Currently, due to the dynamic development of surgical technologies, indications for organ-sparing treatment of kidney cancer are expanding. Acute kidney injury is a serious complication that leads to chronic kidney disease, increased postoperative mortality, deterioration of long-term functional outcomes, and increased hospitalization. At present, it is known that even a slight damage to kidneys or their impairment, presented by a decreased urine output and change in blood biochemical parameters, entails serious clinical consequences and is associated with a poor prognosis. Damaging factors, when the kidney is exposed, initially induce molecular changes, which entail the production of certain biomarkers, and only after that clinical aspects of kidney damage develop. The causes of acute kidney injury can be different, from specific renal disorders (acute interstitial nephritis, vascular and glomerular lesions, prerenal azotemia, obstructive disorders) to toxic damages, direct trauma and surgical treatment. The development of acute renal injury in the postoperative period is a serious complication of the surgical treatment of kidney disease, and, according to various authors, the frequency of its occurrence varies from 5.5 % to 34 %. An active study of this problem made it possible to find specific biomarkers that give the possibility to predict and diagnose acute renal injury in the early stages, to optimize the treatment strategy, to reduce the incidence of postoperative complications, and to shorten the period of postoperative rehabilitation. Currently, the most studied of acute kidney injury (AKI) biomarkers are cystatin C, neutrophil gelatinase-associated lipocalin‑2 (NGAL), hepatic protein L-FABP, KIM‑1 (Kidney injury molecule‑1), Interleukin – 18. Further study of AKI biomarkers will make it possible to determine the most significant ones for subsequent use in everyday practice

Background. Renal cell carcinoma is one of the most common urologic cancers. Due to development of modern diagnostic methods, kidney tumors are often diagnosed at early stages (cT1a-T1b). The golden standard of treatment of localized renal cell carcinoma is tumor resection. In retroperitoneoscopic access, the time to artery access is decreased, the risk of intra- and postoperative complications is reduced. Retroperitoneal access is preferable for tumors located on the lateral or posterior kidney surface.Aim. To analyze the results of treatment of patients after retroperitoneoscopic kidney resection.Materials and methods. Between 2018 and 2021, at the A.F. Tsyb Medical Radiological Research Center - branch of the National Medical Research Radiological Center 47 retroperitoneoscopic kidney resections were performed (29 (61.7 %) in men, 18 (38.3 %) in women) due to stage cT1aN0M0 renal cell carcinoma. Retrospective analysis of demographic data, comorbid status, tumor characteristics, operative time, blood loss volume, frequency and severity of complications per the Clavien-Dindo classification was performed. Complexity of resection was evaluated using the R.E.N.A.L. scale.Results. Mean patient age was 63 (38-79) years, body mass index was 29.9 (22-39) kg/m2. Tumor of the left kidney was diagnosed in 24 (51.0 %) cases, of the right kidney - in 22 (46.8 %) cases, bilateral lesions - in 1 (2.2 %) case. Mean tumor size was 22.4 (11-39) mm. Resection had low complexity in 35 (74.5 %) cases, intermediate complexity in 12 (25.5 %) cases. Mean operative time was 156 (80-280) minutes, mean warm ischemia time was 19 (7-32) minutes, number of resections with zero ischemia was 15 (31.9 %), mean blood loss volume was 53 (10-300) mL, number of resections without renal parenchyma suturing was 10 (21.3 %). Mean hospitalization time after surgery was 5 days. Postoperative complications were observed in 4 (8.5 %) cases: bleeding (severity grade II per the Clavien-Dindo classification) in 1 (2.1 %) case, postoperative infectious complications (severity grade II) - in 2 (4.2 %) cases, subcutaneous hematoma (severity grade I) - in 1 (2.1 %) case.Conclusion. Retroperitoneoscopic access is effective and safe. This is confirmed by low frequency and severity of postoperative complications. This access allows to reduce hospitalization time and pain management medication which accelerates patient mobilization and recovery. Comparative analysis shows that retroperitoneoscopic kidney resection has the same effectiveness as laparoscopic resection.

Purpose of the study. Assessment of safety and short‑term effectiveness of high and very high‑risk prostate cancer neoadjuvant chemo‑ hormonal treatment without distant metastases.Patients and methods. Combined hormone chemo‑ radiation treatment of 33 patients with prostate cancer of high and very high risk of progression without distant metastases was performed. Metastases to regional lymph nodes were found in 9 patients according to the examination data (MRI, MSCT), no metastases were detected in 24 patients. All patients underwent combined chemohormonal therapy in the amount of 4 courses of docetaxel intravenously at a dose of 75 mg/m2 every 3 weeks as the first stage of treatment. in combination with androgen deprivation therapy with agonists or antagonists of GnRH before performing radical radiation therapy (combined or remote). All patients underwent neoadjuvant hormone therapy: 16 patients – with the use of GnRH antagonists (Degarelix), 17 – with the use of GnRH agonists (Gozerelin/Leuprorelin/Triptorelin). The toxicity of the presented treatment regimen and its immediate effectiveness – the effect on the level of prostate‑s pecific antigen (PSA), prostate volume, and the quality of urination – were evaluated.Results. Treatment regimen was highly effective concerning PSA decrease (from initial median level 79,67 ng/ml to 1,45 ng/ml after neoadjuvant treatment), all subjects responded well, no non‑responders observed. Median prostate volume decreased from 44 cm3 to 25 cm3 after treatment, which guaranteed availability and safety of further radical radiation treatment. Urinary function was restored in all subject with initial urinary retention.Conclusion. Neoadjuvant chemo‑h ormonal treatment was highly effective in PSA level, prostate volume decrease and functional results improvement which secured further radical radiation treatment in one of its types. Toxicity was acceptable, adverse events did not exceed grade II in most cases and did not lead to treatment discontinuation in any cases, while quality of life remained high enough.

Use of immunotherapy in treatment of muscle-invasive bladder cancer remains the most promising method in case of impossibility of chemotherapy with cisplatin or progression during cisplatin treatment. This approach is the method of choice and can prolong patient’s life. In particular, use of checkpoint inhibitors allows to obtain effective treatment of bladder cancer. However, to prescribe immunotherapeutic medication, patient must have point of application for these drugs. Individualized approach will allow to increase treatment effectiveness and disease prognosis while maximally improving the quality of life.