ISSN (print): 2225-9074, ISSN (online): 2687-1416 Founder: Eco-Vector LLC Editor-in-Chief: Tkachuk Vladimir Nikolaevich, Doctor of Medical Sciences, Professor Frequency / Access: 4 issues per year / Subscription Included in: Higher Attestation Commission List, RISC
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Radical surgery in patients with bladder cancer: long-term outcomes
BACKGROUND: Radical cystectomy with pelvic lymphadenectomy is the mainstay of treatment for muscle-invasive bladder cancer. Reported 5- and 10-year survival rates after surgery vary widely. AIM: This study aimed to evaluate survival outcomes and the incidence of local recurrence in patients with bladder cancer following radical cystectomy. METHODS: A cohort study with prospective outcome assessment included 407 patients with bladder cancer who underwent radical cystectomy with various types of urinary diversion between 1995 and 2025. The cohort comprised 344 men (86.4%) and 63 women (13.6%). 5- and 10-year overall survival and cancer-specific survival were analyzed. RESULTS: Postoperative mortality was observed in 12 patients (3.1%). Early postoperative complications occurred in 136 patients (33.6%), and late complications in 117 patients (28.9%). Local pelvic recurrence after radical cystectomy was detected in 33 patients (8.5%). Overall survival at 10 years of follow-up was 43.4%, whereas 10-year cancer-specific survival reached 47.2%. In patients without regional lymph node metastases, 2- and 5-year overall survival rates were 81.2% and 67.2%, respectively; in patients with lymph node metastases, these rates were 46.9% and 13.9%. Cancer-specific survival in the lymph node–negative group was 83.6% at 2 years and 70.7% at 5 years, whereas in the lymph node–positive group it was 51.0% and 15.1%, respectively. Increasing tumor stage and histopathological grade were associated with a progressive decline in both overall and cancer-specific survival. CONCLUSION: Tumor stage, lymph node status, and histopathological grade exert a substantial independent impact on overall and cancer-specific survival in patients with bladder cancer following radical cystectomy.
Copyright (c) 2025 Eco-Vector https://creativecommons.org/licenses/by-nc-nd/4.0/
Systematic assessment of early complications after radical cystectomy for non–muscle-invasive bladder cancer and bladder cancer with minimal intradetrusor invasion at a single center
BACKGROUND: Bladder cancer ranks tenth among all malignant neoplasms worldwide, with about 573,300 newly diagnosed cases and about 212,500 deaths annually. Patients with very high-risk non–muscle-invasive bladder cancer, as well as those with tumor progression, are eligible for the same treatment as patients with muscle-invasive bladder cancer—namely, immediate radical cystectomy. AIM: This study aimed to assess morbidity in patients undergoing radical cystectomy for non–muscle-invasive bladder cancer and bladder cancer with minimal muscle invasion. METHODS: The study analyzed outcomes of radical treatment in 151 patients who underwent radical cystectomy. Based on postoperative pathological examination, two study groups were formed: group 1 included 49 patients with non–muscle-invasive bladder cancer (pT1 stage), and group 2 included 102 patients with bladder cancer with minimal muscle invasion (pT2a stage). RESULTS: Early postoperative complications not related to urinary diversion were observed in 44.9% of patients in group 1 and in 32.4% of patients in group 2 (p = 0.135). The incidence of these complications was 77.6 ± 12.6 versus 51.0 ± 7.1 cases per 100 patients in the comparison groups, respectively (p > 0.05). Urinary diversion–related complications occurred in 13.3% and 16.7% of patients in groups 1 and 2, respectively. The incidence of these complications in groups 1 and 2 was 14.3 ± 5.4 and 16.6 ± 4.0 cases per 100 patients, respectively. At the same time, significant differences were identified in the distribution of patients across Clavien–Dindo complication grades 1, 2–3a, 3b, and more severe complications: 43.5%, 21.7%, and 34.8% in group 1, and 23.8%, 42.9%, and 33.3% in group 2, respectively (p = 0.0025). CONCLUSION: Substantial differences in the pattern of early postoperative complications after radical cystectomy were identified in the pT1 group, likely attributable to multiple prior organ-sparing interventions and other treatment modalities. In addition, more severe Clavien–Dindo complications were more frequently observed in the pT2a group compared with group 1.
