Publications by authors named "Leonid Rapoport"

48 Publications

Predictive model for systemic recurrence following cisplatin-based neoadjuvant chemotherapy and radical nephroureterectomy for high risk upper tract urothelial carcinoma.

Urol Oncol 2021 Jul 28. Epub 2021 Jul 28.

Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX; Institute for Urology and Reproductive Health, Sechenov University, Moscow.

Introduction: Neoadjuvant chemotherapy (NAC) is increasingly used prior to radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC). Systemic recurrence (SR) carries a dismal prognosis. We sought to determine risk factors associated with SR in this setting.

Methods: We evaluated a multi-center database of patients with UTUC who received cisplatin-based NAC before RNU. Final pathology at RNU was dichotomized into ypT<2 vs ypT≥2. Univariable and multivariable analyses were performed to identify risk factors associated with SR. Three groups were defined based on the number of significant risk factors (groups 1, 2, 3 for 0-1, 2, 3 risk factors, respectively) and evaluated for recurrence-free survival (RFS) using the Kaplan-Meier method.

Results: 106 patients were identified between 2004 and 2018. Median age was 67.0 years [IQR = 61-73.3]; 57 (54%) and 49 (46 %) patients received MVAC and GC, respectively. Final pathological stage was ypT<2 in 57 (54%); 23% (24/106) had SR. On univariable analysis, pathological variables on final specimen including ypT≥2, lymphovascular invasion (ypLVI), and nodal involvement were associated with SR. On multivariable analysis, ypLVI OR = 4.1 (95% CI 1.2-13.6; P = 0.024) and pathological nodal involvement OR = 4.5 (95% CI 1.3-15.7; P = 0.017) were predictive of recurrence. Stratifying by the number of risk factors, the 2-year RFS was 95%, 55%, and 18% for groups 1, 2, and 3 respectively (log-rank <0.001).

Conclusion: This model evaluates the risk of SR following NAC and RNU to guide counseling and decision-making after surgery. Adverse pathological variable including ypLVI and nodal involvement, in combination with ypT-stage, are strongly associated with SR.
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http://dx.doi.org/10.1016/j.urolonc.2021.05.037DOI Listing
July 2021

Laser endoscopic procedures on the prostate: it is the small details that count.

Curr Opin Urol 2021 Jul 6. Epub 2021 Jul 6.

Institute for Urology and Reproductive Health International School "Medicine of the Future", Sechenov University Moscow State University of Medicine and Dentistry Department of Internal Diseases, Sechenov University, Moscow, Russia.

Purpose Of Review: This review aims to highlight the pros and cons of each laser device and to consider additional possible milestones for the development of laser technologies in the surgical treatment of benign prostate hyperplasia.

Recent Findings: Over the last three decades, lasers' role in endourology has gone from strength to strength. Specifically, the primary techniques where laser surgery for BPO relief is concerned are vaporization and enucleation. The idea behind vaporization is that lasers are able to vaporize substantial amounts of tissue due to deep ablation depth and increased power. The most efficient devices for vaporization are those affecting hemoglobin as primary chromophore and/or using a continuous firing mode (KTP/LBO:YAG, diode lasers, Tm:YAG). As for enucleation, multiple devices have been suggested for the adequate anatomical enucleation of the prostate (EEP). As it is a skill-dependent technique, the EEP is effective irrespective of which device the surgeon uses. However, some devices have shown significant advances where enucleation is concerned.

Summary: The choice of device should be based primarily on the technique the surgeon prefers. Although the most suitable lasers for vaporization are hemoglobin-targeting and/or continuous wave devices, the EEP may be done with any enough powered laser, yet some provides specific effects which you should be aware before the surgery.
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http://dx.doi.org/10.1097/MOU.0000000000000919DOI Listing
July 2021

Postoperative medical treatment of lower urinary tract symptoms after benign prostatic hyperplasia surgery. Are we underestimating the problem?

Curr Opin Urol 2021 Jun 25. Epub 2021 Jun 25.

Institute for Urology and Reproductive Health International School 'Medicine of the Future', Sechenov University, Moscow, Russia.

Purpose Of Review: The aim of this study was to determine whether well timed start of medical and surgical treatment of benign prostatic obstruction (BPO) influences the treatment's effectiveness and thus the patients' overall functional outcomes and quality of life.

Recent Findings: Pharmacological therapy even in high-volume (>80 cm3) BPH typically begins with α-blockers sole and only subsequently are 5ARI added. Several studies showed that acute urinary retention (AUR) developed more frequently in men who suffered severe lower urinary tract symptoms (LUTS) and who did not start combination therapy immediately. Moreover, there are no strict criteria which determine the right time for performing surgery in patients with mild and moderate LUTS, especially when pharmacological therapy fails. However, sometimes, the surgery does not eliminate all the symptoms, as it deals effectively with BPO, but does not treat an overactive bladder. Also, data show that surgery should be performed as soon as possible and be more radical after the first episode of AUR.

Summary: A combination of α-blockers and 5ARI makes for a good starting point where the treatment of high volume BPH is concerned. Ideally, surgery should be performed immediately or as soon as possible in patients with the first episode of AUR and 'anatomic' BPH tissue removal is preferable (dissection of tissue along the prostate capsule to remove its maximum volume).
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http://dx.doi.org/10.1097/MOU.0000000000000912DOI Listing
June 2021

3D modeling in adherent perinephric fat prediction in nephron-sparing surgery planning in patients with localized renal neoplasms.

Urologia 2021 Mar 16:3915603211001695. Epub 2021 Mar 16.

Institute of Urology and Reproductive Health, Sechenov University, Moscow, Russia.

Study Objective: To develop a 3D-image based morphometry scoring system for Adherent Perinephric Fat (APF) prediction in nephron-sparing surgery in renal neoplasm patients.

Materials And Methods: The retrospective study involved 391 patients who underwent a laparoscopic partial nephrectomy performed by five surgeons from January 2014 till December 2018. The surgery involved the 3D virtual operation planning with «Amira» 3D modeling software. With the multivariate logistic regression models, we developed a scoring system based on 3D-models. We tested the significance and sensitivity of new scoring system in a comparative ROC analysis with Mayo Adhesive Probability Score (MAP).

Results: We found APF in 111 patients (28.4%). The univariate analysis revealed that significant indicators included mean age 59.88 (55-67) ( < 0.001), male sex ( < 0.001), Body Mass Index (BMI) >30 (21.47-35.08) kg/m ( < 0.001), arterial hypertension ( < 0.001), coronary heart disease ( = 0.019), diabetes mellitus ( = 0.005), urolithiasis ( = 0.002). The multivariate regression analysis identified three most significant indicators in 3D models evaluation: additional >5 mm shadows in perirenal space OR = 7.3 (3.6-15.3) ( < 0.001), the number of shadows >5 OR = 3.8 (2.1-6.8) ( < 0.001), the wide shadow base at the renal parenchymal level OR = 0.293 (0.146-0.588) ( = 0.001). The scoring of these indicators comprises a new prediction scale (0-5). The ROC analysis revealed AUC 0.816 (95% CI 0.772-0.861)  < 0.001 of the MAP score, and AUC = 0.803 (95% CI 0.758-0.848)  < 0.001 of the scoring system developed in the present study.

Conclusions: The statistical findings comparison of the scoring system that we developed with those of MAP scale suggests that the scoring system is efficient and applicable.
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http://dx.doi.org/10.1177/03915603211001695DOI Listing
March 2021

Superselective prostatic artery embolization in the treatment of large benign prostatic hyperplasia.

Urologia 2021 Feb 7:391560321993598. Epub 2021 Feb 7.

Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia.

Purpose: To evaluate the use of prostatic artery embolization (PAE) as a treatment option for patients with symptomatic benign prostatic hyperplasia (BPH) with prostate volumes of 80 cc and more.

Materials And Methods: The study included 75 patients with high anesthesia-related risks for conventional surgery (TURP). All patients were surveyed for symptom burden, using IPSS and quality of life score. The prostate volume was determined by transrectal ultrasonography (TRUS). At baseline, prostate-specific antigen (PSA) level was obtained in all patients. Urodynamics was evaluated using uroflowmetry. Clinical outcomes were assessed at follow-up 1, 3, 6, 12, and 24 months after PAE.

Results: The prostate volume decreased significantly at months 1 and 3 post-treatment; the prostate continued shrinking until month 12, and the size was then stabilized. At month 24, prostate volume decreased by 40.82%, from 134.0 ± 8.3 mL at baseline to 79.3 ± 6.6 mL. Postvoid residual (PVR) urine volume was significantly decreased from 55.9 ± 5.3 mL to 22.0 ± 1.8 mL 1 month after PAE ( < 0.001). Qmax increased from 9.2 ± 0.3 mL/s to 15.7 ± 0.4 mL/s. IPSS score following PAE decreased from 28.2 ± 0.7 to 9.7 ± 0.8 ( < 0.001). QoL improvement was observed from 4.8 ± 0.2 at baseline to 1.8 ± 0.2 at month 24 ( < 0.001). Decreased activity and density of adenomatous tissue resulted in decreased total PSA levels: from 5.9 ± 1.1 ng/mL to 2.6 ± 0.2 ng/mL ( < 0.001). TURP became feasible in 35 patients due to reduction of prostate volumes below 80 mL after PAE.

Conclusions: PAE was effective in relieving LUTS and reducing prostate size, and may be considered as a preoperative approach for patients with large prostate.
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http://dx.doi.org/10.1177/0391560321993598DOI Listing
February 2021

Emergency versus elective ureteroscopy for the management of ureteral stones.

Urologia 2021 Jan 9:391560320987163. Epub 2021 Jan 9.

Department of Urology, A.I. Yevdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia.

Objective: To assess the safety and efficacy of emergency ureteroscopy (URS) compared with elective URS.

Methods: We conducted a retrospective analysis of patients who underwent URS for isolated ureteral stones in a single center from October 2001 to February 2014. Our patient cohort was divided into two groups: an emergency URS group (Group A), which consisted of patients who underwent URS within the first 24 h of admission, and an elective or planned URS group (Group B). The URS success rate was defined as being the incidence of successful stone fragmentation and whether there was resolution of renal obstruction.

Results: A total of 2957 patients' medical records were available for analysis. Of these, 704 (21%) comprised of emergency cases and the remaining 2253 (79%) were elective cases. Patients in Group A were younger, had a smaller BMIs, and had smaller stone sizes ( < 0.001). The URS success rate was found to be 97% in Group A and 96% in Group B ( = 0.35). Intraoperative or postoperative complication rates were not found to vary significantly between the groups (8% vs 7%, respectively,  = 0.50). The incidence of ureteral stenting was nearly twice as high if URS was performed during night hours (85% vs 45%,  < 0.001). However, ureteral stenting was more prevalent in Group B compared to Group A patients (57% vs 25%,  < 0.001), possibly as a result of the number of pre-stented patients (73%).

Conclusions: Emergency URS is an effective and safe option for patients with renal colic. Younger patients without pre-existing obesity and with stone sizes up to 8 mm located in the distal ureter might be a better match for emergency URS.
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http://dx.doi.org/10.1177/0391560320987163DOI Listing
January 2021

Robotic Nephroureterectomy Laparoscopic Nephroureterectomy: Increased Utilization, Rates of Lymphadenectomy, Decreased Morbidity Robotically.

J Endourol 2021 03 16;35(3):312-318. Epub 2020 Nov 16.

Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.

Robotic radical nephroureterectomy (RRNU) may offer advantages over laparoscopic radical nephroureterectomy (LRNU). The purpose of this study is to evaluate the overall survival (OS) of patients with upper tract urothelial carcinoma (UTUC) who underwent RRNU LRNU and identify factors that account for differences. The National Cancer Database was queried from 2010 to 2016 for patients with American Joint Committee on Cancer 6th/7th edition Stage I/II/III UTUC. Kaplan-Meier analysis compared LRNU and RRNU OS. Univariate analysis detected differences between the groups. Cox regression determined factors associated with mortality rate. Logistic regression identified predictors of a lymph node dissection (LND) and 90-day mortality rate. A total of 2631 patients met the criteria, 1129 of whom underwent RRNU and 1502 LRNU, with a follow-up of 33 and 35 months, respectively ( = 0.063). RRNU had a median OS of 71.1 62.6 months ( = 0.033). LRNU patients were older (72.7 71.4,  < 0.001) and had no differences in comorbidities, pathologic T stage, or grade. The LRNU cohort was less likely to undergo LND (19% 35%,  < 0.001) and had a lower median lymph node yield (3 4,  < 0.001). LRNU patients more likely underwent conversion to an open procedure, had longer hospital stays, and higher 30- and 90-day mortality rates. LRNU was independently associated with mortality rate ( = 0.030). Age, grade, positive margins, pT/pN stage were associated with mortality rate. Younger age, RRNU, surgery at an academic center, and neoadjuvant chemotherapy predicted an LND. RRNU demonstrated increased rates of LND and may offer a short-term morbidity benefit to LRNU. Survival differences may be due to improved characterization of disease through LND.
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http://dx.doi.org/10.1089/end.2020.0496DOI Listing
March 2021

Intraoperative prophylactic intravesical chemotherapy to reduce bladder recurrence following radical nephroureterectomy.

Urol Oncol 2020 09 5;38(9):737.e11-737.e16. Epub 2020 Jul 5.

Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX; Research institute of Uronephrology and Human Reproductive Health, I.M Sechenov First Moscow State Medical University, Moscow, Russia. Electronic address:

Purpose: Single, postoperative instillation of prophylactic intravesical chemotherapy (pIVC) is effective in reducing bladder cancer recurrences following radical nephroureterectomy (RNU). Despite high level evidence, pIVC is underutilized. Intraoperative pIVC (I-pIVC) may be easier and safer to implement than postoperative pIVC (P-pIVC). We aimed to evaluate the efficacy of I-pIVC during RNU.

Materials And Methods: Retrospective analysis of patients undergoing RNU and I-pIVC or postoperative pIVC (P-pVC) with 20 to 40 mg mitomycin-C or 1 to 2 g gemcitabine. Recurrence rates were evaluated using the Kaplan-Meier curves and log rank test. Cox regression was used for univariable and multivariable analysis.

Results: One hundred and thirty-seven patients were included in the final analysis. 81% (111/137) had I-pIVC and 19% (26/137) had P-pIVC. In the I-pIVC group higher rates of HG, muscle invasive disease and gemcitabine use were observed. Overall, 74% (101/137) and 26% (36/137) had mitomycin-C and gemcitabine instillations, respectively. Within 12 months 14% (19/137) of the patients experienced bladder recurrence. Median time to bladder recurrence was 7 months (range 3-27). Twelve months bladder recurrence-free survival rates were 82% for the I-pIVC group, and 72% for the P-pIVC group ((log rank P = 0.365).

