a problem Urgency

Within last two decades urologists and oncologists ascertain sharp augmentation of volume of the information on a carcinogenesis, molecular characteristics, the biological development, new ways of diagnostics and treatment of a cancer of a bladder (93, 105, 220, 333, 342, 344).

Finding-out of a role of causal factors of an environment and an organism in urotelialnom a carcinogenesis passes in a plane of molecular and genetic aspects of development of a cancer. Genetic profiles which define individual enzimnuju ability to activation or neutralisation of external carcinogens, can stop or, on the contrary, to contribute to development in the subsequent urotelialnogo a cancer. Development of its separate forms is interfaced to defects in specific supressornyh genes and changes in a carcinogenesis. Correlation between genetic anomalies and a clinical current of various forms of a cancer of a bladder, and also a susceptibility of the patient to treatment allow absolutely on - new to look at their internal biological potential (8, 57, 90, 144, 146,147).

The dual relation to a problem of surgical treatment of a cancer of a bladder remains. In a number of urological clinics and specialised units the preference to treatment of patients with use of open surgical interventions of type of a cystectomy with ureterotsistoanastomozom or without it is given, in others - the cystectomy comes to the end with numerous variants of transplantation of ureters in various departments of an intestine. Between supporters of a radical cystectomy and adherents organosohranjajushchego a principle in treatment invazirujushchego a bladder cancer scientific discussions (60,65,95,102, 121,217,244,331,343) proceed.

If to look at various aspects of a problem of treatment of patients with a bladder cancer their evolution confirms progress in such sections, as use of informative visual models, prospects of application of tumoral markers, photodynamic diagnostics and a transurethral resection with the subsequent in vesical and system immunotherapy, regionarnaja and system polychemotherapy, various forms of creation of the tanks keeping urine and first of all a design ortotopicheskogo of a bladder (53,78, 81,86,169, 191, 202,349).

Does not descend from the agenda of many urological congresses of the European association of urologists (Geneva, 2001; Birmingham, 2002) again brought actual an attention to the question on possibilities of conservation of a bladder at separate forms of an invasive cancer. In absolutely new treatment principles (91,102, 144, 175, 277, 283) appear seeming earlier firm.

On set of clinical problems, a variety and bulkiness of surgical interventions to treatment of a cancer of a bladder one of the first places in onkourologii (8,79,134,210,250,276) is taken away.

Bladder tumours - disease with distinctly expressed variability of clinical implications that demands necessity of carrying out of differential diagnostics, working out adapted to stadijnosti methods of treatment and individual approaches in the subsequent medical observation and the control (19, 44, 143, 213, 221, 245, 266). Histological types of a structure of tumours of a bladder, degree zlokachestvennosti, features of growth (superficial/invazivnyj, unifocal/multifocal) define appreciably the forecast of the given disease (57,68, 117,278,293,318,363).

Conceding “a superiority palm tree” in onkourologicheskoj to practice to a cancer of a prostate, a bladder neoplasm, nevertheless,
Are characterised by plural disturbances of functions of the top and bottom urinary ways (13,31,37, 157,230,276).

The condition of the patient, bladder suffering by a cancer, is burdened by often arising complexities of outflow of urine from the top urinary ways with real threat of disturbance of function of kidneys. It is necessary to notice that significant circumstance, that besides active treatment organnogo a cancer the doctor should solve and such difficult problem, as restoration urodinamiki (13, 33, 38, 45, 49, 204, 213, 265, 345). Thereupon it is necessary to underline especially, that treatment of a cancer of a bladder is represented a cardinal problem in urology for, despite use of rather perfect rational approaches, today still about 70 % sick of invasive forms die throughout 3 years after a surgical intervention (101, 133, 328, 335, 351). More than half of patients within 3-5 years after performance organosohranjajushchih operations has relapses (90,93,308, 318,328).


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A source: Sidorov Vyacheslav Aleksandrovich. the INVASIVE CANCER of the BLADDER. SURGICAL TREATMENT. The DISSERTATION on competition of a scientific degree of the doctor of medical sciences. Moscow - 2004. 2004

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