Blood-sparing strategies in radical prostatectomy using temporary occlusion of the internal iliac arteries
BACKGROUND: Radical prostatectomy is the primary surgical treatment for localized prostate cancer. The procedure is often associated with substantial blood loss, particularly in patients with large prostate volumes. Reducing intraoperative blood loss during radical prostatectomy remains an important objective of contemporary oncological urology. One of the proposed approaches for preventing intraoperative hemorrhage is temporary interruption of blood flow through the internal iliac arteries; however, the scientific data on the application of this technique remain limited. AIM: This work aimed to evaluate the effectiveness of short-term occlusion of the internal iliac arteries for reducing blood loss during radical prostatectomy in patients with large prostate volume. METHODS: This single-center controlled study included 60 patients with localized prostate cancer and a prostate volume of ≥100 cm3. Patients were divided into a main group and a control group, with 30 patients in each. Patients in the main group underwent robotic radical prostatectomy with pelvic lymphadenectomy and temporary interruption of blood flow in the internal iliac arteries. Patients in the control group underwent standard radical prostatectomy with pelvic lymphadenectomy. The groups were comparable regarding the main clinical characteristics. RESULTS: In the main group, blood loss did not exceed 350 mL and was more than twofold lower on average than in the control group: 161.2 vs. 376.1 mL, respectively (p < 0.001). Operative time was also significantly shorter in the main group compared with the control group: 156.4 vs. 188.4 minutes, respectively (p = 0.01). Two patients in the control group required intraoperative blood transfusion due to high blood loss, whereas no transfusions were required in the main group. CONCLUSION: Radical prostatectomy with pelvic lymphadenectomy in patients with prostate cancer and large prostate volume (>100 cm3), when performed using temporary occlusion of the internal iliac arteries, allows for a substantial reduction in intraoperative blood loss and operative time.
Impact of hypertension on lower urinary tract symptoms in men with benign prostatic hyperplasia
BACKGROUND: Impaired blood supply to the bladder is considered a risk factor for urinary dysfunction, including in patients with benign prostatic hyperplasia. One of the possible causes of pelvic hemodynamic disturbances is hypertension. AIM: This study aimed to evaluate the impact of hypertension on the severity of lower urinary tract symptoms in patients with benign prostatic hyperplasia. METHODS: This retrospective and prospective observational study included 6117 men aged 48 to 83 years (mean age: 59.57 ± 10.1 years) who underwent surgical treatment for benign prostatic hyperplasia; 5960 patients were included in the final analysis. Medical records were reviewed with assessment of International Prostate Symptom Score, ultrasonographic findings of the prostate and bladder, and the presence and characteristics of comorbid conditions. RESULTS: Hypertension was identified in 3052 (51.2%) patients, of whom only 1385 (45.4%) were aware of the diagnosis. Patients with benign prostatic hyperplasia and concomitant hypertension demonstrated greater severity of lower urinary tract symptoms, with significant differences observed not only in overall International Prostate Symptom Score but also separately for storage and voiding symptoms. The severity of urinary dysfunction, primarily storage symptoms, depended on the stage and duration of hypertension, as well as on pharmacological blood pressure control. The presence of hypertension influenced the likelihood of persistent urinary dysfunction after surgical treatment of benign prostatic hyperplasia. In the postoperative period, lower urinary tract symptoms were observed in 2078 (68.1%) of 3052 patients with hypertension, compared with only 577 (19.8%) of 2908 patients without hypertension. CONCLUSION: Hypertension is associated with increased severity of lower urinary tract symptoms in patients with benign prostatic hyperplasia; the duration and stage of hypertension, as well as antihypertensive therapy, are of significance. Hypertension may be considered a risk factor for persistent lower urinary tract symptoms in the long-term postoperative period. Prior to deciding on surgical intervention for benign prostatic hyperplasia in patients with hypertension, adequate blood pressure control followed by reassessment of lower urinary tract symptom severity appears to be necessary.
