. The amount of blood loss made up 729.03 ± 481.4 ml. Perioperative complications were detected in 3 (8.1%) patients. In two cases after starting the renal blood flow the kidney was found to be nonviable and had to be removed. And in one case the recurrent prosthetic thrombosis of the renal artery resulted in a renal scarring. Postoperative complications were observed in 18 (48.6%) patients. According to Clavien-Dindo classification there were 8 low grade (I-II degree) complications (44.4%), 8 other of III degree, and one IV degree complication, and there was one lethal case (V degree). Conclusion. Extracorporeal partial nephrectomy in terms of pharmaco-cold ischemia without crossing the ureter with orthotopic renal vessels replantation in patients with RCC is a relatively safe organ-preserving treatment. The long period of cold ischemia allows one to perform the resection stage of any complexity and duration. This technique gives the possibility to remove tumor larger than 40 mm and of any location. Extended resections up to one-stage excision of solitary kidney with thrombectomy from inferior vena cava and the inferior vena cava resection are possible and safe. The proposed technique allows one to put the kidney back into its place with the orthotopic renal vessels replantation and excludes the complementary access with the consequent loss of time for dissection and autologous transplantation of kidney in the iliac region. Moreover, there is no necessity to cross the ureter and to make uretero-ureteroanastomosis, uretero-cystoanastomosis.

The aim of our study was the evaluation of the prognostic role of 42 genes, which were shown to be relates to prostate cancer aggressiveness in previous studies. We have included 28 patients in the study, 19 with localized prostate cancer according to final pathology after radical prostatectomy (pT2a-2c) and 9 patients with locally advanced prostate cancer (pT3a-b). Analysis of the gene expression (PCR) revealed 6 genes with differential expression in tumor tissues of patients from 2 aforementioned groups: GOLM1, GBX2, XPO6, SSTR1, TOP2A and CDCA5. We have created a prognostic model of the pT-stage based on the expression of these 6 genes, which proved to be accurate in 75% of the included cases.

The goal of the study was to evaluate cancer-specific survival in men with newly diagnosed prostate cancer after external beam radiotherapy. The long-term results of 178 patients treated with 3D-confirmal radiotherapy at N.N. Alexandrov National Cancer Centre of Belarus, Minsk, Belarus in 2005-2008 were analyzed. According to prostate-specific antigen level, clinical stage and Gleason sum patients were stratified into four groups of progression. 9-years cancerspecific survival in patients with low, intermediate, high and very high risk was 81,3±0,1%, 94,3±0,04%, 63,4±0,1% and 49,1±0,09%, respectively (р < 0,005).

During the period from 2004 to 2014, prostatic artery embolization was performed in 59 patients with benign prostatic hyperplasia (BPH) and superselective chemoembolization in 36 patients with prostate cancer. After the embolization in BPH cases, the number of symptoms according to IPSS significantly decreased, and Qmax increased. The volume of the prostate and hyperplastic lesions decreased on the average by 53% and 47% on the average, respectively. The positive effect of chemoembolization was achieved in 30 patients (83.3%). The objective response was observed by the reduced PSA levels, prostate volume reduction and the improvement of urination parameters.In 12 months, check biopsy was performed in 16 patients. In 12 cases, fibrosis and epithelial dystrophy without atypia signs were observed, in 2 cases, therapeutic pathomorphism was observed.The application of the methods of embolization in BHP cases and chemoembolization in localized prostate cancer cases has showed their high effectiveness and safety in the patients who are not amenable to conventional therapy.

The diagnostic consideration of the most commonly used methods of radial diagnostics in identifying local recurrence of prostate cancer after radical prostatectomy in patients with biochemical recurrence is reflected in the literature review. The identified level of PSA after radical prostatectomy can argue for both local recurrence, the presence of tumor dissemination, and a residual prostate tissue without tumor that was left on the edge of the cut. With the purpose of early diagnosis of prostate cancer recurrence, it is advisable to monitor PSA levels after 3 months after radical prostatectomy. In case of growth of PSA levels after radical prostatectomy, it is necessary to answer the question: whether the recurrence is local or metastatic. Modern imaging methods, such as transrectal ultrasound examination, bone scanning, multislice computed tomography, positron emission tomography and endorectal magnetic resonance imaging provide excluding or establishing the presence of recurrence of prostate cancer after radical prostatectomy. It should be noted that none of the methods of radiodiagnostics are not ahead of the results of PSA in the identification of local recurrence of prostate cancer after radical prostatectomy; however, in their complex application, prostate cancer recurrent after radical prostatectomy can be visualized at its earliest stages.

 

Tuberculosis remains important medical and social problem. Prostate TB is often underdiagnosed disease in patients with pulmonary TB: in fact every third pulmonary TB patient had prostate TB, confirmed by pathomorphological investigation of prostate biopsies, although clinical symptoms were absent. Seventy seven percents of men died from TB any localization had prostate TB, mostly overlooked alive. Chronic inflammation of the prostate gland – both nonspecific and TB etiology, - leads to decreasing of a quality of ejaculate; in low basic fertility of population it may have dramatic consequences. Infertility may be a first symptom which stimulates a TB patient to address a doctor. But now the influence of prostate TB on a quality of ejaculate is not evaluated. It was showed a positive role of selenium and zinc on a quality of ejaculate in patients with chronic prostatitis, with idiopathic infertility – but there is no knowledge of the influence these elements on fertility in patients with prostate TB.