Conclusions: I-pIVC during RNU may reduce bladder recurrence rates. Bladder recurrence rates are comparable to those reported using postoperative instillations. Intraoperative instillations may be easier to implement and may increase usage rates.
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http://dx.doi.org/10.1016/j.urolonc.2020.05.002DOI Listing
September 2020

Comparative Analysis of Vaporization and Coagulation Properties of a Hybrid Laser (Combination of a Thulium and Blue Diode Laser) Thulium and Ho:YAG Lasers: Potential Applications in Endoscopic Enucleation of the Prostate.

J Endourol 2020 Aug;34(8):862-867

Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia.

To test the characteristics of a hybrid laser (combination of a thulium and blue diode laser) thulium and Ho:YAG lasers regarding soft tissue ablation. Tissue samples of fresh nonfrozen porcine kidneys were used to compare the three lasers. A motorized translation XY stage with a fixed fiber holder to control the speed of cutting (2 and 5 mm/s) was used. Five incisions with each laser were performed. Lactate dehydrogenase staining of the embedded specimens was performed to determine incision depth, zones of vaporization, coagulation zone, carbonization grade, and thermomechanical damage of the coagulated tissue. All data are expressed as mean ± standard deviation. The hybrid laser demonstrated the highest vaporization speed (34.4 ± 0.1 mm/s) and coagulation zones (10 ± 0.1 mm) at a drag speed of 5 mm/s among the investigated lasers. It showed a two to three times larger coagulation zone compared with the Ho:YAG laser (4 ± 0.1 mm). The continuous wave thulium fiber laser (cwTFL) showed a significantly higher grade of carbonized tissue compared with the hybrid and Ho:YAG lasers. The hybrid laser showed deeper incisions and a faster vaporization speed compared with the cwTFL and the Ho:YAG laser. It might be an effective tool to combine the advantages of both lasers to effectively vaporize soft tissue with excellent coagulative properties.
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http://dx.doi.org/10.1089/end.2020.0009DOI Listing
August 2020

Thulium-fiber laser for lithotripsy: first clinical experience in percutaneous nephrolithotomy.

World J Urol 2020 Dec 27;38(12):3069-3074. Epub 2020 Feb 27.

GRC #20 Lithiase Urinaire, Hôpital Tenon, Sorbonne University, Paris, France.

Purpose: To evaluate the efficacy and safety of thulium-fiber laser (TFL) in laser lithotripsy during percutaneous nephrolithotomy (PCNL).

Methods: Patients with stones < 30 mm were prospectively recruited to undergo PCNL using TFL "FiberLase" (NTO IRE-Polus, Russia). Stone size, stone density, operative time, and "laser on" time (LOT) were recorded. Study included only cases managed with fragmentation. Stone-free rate and residual fragments were determined on postoperative computer tomography. Complications were classified using the Clavien-Dindo grade. Stone retropulsion and endoscopic visibility were assessed based on surgeons' feedback using a questionnaire.

Results: A total of 120 patients were included in the study with a mean age of 52 (± 1.8) years; of these 77 (56%) were males. Mean stone size was 12.5 (± 8.8) mm with a mean density of 1019 (± 375) HU. Mean operative time was 23.4 (± 17.9) min and mean LOT was 5.0 (± 5.7) min. Most used settings were of 0.8 J/25-30 W/31-38 Hz (fragmentation). The mean total energy for stone ablation was 3.6 (± 4.3) kJ. Overall stone-free rate was 85%. The overall complication rate was 17%. Surgeons reported stone retropulsion that interfered with surgery in 2 (1.7%) cases insignificant retropulsion was noted in 16 (10.8%) cases. Poor visualization was reported in three (2.5%) cases and minor difficulties with visibility in four (3.3%) cases.

Conclusions: TFL is a safe and effective modality for lithotripsy during PCNL and results in minimal retropulsion.
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http://dx.doi.org/10.1007/s00345-020-03134-xDOI Listing
December 2020

Extracorporeal ureter handling during laparoscopic pyeloplasty: tips and tricks for beginners.

Cent European J Urol 2019 6;72(4):413-417. Epub 2019 Dec 6.

Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia.

Introduction: Laparoscopic preparation of the ureter is a challenging part of upper urinary tract reconstruction, due to limited depth perception provided by the camera and lack of wristed motion of most laparoscopic instruments needed for adequate spatulation and scar tissue removal. One solution has been to perform the more difficult portions of the surgery in an extracorporeal manner. A hybrid intracorporeal-extracorporeal approach to upper tract ureteral reconstruction facilitates ureteral preparation at the stage of mastering the technique.

Material And Methods: This retrospective study included 100 patients with primary ureteropelvic junction obstruction, who underwent laparoscopic pyeloplasty from 2014 to 2017. The patients were stratified into 2 groups: those who underwent conventional laparoscopic surgery and those who were managed with the hybrid approach. For the hybrid approach, externalizing the ureter to skin level required additional mobilization of the upper urinary tract.

Results: A total of 47 patients underwent conventional laparoscopic pyeloplasty and 53 - hybrid surgery. The maximum body mass index was 32. The hybrid approach was 8.5 minutes shorter compared to the conventional approach (p <0.001). No complications higher than Clavien-Dindo IIIb (n = 2) were observed (in both groups). Complete success (the resolution of pain and/or hydronephrosis) was observed in 92.5% in the hybrid group and in 95.7% in the conventional treatment group.

Conclusions: Hybrid pyeloplasty may be considered safe and effective. It has the advantage of making the surgery less challenging and time-consuming while offering improved precision. The advantages of the technique are particularly apparent during training. This technique can be recommended in the learning process of the surgeon.
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http://dx.doi.org/10.5173/ceju.2019.0022DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6979559PMC
December 2019

PTRF independently predicts progression and survival in multiracial upper tract urothelial carcinoma following radical nephroureterectomy.

Urol Oncol 2020 05 18;38(5):496-505. Epub 2019 Dec 18.

Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Department of Urology, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Institute of Medical Science and Technology, National Sun Yat-sen University, Kaohsiung, Taiwan. Electronic address:

Objectives: Polymerase I and transcript release factor (PTRF) has been implicated in cancer biology but its role in upper tract urothelial carcinoma (UTUC) is unknown. From a pilot transcriptome, we identified PTRF was significantly upregulated in high stage UTUC. Bladder cancer transcriptome from The Cancer Genome Atlas (TCGA) supported our finding and high PTRF level also predicted poor survival. We, therefore, investigated the correlation of PTRF with patients' clinicopathologic characteristics and outcomes in a multiracial UTUC cohort.

Materials And Methods: By immunohistochemical staining, PTRF expression was determined using H-score. PTRF expression of 575 UTUCs from 8 institutions, including 118 Asians and 457 Caucasians, was compared with various clinicopathologic parameters. Human urothelial cancer cell lines were used to evaluate the level of PTRF protein and mRNA expression, and PTRF transcript level was assessed in fresh samples from 12 cases of the cohort. The impact of PTRF expression on disease progression, cancer-specific death and overall mortality was also examined.

Results: High PTRF expression was significantly associated with multifocality (P = 0.023), high pathologic tumor stage (P < 0.00001), nonurothelial differentiation (P = 0.035), lymphovascular invasion (P = 0.003) and lymph node metastasis (P = 0.031). PTRF mRNA expression was also markedly increased in advanced stage UTUC (P = 0.0003). High PTRF expressing patients had consistently worse outcomes than patients with low PTRF expression regardless of demographic variation (all P < 0.005). In multivariate analysis, high PTRF expression was an independent predictor for progression-free survival (hazard ratio [HR] 1.70, 95% confidence interval [CI] 1.07-2.69, P = 0.025), cancer-specific survival (HR 2.09, 95% CI 1.28-3.42, P = 0.003), and overall survival (HR 2.04, 95% CI 1.33-3.14, P = 0.001).