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Prostatic artery embolization as a method for prevention of infravesical obstruction after low-dose-rate brachytherapy
BACKGROUND: Infravesical obstruction in patients with localized prostate cancer caused by concomitant benign prostatic hyperplasia substantially limits the feasibility of low-dose-rate brachytherapy. Traditional methods of obstruction correction, particularly transurethral resection of the prostate, are associated with a risk of postoperative complications and complicate the technical performance of radioactive seed implantation. Therefore, the search for new approaches to patient preparation for low-dose-rate brachytherapy is of considerable clinical relevance. AIM: This work aimed to evaluate the effectiveness of prostatic artery embolization in patients with prostate cancer and concomitant infravesical obstruction due to benign prostatic hyperplasia prior to low-dose-rate brachytherapy. METHODS: The study included 49 patients with localized prostate cancer and symptoms of infravesical obstruction caused by benign prostatic hyperplasia who were scheduled for low-dose-rate brachytherapy. According to the method of preparation for low-dose-rate brachytherapy, patients were allocated into two groups: group 1 received prostatic artery embolization; group 2 received prostatic artery embolization combined with androgen deprivation therapy. The effectiveness of embolization was assessed based on changes in uroflowmetry parameters, prostate volume, and postvoid residual urine volume. Upon achieving satisfactory voiding parameters (Qmax ≥ 15 mL/s, postvoid residual urine volume ≤ 50 mL), low-dose-rate brachytherapy was performed. The analyzed parameters were assessed before embolization, 1 month after embolization, and 12 months after brachytherapy. RESULTS: After prostatic artery embolization, a substantial reduction in prostate volume and improvement in urinary function were observed, including decreased postvoid residual urine volume and increased urinary flow rate. Significantly greater positive changes in the assessed parameters were observed in the combined preparation group (prostatic artery embolization + androgen deprivation therapy). Low-dose-rate brachytherapy was successfully performed in 18 patients from both groups. Following prostatic artery embolization, spontaneous voiding was restored in 4 of 5 men who had previously undergone cystostomy, which allowed removal of the cystostomy drainage and subsequent low-dose-rate brachytherapy. No episodes of acute or chronic urinary retention were observed in the post-implantation period. CONCLUSION: Prostatic artery embolization can be used to reduce prostate volume and improve urinary function in patients with prostate cancer and infravesical obstruction caused by benign prostatic hyperplasia prior to low-dose-rate brachytherapy. This method reduces the severity of infravesical obstruction and decreases the risk of acute and chronic urinary retention in the post-implantation period.
Long-term outcomes of free synthetic sling placement for the treatment of urinary incontinence in patients with morbid obesity
BACKGROUND: Stress urinary incontinence is the most common lower urinary tract disorder in women. Obesity notably increases the risk of this condition. Surgical correction using a free synthetic sling is considered the gold standard of treatment; however, long-term outcomes in patients with morbid obesity remain controversial. AIM: This work aimed to evaluate the long-term outcomes of urethropexy using a free synthetic sling in patients with urinary incontinence and morbid obesity. METHODS: A comparative analysis of treatment outcomes was performed in 81 women with urinary incontinence and morbid obesity, divided into two groups according to the surgical approach: transobturator (n = 40) and retropubic (n = 41). Treatment outcomes were assessed at 1, 3, and 6 months postoperatively. Long-term results were evaluated after 12 months or longer. Follow-up examinations included vaginal examination with cough stress test, uroflowmetry, bladder ultrasonography with assessment of postvoid residual urine volume, and completion of the UDI-6, ICIQ-SF, and I-QOL questionnaires. RESULTS: The median age was 57.5 years [51.5; 63.5] in the transobturator group and 61 years [54; 65] in the retropubic group. The median body mass index was 38.9 kg/m2 [36.9; 40.1] in the transobturator group and 39.1 kg/m2 [37.2; 40.5] in the retropubic group. The mean postoperative follow-up period was 12 ± 2.4 months. Patients in both groups reported improved quality of life. The rate of recurrent urinary incontinence based on the cough stress test was 6 cases (14.6%) in the transobturator group and 4 cases (10%) in the retropubic group. CONCLUSION: A free synthetic sling is an effective method for the correction of stress urinary incontinence in patients with morbid obesity. A lower recurrence rate in the long-term period was observed in the retropubic approach group.
