The article presents an analysis of the medical statistical indicators characterizing the state of uro-oncological care for inhabitants of the Crimean Republic. We studied rough indicators of morbidity, morphological verification of tumors, overall mortality of the Crimean population in cases of malignant tumors of urinary system during 2005-2014. Based to the available data about the actual staffing in medical institutions of the Republic of Crimea, we suggested the ways for improving the quality of health care for the Crimean patients with uro-oncological pathology.

Purpose. To evaluate the long-term results and effectiveness of laparoscopic ileal ureteral replacement. Material and Methods. To this study included the results of ileal ureteral substitution in 17 patients. In 10 patients we used open, in 7 patients used laparoscopic approach. Technique of operation (mobilization of ureter, ileal resection, creation of ureteroileal and ileobladder anastomoses) was similar in the both groups. We performed comparative analysis parameters, such as operative time, blood loss, narcotic analgesic, hospital stay and time to convalescence. Results. No conversion in patients who were underwent laparoscopic ileal replacement of ueter. Operative time was longer for 70 min in laparoscopic group, but this difference wasn’t significantly (p < 0,05). Narcotic analgesic use was dramatically less for the laparoscopic group than for the open group (40 mg versus 240 mg, p < 0,05). Hospital stay was significantly less in laparoscopic group (6 d versus 9 d, p < 0,05). Preoperative and postoperative serum creatinine, bicarbonate and chloride levels were unchanged for the laparoscopic and open groups. Moderate metabolic acidosis developed in 1 patient in open group. Time to convalescence was significantly less for the laparoscopic group (4 weeks versus 5,5 weeks, p < 0,05). Conclusion. Ileal ureteral substitution using laparoscopic approach is an effective and minimally invasive procedure. Compared with open procedures this technique allows to decrease trauma of surgery, hospital stay and time convalescence.

The authors Analyzed the immediate and remote results of treatment of patients with prostate cancer treated by the method - a robotic radiotherapy. Immediate results of treatment were estimated on the level of total PSA, prostate volume, residual urine, change according to the international scale IPSS. The dynamics of the above indicators showed regression of the primary lesion, and the absence of pronounced radiation reactions affect the quality of life of patients. We analyzed the results of overall, relapse-free survival and oncospecific. Three-year disease-free survival in patients receiving radiation therapy is of 88.8%. Overall survival, as well as oncospecific survival rate is 100%.

Also presents first experience of using stereotactic radiotherapy in patients of renal cell carcinoma. Treatment received two (one patient carried out the irradiation of both kidneys). In one patient, complete tumor resorption of the right kidney and a decrease in the size and reduction of contrast enhancement of the tumor of the left kidney. Renal function did not deteriorate. The second patient decreased the size of the tumor, but preserved the contrast enhancement in the vascular phase. The only function of the kidney has not deteriorated.

 

Radical nephrectomy involves removal of the kidney with paranephrium within Gerota's fascia. The need to perform adrenalectomy, the appropriateness and extent of lymph node dissection remains controversial. The results of treatment of patients with renal cell carcinoma are in the article. In this group, 38.6% of patients had vascular invasion. Nephrectomy was performed from laparotomy, the proximal and distal boundaries of dissection became superior mesenteric artery and the aortic bifurcation. Morphological examination did not reveal highly differentiated tumors. The frequency of renal capsule and perinephric invasion reached 40.9%, unchanged adrenal - 9.1%, regional lymph nodes - 22.7%. This is higher than the published data on the frequency of neoplastic lesions of the lymph nodes. Patients affected appeared to 2 lymph nodes. In conclusion, the authors concluded that such an aggressive approach could improve treatment outcomes.

 

The purpose of our research is to improve the quality of life of patients undergoing radical prostatectomy. With the increasing frequency of prostate cancer and determining the effectiveness of surgical treatment significantly increased the number of radical prostatectomy. Surgical treatment is definitely in much greater extent when compared to radiation treatments related to the development of impotence, erectile dysfunction and urinary incontinence.The incidence of erectile dysfunction after prostatectomy ranges from 10 to 50%. Therefore, the development of new programmes for the rehabilitation of patients can improve their quality of life, due to the greater likelihood of recovery of erectile function after the operation. In our study we observed 84 patient. The incidence of erectile dysfunction was 76%. After applying one of the existing methods of stimulation: FDÈ5 inhibitors, intracavernose injections of prostaglandin, physical therapy, we were able to increase the effectiveness of treatment up to 54.8%, 40% and 70% respectively.