Conclusions: Results indicate that PTRF is a predictive biomarker for progression and survival and an independent prognosticator of UTUC. Elevated PTRF could probably propel clinically aggressive disease and serve as a potential therapeutic target for UTUC.
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http://dx.doi.org/10.1016/j.urolonc.2019.11.010DOI Listing
May 2020

Repair of cystocele and apical genital prolapse using 6-strap mesh implant.

Urologia 2020 Aug 16;87(3):130-136. Epub 2019 Dec 16.

Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia.

Objective: To assess the outcomes of surgical repair of anterior apical prolapse using the 6-strap mesh implant.

Study Design: The prospective study included 100 patients with genitourinary prolapse. We used advanced 6-strap mesh implant. The results were assessed at 1 (n = 100) and 12 (n = 93) months after surgery. Maximum follow-up was over 4 years. The anatomical outcomes according to the Pelvic Organ Prolapse Quantification system and intraoperative and postoperative complications were assessed. Stage II and higher prolapse was considered to be a recurrence. The quality of life and sexual function were assessed using Pelvic Organ Prolapse Distress Inventory 20, Pelvic Floor Impact Questionnaire 7, and Pelvic Organ Prolapse/Incontinence Sexual Questionnaire 12.

Results: Median age was 57 years (34-78 years (95% confidence interval)). All patients had stage III cystocele. The anterior vaginal wall descent in all the patients was associated with uterine descent: 37 (37%), stage II; 60 (60%), stage III; in 3 (3%), stage IV. In eight cases, postoperative de novo stress urinary incontinence developed. The quality of life improved in 93 (93%) women as judged by the Pelvic Floor Distress Inventory 20 data and in 87 (87%) women, according to the Pelvic Floor Impact Questionnaire 7 data. The desirable anatomical result (⩽stage I according to the Pelvic Organ Prolapse Quantification system) was achieved in 97 (97%) patients. With the exception of mesh fragment excision due to erosion (grade 3a), all the complications were classified as grade I according to the Clavien-Dindo classification.

Conclusion: Genitourinary prolapse repair using 6-strap mesh is efficacious and relatively safe. The method demonstrates good anatomical results in relation to both anterior and apical prolapses with relatively short-term complications.
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http://dx.doi.org/10.1177/0391560319890999DOI Listing
August 2020

Expression of urokinase-type plasminogen activator system in non-metastatic prostate cancer.

World J Urol 2020 Oct 4;38(10):2501-2511. Epub 2019 Dec 4.

Department of Urology and Comprehensive Cancer Center, Vienna General Hospital, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.

Purpose: To investigate the prognostic role of expression of urokinase-type plasminogen activator system members, such as urokinase-type activator (uPA), uPA-receptor (uPAR), and plasminogen activator inhibitor-1 (PAI-1), in patients treated with radical prostatectomy (RP) for prostate cancer (PCa).

Methods: Immunohistochemical staining for uPA system was performed on a tissue microarray of specimens from 3121 patients who underwent RP. Cox regression analyses were performed to investigate the association of overexpression of these markers alone or in combination with biochemical recurrence (BCR). Decision curve analysis was used to assess the clinical impact of these markers.

Results: uPA, uPAR, and PAI-1 were overexpressed in 1012 (32.4%), 1271 (40.7%), and 1311 (42%) patients, respectively. uPA overexpression was associated with all clinicopathologic characteristics of biologically aggressive PCa. On multivariable analysis, uPA, uPAR, and PAI-1 overexpression were all three associated with BCR (HR: 1.75, p < 0.01, HR: 1.22, p = 0.01 and HR: 1.20, p = 0.03, respectively). Moreover, the probability of BCR increased incrementally with increasing cumulative number of overexpressed markers. Decision curve analysis showed that addition of uPA, uPAR, and PAI-1 resulted in a net benefit compared to a base model comparing standard clinicopathologic features across the entire threshold probability range. In subgroup analyses, overexpression of all three markers remained associated with BCR in patients with favorable pathologic characteristics.

Conclusion: Overexpression of uPA, uPAR, and PAI-1 in PCa tissue were each associated with worse BCR. Additionally, overexpression of all three markers is informative even in patients with favorable pathologic characteristics potentially helping clinical decision-making regarding adjuvant therapy and/or intensified follow-up.
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http://dx.doi.org/10.1007/s00345-019-03038-5DOI Listing
October 2020

Novel thulium fiber laser for endoscopic enucleation of the prostate: A prospective comparison with conventional transurethral resection of the prostate.

Int J Urol 2019 12 22;26(12):1138-1143. Epub 2019 Sep 22.

Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia.

Objective: To compare the efficacy and safety of a novel thulium fiber laser for endoscopic enucleation of the prostate with monopolar transurethral resection of the prostate in patients with smaller glands (<80 cc).

Methods: A total of 51 patients underwent thulium fiber laser enucleation of the prostate, and 52 patients underwent monopolar transurethral resection of the prostate. All patients were assessed preoperatively, and at 3, 6, and 12 months postoperatively (International Prostate Symptom Score, maximum urine flow rate, International Prostate Symptom Score-quality of life). Preoperative prostate volumes and prostate-specific antigen levels were comparable (P = 0.543 and P = 0.078, respectively). The complications were graded according to the Clavien classification.

Results: Mean surgery time was longer in the thulium fiber laser enucleation of the prostate group (46.6 ± 10.2 vs 39.9 ± 8.6 min, P < 0.001), while catheterization and hospital stay were greater in the transurethral resection of the prostate group (P < 0.001). At 12 months, there were no differences in functional outcomes (International Prostate Symptom Score, maximum urine flow rate). Despite comparable prostate volumes at 12 months (P = 0.864), the prostate-specific antigen level in the thulium fiber laser enucleation of the prostate group (0.5 ± 0.5 ng/mL) was lower than in the transurethral resection of the prostate group (1.1 ± 1.0 ng/mL; P < 0.001). Hemoglobin and serum sodium decrease was lower in the thulium fiber laser enucleation of the prostate group (1.01 ± 0.4 g/dL and 1.1 ± 1.1 mmol/L) than in the transurethral resection of the prostate group (1.8 ± 0.8 g/dL and 4.1 ± 1.1 mmol/L; P < 0.001). Urinary incontinence rates at 12 months were comparable (P = 0.316).

Conclusions: Thulium fiber laser enucleation of the prostate with novel thulium fiber laser in patients with smaller prostate glands (<80 cc) is comparable to transurethral resection of the prostate in voiding parameters improvement and complication rates. At the same time, the technique allows for a more substantial prostate-specific antigen decrease, indicating more complete removal of adenoma.
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http://dx.doi.org/10.1111/iju.14115DOI Listing
December 2019

Pathologic response and surgical outcomes in patients undergoing nephrectomy following receipt of immune checkpoint inhibitors for renal cell carcinoma.

Urol Oncol 2019 12 12;37(12):924-931. Epub 2019 Sep 12.

Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX. Electronic address:

Objective: To evaluate the pathologic response, safety, and feasibility of nephrectomy following receipt of immune checkpoint inhibition (ICI) for renal cell carcinoma (RCC).

Methods: Patients who underwent nephrectomy for RCC after exposure to nivolumab monotherapy or combination ipilimumab/nivolumab were reviewed. Primary surgical outcomes included operative time (OT), estimated blood loss (EBL), length of stay (LOS), readmission rates, and complication rates. Pathologic response in the primary and metastatic sites constituted secondary outcomes.

