Urology reports (St. - Petersburg)

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.

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.

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 (Q_max ≥ 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.

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.

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.

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.

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.

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.