Differential diagnosis of the mineralogical composition of urinary stones
BACKGROUND: Urolithiasis is a common chronic disease with a high tendency to recurrence. The high rate of stone recurrence determines the clinical importance of metaphylaxis, which requires precise knowledge of the chemical composition of the calculi. AIM: This work aimed to develop an optimal algorithm for mathematical processing of infrared spectra and differential diagnostic profiles of various mineralogical types of kidney stones. METHODS: The object of the study comprised 115 kidney stones obtained during surgical treatment of patients with urolithiasis. Reference samples of the corresponding salts constituting kidney stones were used as standards. Pure reference substances were ground in an agate mortar with potassium bromide (KBr) crystals; the resulting mixture was compressed into transparent pellets, and infrared spectra were recorded using a Fourier-transform infrared spectrometer (Shimadzu IR Prestige 21, Japan). In the infrared spectra of the reference standards, the most frequently occurring and most intense absorption bands were selected (34 maxima). RESULTS: For chemical compounds commonly present in urinary stones, two differential diagnostic profiles were constructed for each compound based on infrared spectral data. Visual comparison of the differential diagnostic profiles of urinary stones with the reference profiles allowed accurate identification of the chemical composition of the calculi in all cases. CONCLUSION: Differential diagnostic profiles represent individual characteristics of each stone type and can be used to determine its chemical composition and to develop a personalized approach to the metaphylaxis of urolithiasis.
Comparing surgical and conservative treatment of keratinizing squamous metaplasia (leukoplakia) of the bladder: a systematic review
BACKGROUND: Leukoplakia is a condition requiring histological confirmation and is associated with persistent symptoms of recurrent cystitis. No universal treatment standards are currently available. AIM: This study aimed to compare surgical and conservative treatment approaches for keratinizing squamous metaplasia (leukoplakia) of the bladder in adults. METHODS: A scientific data search was conducted in MEDLINE/PubMed, Scopus, Web of Science, the Russian Science Citation Index, and other databases (last search: September 2025). Comparative studies and surgical case series following drug therapy failure were included; single case reports, pediatric cases, and schistosomiasis-associated cases were excluded. The primary outcome was clinical and endoscopic resolution, i.e. symptom disappearance and complete epithelialization on follow-up cystoscopy. Secondary outcomes included recurrence, adverse events, cancer occurrence, and quality-of-life measures. Risk of bias was assessed using ROBINS-I and RoB 2.0 tools (ROBINS-I prioritized), and overall certainty of evidence was evaluated using the GRADE approach. A random-effects meta-analysis (DerSimonian–Laird method with Hartung–Knapp adjustment) with heterogeneity assessment (I2, Cochran χ2) was pre-specified but was limited by small sample sizes and substantial heterogeneity. RESULTS: Seven studies were included (0 randomized controlled trials), comprising a total of 826 patients. Conservative strategies (antibacterial and anti-inflammatory therapy, intravesical instillations) rarely resulted in lesion regression and provided mainly short-term symptom relief. Endoscopic removal or ablation of lesions (laser ablation, argon plasma coagulation, mono- or bipolar transurethral resection) demonstrated high rates of clinical and morphological resolution (80%–97%) and meaningful improvements in quality of life. In the largest series, the 5-year recurrence risk after complete endoscopic removal was 13.9%, with no cases of cancer reported over a median follow-up of 49 months. Laser ablation was associated with fewer coarse scars in the surgical treatment area and greater reduction in pain symptoms compared with transurethral resection; serious complications were rare. Overall certainty of evidence was low to very low (due to retrospective study designs, confounding, and selective reporting), although effect directions were consistent. CONCLUSION: In symptomatic keratinizing squamous metaplasia of the urothelium, an active management approach is justified, comprising biopsy-based diagnosis verification, elimination of inflammatory triggers, and organ-sparing endoscopic removal of lesions (preferably using laser techniques), followed by scheduled follow-up cystoscopy. Conservative therapy plays an adjunctive role and rarely provides durable resolution. The quality of available evidence remains low to very low, underscoring the need for prospective comparative studies.
Impact of botulinum toxin injections into the external urethral sphincter on urodynamic parameters in neurogenic lower urinary tract dysfunction
Detrusor–sphincter dyssynergia, characterized by impaired voiding, is a common condition in patients with neurogenic lower urinary tract dysfunction, including those with spinal cord injury. The elevated intravesical pressure associated with detrusor–sphincter dyssynergia is considered a predictor of upper urinary tract deterioration, development of autonomic dysreflexia, recurrent urinary tract infections, and urinary incontinence. Current treatment approaches for detrusor–sphincter dyssynergia have notable limitations and demonstrate high rates of complications. Over the past decades, a number of studies have investigated the management of voiding disorders in detrusor–sphincter dyssynergia using injections of botulinum toxin type A. This review evaluates the efficacy of chemical denervation of the external urethral sphincter in patients with neurogenic lower urinary tract dysfunction, with particular emphasis on urodynamic parameters as the primary objective criteria for treatment effectiveness. Studies conducted to date have shown that injection of botulinum toxin type A into the external urethral sphincter reduces urethral pressure and postvoid residual urine volume and increases voiding efficiency in patients with neurogenic lower urinary tract dysfunction. However, the need for well-designed randomized studies in larger patient populations with long-term urodynamic follow-up is emphasized.