Results: Eleven nephrectomies (10 radical, 1 partial) were performed in 10 patients after ICI with median postoperative follow-up 180 days. Six patients received 1 to 4 cycles of ipilimumab/nivolumab, while 5 received 2 to 12 infusions of nivolumab preoperatively. Five surgeries were performed laparoscopically, and 4 patients underwent concomitant thrombectomy. One patient exhibited complete response (pT0) to ICI, and 3/4 patients who underwent metastasectomy for hepatic, pulmonary, or adrenal lesions exhibited no detectable malignancy in any of the metastases resected. No patients experienced any major intraoperative complications, and all surgical margins were negative. Median OT, EBL, and LOS were 180 minutes, 100 ml, and 4 days, respectively. Four patients experienced a complication, including 3 that were addressed with interventional radiology procedures. One patient died of progressive disease >3 months after surgery, and 1 patient succumbed to pulmonary embolism complicated by sepsis. No complications or readmissions were noted in 6 patients.

Conclusion: Nephrectomy following ICI for RCC is safe and technically feasible with favorable surgical outcomes and pathologic response. Timing of the nephrectomy relative to checkpoint dosing did not seem to impact outcome. Biopsies of lesions responding radiographically to ICI may warrant attention prior to surgical excision.
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http://dx.doi.org/10.1016/j.urolonc.2019.08.012DOI Listing
December 2019

Effect of optical fiber diameter and laser emission mode (cw vs pulse) on tissue damage profile using 1.94 µm Tm:fiber lasers in a porcine kidney model.

World J Urol 2020 Jun 12;38(6):1563-1568. Epub 2019 Sep 12.

Department of Urology, Asklepios Hospital Barmbek, Rübenkamp 220, 22291, Hamburg, Germany.

Purpose: To evaluate the ablation capacity using two Thulium fiber lasers (TFL) in a porcine kidney model.

Methods: All tissue samples were mounted on a motorized stage for a precise speed of cutting. A continuous wave (cw) TFL and a super pulsed (SP) TFL were used at power settings of 60 and 120 W with 200 and 600 µm laser fibers. After lactate dehydrogenase staining, histological evaluation was performed to measure the vaporization volume (VV), ablation depth (AD), thermo-mechanical damage zones (TMZ), coagulation zones (CZ) and the carbonization grade (CG).

Results: At 120 W, no significant differences were seen between 200 and 600 µm fibers utilizing the cw TFL regarding VV (24.6 vs. 28.2 mm/s), AD (5.6 vs. 5.7 mm), TMZ (0 vs. 0 mm) and CZ (18.1 vs. 12.3 mm). Using the SP TFL, no significant differences between both fiber diameters with regard to VV (4 vs. 6.2 mm/s), AD (2.7 vs. 3.4 mm), TMZ (1 vs. 2.6 mm) and CZ (3.1 vs. 2.2 mm) at 120 W were found, respectively. However, the VV of the cw TFL at 60 W was significantly less compared to 120 W using 200 and 600 µm fibers, respectively, whereas the SP TFL did not show significant differences between 60 and 120 W with regard to VV. SP TFL showed a consistently lower CG compared to cw TFL.

Conclusions: This experiment suggests that there is no significant difference using 200 or 600 µm laser fibers in cw or SP TFLs. However, the cw TFL produces a coagulation zone three to five times larger than the SP TFL regardless of the fiber diameter.
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http://dx.doi.org/10.1007/s00345-019-02944-yDOI Listing
June 2020

Preoperative predictive model and nomogram for disease recurrence following radical nephroureterectomy for high grade upper tract urothelial carcinoma.

Urol Oncol 2019 10 2;37(10):758-764. Epub 2019 Aug 2.

Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX. Electronic address:

Purpose: To identify preoperative risk factors for disease recurrence, following radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC), and to create a predictive nomogram.

Materials And Methods: Based on a multicenter database, we identified patients who underwent RNU due to high grade UTUC. Urothelial carcinoma of the bladder or contralateral UTUC was not considered as recurrence. Cox regression model was used to determine the effect of different preoperative variables as predictors of recurrence.

Results: Two hundred and forty-five patients were included in the analysis. The 2 and 5 years recurrence rates were 16.3% and 19.2%, respectively. Factors associated with recurrence on univariable analysis were sessile architecture hazard ratio (HR) 3.16 (95% CI, 1.38-7.26, P = 0.006), ≥cT3 disease HR 2.30 (95% CI, 1.12-4.72, P= 0.023), age >65 HR 2.02 (95% CI, 1.00-4.05, P= 0.048), Eastern Cooperative Group > 0 HR 1.98 (95% CI, 1.09-3.57, P= 0.023), hydronephrosis HR 1.93 (95% CI, 1.04-3.57, P= 0.035). Higher hemoglobin levels HR 0.81 (95% CI, 0.69-0.96, P= 0.013) and preoperative estimated glomerular filtration rate ≥ 50 HR 0.48 (95% CI, 0.25-0.92, P = 0.028) were associated with lower probability for recurrence. Multivariable analysis identified sessile architecture as the only independent predictor of recurrence HR 2.52 (95% CI, 1.09-5.86, P= 0.0308). C-index of 0.71 was calculated for a predictive model including all variables in the multivariable analysis, indicating good predictive accuracy. A nomogram predicting 2 and 5 year recurrence free probability was developed accordingly.

Conclusions: Based on a multicenter database, we developed a nomogram with good predictive accuracy for recurrence following RNU. This may serve as an aid in decision-making regarding the use of neoadjuvant chemotherapy.
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http://dx.doi.org/10.1016/j.urolonc.2019.06.009DOI Listing
October 2019

Prognostic role of the urokinase plasminogen activator (uPA) system in patients with nonmuscle invasive bladder cancer.

Urol Oncol 2019 10 27;37(10):774-783. Epub 2019 Jun 27.

Department of Urology, Medical University of Vienna, Vienna, Austria; Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia; Department of Urology, Weill Cornell Medical College, New York, NY; Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX; Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria. Electronic address:

Objectives: To assess the role of the urokinase plasminogen activator (uPA) system as a prognostic biomarker in patients with nonmuscle invasive bladder cancer (NMIBC) treated with transurethral resection of the bladder (TURB) with or without adjuvant intravesical therapy.

Material And Methods: We stained TURB tissue from 827 NMIBC patients with uPA, its receptor (uPAR) and its inhibitor (PAI-1). The status of these markers was categorized as normal vs. overexpressed using the cutoffs of 30% for uPA, 50% for uPAR, and 30% for PAI-1. Multivariable Cox regression analyses were performed to evaluate the prognostic value of these markers.

Results: uPA was overexpressed in 37.7% of patients, uPAR in 44.7% and PAI-1 in 44.6%. Overexpression of these markers was associated with high tumor grade. Within a median follow-up was 60 months (interquartile range: 22-109), uPA (hazard ratio [HR]: 1.40; P = 0.006), uPAR (HR: 1.70; P < 0.001), PAI-1 (HR: 1.35; P = 0.014), and the combination of all 3 markers (HR: 3.38; P < 0.001) were associated with recurrence-free survival (RFS); uPA (HR: 1.68; P = 0.035) and the combination of all 3 markers (HR: 8.79; P = 0.005) were associated with progression-free survival (PFS). The addition of the uPA system to a base model improved the discrimination by 1.3% for RFS and 2.1% for PFS. In subgroup analyses, uPA (HR: 2.19; P = 0.018) was associated with PFS in T1G3 patients and its addition to a base model improved the discrimination by 2.5%. uPA (HR: 1.44; P = 0.019), uPAR (HR: 1.54; P = 0.006), PAI-1 (HR: 1.46; P = 0.013) and the combination of all 3 markers (HR: 3.48; P < 0.001) were associated with RFS in TaG1-2 patients and their addition to a base model improved the discrimination by 2.1%.

