Anushavan O. Papoian

BACKGROUND: Stress urinary incontinence remains a prevalent medical and social issue that significantly reduces women’s quality of life. Despite their high efficacy, synthetic slings are associated with a risk of complications related to limited biocompatibility of materials. Allografts are a promising approach in surgical treatment of stress urinary incontinence because of their high strength, minimal immunogenicity, and reduced risk of postoperative complications. AIM: The work aimed to improve the outcomes of surgical treatment of stress urinary incontinence in women using a combined allogeneic–synthetic suburethral sling. METHODS: The study included 51 female patients with stress urinary incontinence who underwent suburethral loop plasty (TVT-O) using a newly developed combined allogeneic–synthetic sling. The outcomes were evaluated at 1 to 12 months postoperatively using both subjective (validated questionnaires) and objective diagnostic methods (including the cough test, ultrasonography, comprehensive urodynamic studies, and magnetic resonance imaging). RESULTS: The study demonstrated high efficacy and safety of the combined allogeneic–synthetic sling in surgical treatment of stress urinary incontinence. The findings confirmed favorable biomechanical properties of the implant, a significant improvement in patients’ quality of life (ICIQ-SF and PISQ-12 scores), and the absence of erosive complications. Magnetic resonance imaging findings indicated complete biological remodeling of the allogeneic component with the formation of functional connective tissue 12 months postoperatively. CONCLUSION: A combined sling containing a biocompatible allogeneic component (Alloplant) significantly improves surgical treatment outcomes in stress urinary incontinence. Strategic placement of the biological material in the periurethral zone minimizes the risk of rejection and erosive complications, improves functional outcomes (lower risk of dyspareunia and de novo overactive bladder), and promotes physiological tissue remodeling with the formation of a mature connective tissue regenerate within 6–12 months.

Introduction. Prostate cancer (PCa) is one of the most common oncological diseases, the tactics of its treatment directly depends on the stage. According to statistics, prostate cancer (prostate cancer) accounts for more than 1.4 million new cases annually. The «gold» standard at the moment for localized prostate cancer is surgical intervention in the volume of radical robot-assisted prostatectomy. The aim was to development technologies for calculating the trajectory of movements of the traveled path of surgical instruments during robot-assisted radical prostatectomy; devalopment and implementation of an «active» robot system into the learning process, and later into the workflow; devalopment of a self-monitoring system for a surgeon in self-study. Materials and methods. On the basis of the Bashkir State Medical University clinic, 30 surgical robot-assisted radical prostatectomies performed by two surgeons were analyzed, of which surgeon 1 performed 14 surgical interventions and surgeon 2 performed 16 surgical interventions. Results. During the analysis, data were obtained on the average duration of the operation of robot-assisted radical prostatectomies, the movement time of robotic instruments. Conclusion. The study of the analysis of the time of movement of instruments is an important step towards optimizing resources and improving the efficiency of the medical process.

Introduction. Robot-assisted radical prostatectomy is considered to be the “gold standard” for the radical treatment of prostate cancer, achieving excellent oncological outcomes with a low incidence of complications.Aim. To analyze and compare the efficiency of Da Vinci Xi and Da Vinci Si surgical systems applied in performing robot-assisted radical prostatectomy. Materials and methods. 165 patients were divided into two groups: Xi-group (n = 77) and Si-group (n = 88). The perioperative characteristics and oncological outcomes were analyzed and compared.Results. The demographic, clinical, and oncological characteristics of the two patient groups appeared similar and comparable. Interventions involving the preservation of the neurovascular bundle, the pelvic fascia, and the puboprostatic ligament were performed using Xi system significantly more often. The surgery duration was significantly shorter in the Xi-group. The postoperative recovery time and the incidence of postoperative complications appeared to be identical across both groups. No differences were revealed in the rates of positive surgical margins or biochemical recurrence.Discussion. Reasons behind the reduced operative time were considered as follows: first, the docking of the Xi system is more user-friendly, resulting in decreased docking time; second, the operational efficiency of the Xi system had been enhanced, thereby leading to reduced workflow times; third, a number of collisions between robotic arms was significantly lower during the procedure, which accelerates the surgical process.Conclusion. A robot-assisted radical prostatectomy performed by an experienced professional, using the Da Vinci Xi or Da Vinci Si surgical systems, appears to be safe and feasible without an increased risk of serious complications. However, the Xi system ensures better perioperative outcomes with comparable oncological results.

Stress urinary incontinence refers to a multifactorial disease characterized by involuntary urination associated with a sudden increase in intra­abdominal pressure. Millions of females around the world suffer from stress incontinence each year. Conservative methods of treatment and physical rehabilitation are considered to be ineffective, thereby driving the need for surgical treatment. Sling surgeries comprise a widely used surgical technique for the treatment of stress urinary incontinence due to their affordability and minimal time investment. Introduction of synthetic polypropylene mesh prostheses in the treatment of stress incontinence made them the most common material. However, the accumulated experience and complications associated with the use of mesh grafts contribute to the recent decline in the popularity of synthetic slings and give rise to the search for and development of alternative materials for the surgical treatment of stress urinary incontinence. Since the need for treatment of urinary incontinence remains high, fascia autograft surgeries have been proposed, even though they require an additional surgical procedure and expose the patient to complications at the donor site of the graft. In addition, surgeons use allografts and xenografts, and regenerative technology is developing in this field. Considering high social significance of this problem, the present paper is aimed at reviewing the scientific literature concerning grafts for the treatment of stress incontinence.

Corporoplasty is urological correction surgery for penile deviation that causes copulatory dysfunction or aesthetic discomfort. Penile deviation can be congenital or acquired (Peyronie’s disease, penile fracture). Congenital penile deviation is relatively rare and manifests in the curvature of erect penis ventrally and/or laterally, in most cases. According to many studies, patients with curvatures of 30° or more eventually seek surgical treatment. Congenital curvature may be mistaken for Peyronie’s disease for similar manifestations that, however, differ in aetiology and pathophysiology. Excisional, incisional corporoplasty or plication are commonly engaged to treat congenital curvatures, in various techniques and modifications. Augmentation transplantation (grafting) and penile prosthesis implantation with variant deviation treatment options are the usual practice in Peyronie’s disease. Unequivocal judgment of pros and cons in any particular technique is nevertheless implausible to make. This article aims to review current trends, protocols and their relative advantages in corporoplasty.