Contemporary view on the microbiota of kidney stones and urine in patients with urolithiasis: a narrative review
Urolithiasis is a highly prevalent disease with a frequent recurrent course, indicating the limited effectiveness of existing preventive and therapeutic strategies. The revision of the long-standing paradigm of urinary tract sterility, enabled by the advent of high-throughput sequencing technologies, has led to the emergence of the urobiome concept as a complex ecosystem involved in the pathogenesis of urolithiasis. The present review systematizes current data on the role of the microbiota of urine and renal calculi in the pathogenesis of urolithiasis. The analysis demonstrated that urobiome dysbiosis, characterized by reduced alpha diversity and altered proportions of major taxa, represents a pathogenetic factor of lithogenesis rather than its consequence. Metagenomic studies show that the microbiome of kidney stones consists of specific bacterial consortia encapsulated within the mineral matrix. It has been established that different bacterial taxa directly influence stone formation through the production of enzymes initiating the formation of struvite stones (urease) and oxalate-degrading enzymes, with Oxalobacter formigenes being one of the principal producers. An important role in pathogenesis is played by the formation of bacterial biofilms, which serve as a scaffold for microbial colonization and subsequent crystallization. In addition, the role of the gut–kidney axis has been identified, in which intestinal dysbiosis triggers systemic inflammation, disruption of lithogenic metabolite homeostasis, and increased intestinal barrier permeability, collectively creating conditions favorable for lithogenesis. Thus, the available data provide a contemporary and in-depth understanding of the pathogenesis of urolithiasis, in which the microbiota is considered an active pathogenetic factor. Integration of data on the taxonomic and functional status of the urobiome opens new prospects for the development of innovative diagnostic, prognostic, and therapeutic strategies aimed at correcting dysbiosis for the treatment and prevention of urolithiasis recurrence.
Modern aspects of the development and application of drug-eluting ureteral stents: from experimental models to clinical practice
Ureteral stents are widely used in urological practice to restore urinary tract patency in cases of obstruction of various etiologies. However, their use is frequently associated with complications, including urinary tract infections, biofilm formation, encrustation, inflammation, and patient discomfort. Contemporary research is focused on the development of next-generation drug-eluting stents capable of providing localized and sustained release of pharmacologically active agents. This review systematizes current data on modern types of drug-eluting stents used in urology, including those incorporating antibacterial, anti-inflammatory, and antineoplastic agents, and analyzes their effectiveness and limitations. Results of experimental and clinical studies demonstrating the potential of controlled drug-release stents to reduce the risk of infection, hyperplasia, and ureteral strictures are presented. Issues of biocompatibility, material degradation, drug resistance, and future prospects for the implementation of biodegradable and smart stents based on nanotechnology and 3D printing are discussed. The development of such stent designs may substantially improve the efficacy and safety of stenting, enhance patients’ quality of life, and establish a new direction in minimally invasive urologic therapy.
Urethral strictures in historical perspective: from reed catheters to surgical reconstruction
This article presents a historical overview of the evolution of diagnostic and therapeutic approaches to urethral strictures from antiquity to modern surgical technologies. The earliest descriptions of the disease are examined in ancient Egyptian, Indian, and Greek medical treatises, which document primitive methods of catheterization and urethral dilation. Special attention is given to the contributions of prominent historical figures such as Sushruta, Hippocrates, Galen, and Avicenna, as well as to key advances of the Renaissance and early modern period, including the work of Ambroise Paré and John Hunter. The present article provides a detailed description of contemporary treatment methods, including internal optical urethrotomy, anastomotic and substitution urethroplasty using buccal mucosa grafts. The article also describes promising developments in bioengineering, including the use of acellular scaffolds and cellularized grafts. Despite substantial progress in modern medicine, the management of urethral strictures remains associated with postoperative complications and substantial impact on patients’ quality of life. Historical analysis demonstrates that the treatment of urethral strictures has evolved from empirical interventions to highly sophisticated reconstructive techniques; however, the search for optimal therapeutic solutions remains an important challenge.