Conclusion: uPA, uPAR, and PAI-1 are overexpressed in one-third to half of patients with NMIBC. Their overexpression is an independent prognosticator of RFS and PFS which improved the predictive accuracy of current clinicopathological characteristics. Biomarkers that capture the biological and clinical behavior of individual tumors may help personalize clinical decision-making in patients with NMIBC.
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http://dx.doi.org/10.1016/j.urolonc.2019.05.019DOI Listing
October 2019

The clinical role of X-ray computed tomography to predict the clinical efficiency of extracorporeal shock wave lithotripsy.

Urologia 2019 May 26;86(2):63-68. Epub 2018 Mar 26.

1 I.M. Sechenov First Moscow State Medical University, Moscow, Russia.

Aim: To evaluate the clinical efficiency of computed tomography for diagnostics of patients with urolithiasis and the choice of treatment strategy.

Material And Methods: The study was carried out at the Urological Clinic of I.M. Sechenov First Moscow State Medical University and included 1044 patients with urinary stones. The ultimate goal of this study was to predict the clinical efficiency of extracorporeal shock wave lithotripsy using a combination of computed tomography and densitometry. Extracorporeal shock wave lithotripsy was performed on "Siemens Lithostar Plus," "Siemens Modularis Uro," and "Dornier Gemini" lithotripters. Statistical analysis of clinical data included evaluation of individual sampling groups and calculation of weighted arithmetic mean ( M).

Results: The efficiency of extracorporeal shock wave lithotripsy has been determined primarily using X-ray analysis of the concrement outlines and the structure (homogeneous or heterogeneous) of its central zone. However, in terms of efficiency and repetition rate (the number of fragmentation procedures required for complete clearance) of extracorporeal shock wave lithotripsy, the mean density of the concrement along the whole length of its three-dimensional structure (expressed in Hounsfield units) appeared to be the most reliable and informative predictive index in this study.

Conclusion: The combination of computed tomography with densitometry in the treatment of patients with urolithiasis allows one (1) to determine the exact localization, size, X-ray structure, and structural density of urinary stones and (2) to predict, on the basis of densitometric data histograms, the clinical efficiency and repetition rate of extracorporeal shock wave lithotripsy with due regard to the X-ray structure of peripheral and central zones, and mean density (in Hounsfield units) of urinary concrements.
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http://dx.doi.org/10.1177/0391560317749422DOI Listing
May 2019

Holter Monitoring (24-Hour ECG) Parameter Dynamics in Patients with Ischemic Heart Disease and Lower Urinary Tract Symptoms Due to Benign Prostatic Hyperplasia.

Adv Ther 2019 08 30;36(8):2072-2085. Epub 2019 May 30.

Institute for Urology and Human Reproductive Health, I. M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia.

Introduction: This study examined the dynamics of 24-h electrocardiogram (ECG) monitoring parameters (Holter monitoring) in patients with ischemic heart disease (IHD) before and after conservative or surgical treatment of patients with voiding and storage lower urinary tract symptoms (LTS) due to benign prostatic hyperplasia (BPH).

Methods: A total of eighty-three 57 to 81-year-old (mean age 70.4 ± 5.75 years) patients with LUTS/BPH and accompanying IHD were examined and treated at the Institute of Urology and Human Reproductive Health and Clinic of Cardiology of Sechenov University. All patients received recommended cardiac therapy at least 6 months before inclusion in the study.

Results: Our study demonstrated that there is correlation between voiding and storage LUTS/BPH and Holter-detected cardiac impairments in patients with IHD/BPH. These data make it possible to consider LUTS/BPH (voiding and storage) as a factor in the additional functional and psychological load on the activity of patients with ischemic heart disease. Improvement of voiding and storage LUTS due to BPH and objective parameters of urination (Q) in patients treated with alpha-1 adrenoceptor blocker tamsulosin correlated with improvement of 24-h ECG monitoring parameters (Holter monitoring) in 72% of patients. Improvement of 24-h ECG monitoring parameters (Holter monitoring) 1 month after transurethral resection of the prostate (TURP) in IHD/BPH patients and indications for surgical treatment was observed in 65.7%. Negative dynamics of the Holter-based ECG was not registered in patients who were operated on.

Conclusion: Holter monitoring helps to identify groups of patients in whom urinary impairments caused by prostatic hyperplasia negatively affect the course of IHD. Restored urination (either conservatively or operatively) in patients with BPH in 72% of cases decreased the number of fits of angina, thus influencing favourably the course of IHD.

Trial Registration: ClinicalTrials.gov Identifier: NCT03856242.
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http://dx.doi.org/10.1007/s12325-019-00977-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6822867PMC
August 2019

Preclinical comparison of superpulse thulium fiber laser and a holmium:YAG laser for lithotripsy.

World J Urol 2020 Feb 4;38(2):497-503. Epub 2019 May 4.

IPG Photonics, 50 Old Webster Rd, Oxford, MA, 01540, USA.

Purpose: A superpulse (500 W peak power) thulium fiber laser operating at a 1940 nm wavelength, suitable for lithotripsy, has recently been developed. The goal of this study was to compare stone fragmentation and dusting performance of the prototype superpulse thulium fiber laser with leading commercially available, high-power holmium:YAG lithotripters (wavelength 2100 nm) in a controlled in vitro environment.

Methods: Two experimental setups were designed for investigating stone ablation rates and retropulsion effects, respectively. In addition, the ablation setup enabled water temperature measurements during stone fragmentation in the laser-stone interaction zone. Human uric acid (UA) and calcium oxalate monohydrate (COM) stones were used for ablation experiments, whereas standard BegoStone phantoms were utilized in retropulsion experiments. The laser settings were matched in terms of pulse energy, pulse repetition rate, and average power.

Results: At equivalent settings, thulium fiber laser ablation rates were higher than those for holmium:YAG laser in both dusting mode (threefold for COM stones and 2.5-fold for UA stones) and fragmentation mode (twofold for UA stones). For single-pulse retropulsion experiments, the threshold for onset of stone retropulsion was two to four times higher for thulium fiber laser. The holmium:YAG laser generated significantly stronger retropulsion effects at equal pulse energies. The water temperature elevation near the laser-illuminated volume did not differ between the two lasers.

Conclusions: Distinctive features of the thulium fiber laser (optimal wavelength and long pulse duration) resulted in faster stone ablation and lower retropulsion in comparison to the holmium:YAG laser.
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http://dx.doi.org/10.1007/s00345-019-02785-9DOI Listing
February 2020

Mobility of Yield Stress Fluids on Lubricant-Impregnated Surfaces.

ACS Appl Mater Interfaces 2019 May 22;11(17):16123-16129. Epub 2019 Apr 22.

Department of Mechanical Engineering , Massachusetts Institute of Technology , Cambridge , Massachusetts 02139 , United States.

A common problem which we encounter on a daily basis is dispensing of yield stress fluids such as condiments, lotions, toothpaste, etc. from containers. Beyond consumer products, assuring the flow of yield stress fluids such as crude oil, mud, blood, paint, pharmaceutical products, and others, is essential for the respective industries. Elimination of wall-induced friction can lead to significant savings in the energy required for flow of yield stress fluids, as well as associated product loss and cleaning costs. Lubricant-impregnated surfaces (LIS) have been shown to change the dynamic behavior of yield stress fluids and enable them to flow without shearing. Despite the wide applicability of this technology and its general appeal, the fundamental physics governing the flow of yield stress fluids on LIS have not yet been fully explained. In this work, we study the mobility of yield stress fluids on LIS, and explain the relationship between their macroscale flow behavior and the microscale properties of LIS. We show that for yield stress fluids the thermodynamic state of an LIS can be the difference between mobility and immobility. We demonstrate that LIS can induce mobility in yield stress fluids even below their yield stress allowing them to move as a plug without shearing with an infinite slip length. We identify different mobility mechanisms and establish a regime map for drag reduction in terms of the shear stress to yield stress ratio and the microscopic properties of the LIS. We demonstrate these regimes in a practical application of pipe flow thereby providing key insights for the design of LIS to induce mobility of yield stress fluids in a broad range of practical applications.
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http://dx.doi.org/10.1021/acsami.8b21478DOI Listing
May 2019

Monopolar enucleation versus transurethral resection of the prostate for small- and medium-sized (< 80 cc) benign prostate hyperplasia: a prospective analysis.

World J Urol 2020 Jan 8;38(1):167-173. Epub 2019 Apr 8.

Institute for Urology and Reproductive Health, Sechenov University, 2/1 Bolshaya Pirogovskaya St, Moscow, 119991, Russian Federation.

Aim: To assess efficacy and safety of monopolar enucleation of the prostate (MEP) and to compare it with the current treatment standard for medium-sized prostates, < 80 cc, transurethral resection of the prostate (TURP).

Methods: A prospective analysis patients undergoing a surgical procedure for their diagnosis of BPH (benign prostatic hyperplasia) (IPSS > 20, Q < 10; prostate volume < 80 cc) was performed. IPSS, Q were assessed preoperatively, at 6 and 12 months postoperatively. The complications were classified according to the modified Clavien-Dindo grading system.

Results: A total of 134 patients were included in the study: 70 underwent MEP and 64 - TURP for BPH (mean prostate volumes were comparable with p = 0.163). The mean surgery time was 44 min in the TURP group and 48.2 min in the MEP group, (p = 0.026). Catheterization time for MEP was 1.7 and 3.2 days for TURP (p < 0.001). Hospital stay for MEP was 3.2 days vs. 4.8 days for TURP (p < 0.001). Both techniques shown comparable efficiency in benign prostatic obstruction relief with IPSS drop in MEP from 23.1 to 5.9 and in TURP group from 22.8 to 7.3, whereas Q increased from 8.2 to 20.5 after MEP and from 8.3 and 19.9 after TURP. Urinary incontinence rate after catheter removal in TURP group was 9.0% and 7.8% in MEP group, at 1 year follow-up, it was 1.4% and 3.1% in MEP and TURP, respectively (p = 0.466).

Conclusions: Our experience demonstrated that MEP is an effective and safe BPH treatment option combining the efficacy of endoscopic enucleation techniques and accessibility of conventional TURP.
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http://dx.doi.org/10.1007/s00345-019-02757-zDOI Listing
January 2020

Focal Neuroendocrine Differentiation of Conventional Prostate Adenocarcinoma as a Prognostic Factor after Radical Prostatectomy: A Systematic Review and Meta-Analysis.

Int J Mol Sci 2019 Mar 19;20(6). Epub 2019 Mar 19.

Institute for Urology and Reproductive Health, Sechenov University, Moscow 119991, Russia.

The biologic and prognostic value of focal neuroendocrine differentiation (NED) in conventional prostate adenocarcinoma (PC) patients who undergo radical prostatectomy (RP) remains controversial. In this systematic review and meta-analysis, we assessed the association of focal NED in conventional PC with oncological outcomes after RP. A literature search using PubMed, Scopus, Web of Science, and Cochrane Library was conducted on December 2018 to find relevant studies according to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. We used a fixed-effect model to analyze the impact of focal NED in RP specimen on progression-free survival defined by biochemical recurrence (BCR). A total of 16 studies with the outcomes of disease progression and survival were eligible. No patient in these studies received androgen deprivation therapy prior to RP. Eleven studies found no significant correlation between focal NED and outcomes of interest, while five studies reported a significant association of focal NED assessed by immunohistochemical chromogranin A or serotonin staining with BCR or survival. Focal NED was associated with higher BCR rates after RP with a pooled HR of 1.39 (95% CI 1.07‒1.81) in five studies. No heterogeneity was reported in this analysis (I² = 21.7%, = 0.276). In conclusion, focal NED in conventional PC is associated with worse prognosis after RP. Its presence should be reported in pathologic reports and its true clinical impact should be assessed in well-designed prospective controlled studies.
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http://dx.doi.org/10.3390/ijms20061374DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6471399PMC
March 2019

Radical prostatectomy performed via robotic, transperitoneal and extraperitoneoscopic approaches: functional and early oncological outcomes.

Cent European J Urol 2018 30;71(4):378-385. Epub 2018 Oct 30.

Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia.

Introduction: Oncological remission along with high postoperative functionality [continence and erectile function (EF)] are the main aspects of prostate cancer (PCa) treatment. The aim of this study was to compare functional and oncological treatment results achieved after a nerve-sparing radical prostatectomy (RP) via transperitoneal (TPRP), extraperitoneal (EPRP) and robot-assisted (RARP) approach.

Material And Methods: From March 2015 to March 2016, 507 RP were performed at the Institute for Urology and Reproductive Health (Moscow, Russia). A total of 264 patients with localized (cТ1а-2с) prostate cancer [prostate-specific antigen (PSA) <20 ng/ml, Gleason score ≤7], intact prostate capsule (according to MRI), International Index of Erectile Function (IIEF-5) ≥19 and a life expectancy >10 years were included into the retrospective study. All the surgeries were performed by a single surgeon. The outcomes were evaluated after urethral catheter removal and 3-6-12 months after RP.

Results: Nerve preservation (NP) was performed for 153 patients without significant distinctions in time (р = 0.064) and blood loss (р = 0.073). The International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-SF) score was lower for NP: 9.23 ±6.59 and 3.86 ±5.38 after 3 and 12 months respectively compared with continence after RP without nerve preservation (NP): 14.27 ±5.1 vs. 6.15 ±4.76 (р <0.001). Continent was 52.2% vs. 83.3% vs. 81.8% in TPRP, RARP and EPRP groups; р <0.001. IIEF-5 scores were 14.67 ±9.4, 4.2 ±4.26 and 4.0 ±2.07 after RARP, TPRP and EPRP respectively (р = 0.002). After 12 months the PSA: TPRP = 0.11 ±0.19, RARP = 0.03 ±0.05 and EPRP = 0.53 ±1.87 ng/ml (р <0.001). Outcomes depend on surgical approach and was better in the RARP-group (AUC = 0.768 ±0.034 (CI 95% 0,701-0.834; р <0.001).

Conclusions: We suggest RARP with NP as a method of choice for treatment of prostate cancer in patients interested in preservation of EF and quality of life in general.
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http://dx.doi.org/10.5173/ceju.2018.1739DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6338822PMC
October 2018

Novel Thulium Fiber Laser for Enucleation of Prostate: A Retrospective Comparison with Open Simple Prostatectomy.

J Endourol 2019 01;33(1):16-21

1 Institute of Urology and Reproductive Health, Sechenov University, Moscow, Russia.

Introduction: The objective of this study was to assess the efficacy and safety of novel thulium fiber laser enucleation of the prostate (ThuFLEP) vs conventional open simple retropubic prostatectomy (OP) for large volume benign prostatic hyperplasia (BPH).

Methods: We performed a retrospective review of patients who underwent surgical treatment for large volume BPH (>80 cc) from 2015 to 2017. Preoperative patient examination included the assessment of functional parameters: International Prostate Symptom Score (IPSS), quality of life (QoL), maximum urine flow rate (Q), and postvoid residual urine volume. The hemoglobin level was measured before and after the operation.

Results: A total of 130 patients were included in the study. Of these, 40 patients underwent OP, and 90 patients underwent ThuFLEP. Groups were similar in terms of preoperative functional parameters (IPSS, QoL, and Q). The mean operative time was comparable for both procedures (p = 0.285) as well as the mass of adenomatous tissue resected (p = 0.412). Resection speed was comparable (OP-0.9 vs ThuFLEP-1.0 g/min, p = 0.52). Patients in OP had significantly longer catheterization time and length of hospital stay (9.0 days vs 3.3 days, p < 0.001). At 6 months, stress urinary incontinence rate were 1.1% after ThuFLEP and 2.5% after OP.

Conclusions: Despite the equally high efficacy of both modalities for infravesical obstruction due to BPH, ThuFLEP is a minimally invasive modality that is associated with a shorter hospital stay, a significantly greater return to normal activities, and a considerable reduction in rehabilitation time. Our results demonstrated that the ThuFLEP is a highly efficacious, minimally invasive modality for the management of BPH in large volume glands (>80 cc).
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http://dx.doi.org/10.1089/end.2018.0791DOI Listing
January 2019

Risk factors for urethral stricture and/or bladder neck contracture after monopolar transurethral resection of the prostate for benign prostatic hyperplasia.

Urologia 2018 Nov 4;85(4):150-157. Epub 2018 Apr 4.

1 Sechenov First Moscow State Medical University, Moscow, Russia.

Objective:: To identify risk factors for urethral stricture and/or bladder neck contracture after transurethral resection of benign prostatic hyperplasia.

Materials And Methods:: We performed a retrospective analysis of 402 patients, which underwent a monopolar transurethral resection of the prostate in the urology clinic of Sechenov First Moscow State Medical University for prostatic hyperplasia during the period 2011-2014. Urethral stricture and (or) bladder neck contracture in the postoperative period were diagnosed in 61 (15.27%) patients; 34 patients (8.6%) had urethral stricture, 20 (4.97%) bladder neck contracture, and 7 (1.7%) had a combination of urethral stricture and bladder neck contracture. In 341 of cases (84.73%), no late postoperative complications were observed. A total of 106 of the 341 patients met the inclusion criteria, hence, containing all the information necessary for analysis such as the volume of the prostate, the duration of the surgery, the size of the endoscope, data on concomitant diseases, analysis prostatic secretion, and so on. Thus, two groups were formed. Group 1 (106 patients) is the control group in which urethral strictures and/or bladder neck contractures did not occur in the long-term postoperative period and group 2 (61 patients), in which was observed the formation of these complications. To calculate the statistical significance of the differences for categorical data, Fisher criterion was used. For quantitative variables, in the case of normal data distribution, an unpaired t-test or one-way analysis of variance was used; for data having a distribution different from normal, a Mann-Whitney rank test was used.

Results:: Regression analysis established the significance of the influence of four factors on the development of scar-sclerotic changes of urethra and bladder neck: the tool diameter 27 Fr ( p < 0.0001), presence of prostatitis in past medical history ( p < 0.0001), prostate volume ( p = 0.003), and redraining of the bladder ( p = 0.0162).

Conclusion:: The relationship between the diameter of the instrument, presence of chronic prostatitis in anamnesis, increased volume of the prostate, and repeated drainage of the bladder using the urethral catheter with the risk of developing scar-sclerotic changes in the urethra and/or bladder neck are statistically reliable and confirmed as a result of regression analysis.
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http://dx.doi.org/10.1177/0391560318758195DOI Listing
November 2018

Need for upper urinary tract stenting in cases of ureteral orifice injury during laser enucleation of the prostate.

Int Urol Nephrol 2018 Dec 22;50(12):2173-2177. Epub 2018 Oct 22.

Department of Urology, UT Southwestern Medical Center, Dallas, TX, USA.

Introduction: Benign prostatic hyperplasia (BPH) can be associated with marked intravesical protrusion, placing ureteral orifices at risk for injury during bladder outlet procedures.

Aim: To determine whether ureteral stenting is necessary in cases of ureteral orifice injury during laser enucleation.

Materials And Methods: Retrospective study included 465 patients with bladder outlet obstruction (IPSS > 20, Qmax < 10) secondary to BPH who were managed with thulium fiber laser (ThuFLEP) or holmium laser enucleation of the prostate (HoLEP). In seven patients, the ureteral orifices were injured during surgery (3-HoLEP; 4-ThuFLEP). Three of the seven patients underwent intraoperative stenting of the upper urinary tract (1-HoLEP; 2-ThuFLEP). In four cases, stenting was not performed (2-HoLEP; 2-ThuFLEP). The follow-up period was 6 months.

Results: Postoperatively, none of the patients with a stent in the upper urinary tract exhibited signs of pelvicalyceal system (PCS) dilatation or inhibited urine flow from the kidney (assessed with abdominal ultrasound at 1, 3, 10, and 30 days after surgery). In two patients without stents, follow-up revealed no dilatation of the PCS. The other two patients without stents developed asymptomatic dilatation of the PCS (the pelvis-up to 1.5 cm; the calyx-up to 0.5 cm). At 1 month after surgery, no patients had dilatation of the PCS.

Conclusions: Upper urinary tract stenting in cases of intraoperative ureteral orifice injury during laser enucleation of the prostate for BPH may not be warranted.
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http://dx.doi.org/10.1007/s11255-018-2007-6DOI Listing
December 2018

Impact of endoscopic enucleation of the prostate with thulium fiber laser on the erectile function.

BMC Urol 2018 Oct 12;18(1):87. Epub 2018 Oct 12.

Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia.

Background: The impact of number of endoscopic enucleation of the prostate techniques (holmium laser enucleation - HoLEP for example) on erectile function have already been investigated. However, the thulium-fiber laser, in this setting remains unstudied. In this study, we compared sexual function outcomes in patients with benign prostatic hyperplasia (BPH) treated with transurethral resection of the prostate (TURP) or thulium-fiber laser enucleation (ThuFLEP).

Methods: We performed a retrospective analysis of patients who underwent transurethral resection and endoscopic enucleation of the prostate for BPH; inclusion criteria was the presence of infravesical obstruction (IPSS > 20, Qmax < 10 mL/s). Erectile function (EF) was assessed using the International Index of Erectile Function (IIEF-5) both prior to endoscopic examination, and six months after.

Results: A total of 469 patients with BPH were included in the study; of these, 211 underwent to ThuFLEP, and 258 TURP. Preoperative IIEF-5 in TURP and ThuFLEP groups were 11.7 (±4.5) and 11.1 (±5.0), respectively (p = 0.17). At six month the IIEF-5 score was unchanged (p = 0.26 and p = 0.08) and comparable in both groups (p = 0.49). However, mean IIEF-5 score shown significant increase of 0.72 in ThuFLEP group, comparing to decrease of 0.24 in TURP patients (p < 0.001).

Conclusions: Both TURP and ThuFLEP are effective modalities in the management of infravesical obstruction due to BPH. At six months follow-up after surgery, both techniques lead to comparable IIEF-5 score. However, our results demonstrated that the ThuFLEP is more likely to preserve the erectile function leading to increase of IIEF-5 at six months in contrast to TURP which lead to slight drop in IIEF-5 score.
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http://dx.doi.org/10.1186/s12894-018-0400-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6186032PMC
October 2018
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