On the possibilities and expediency of performing radical prostatectomy outside the head medical organizations of the regions.

The technique of radical prostatectomy has already been developed in detail, tested and widely used by oncourologists in the treatment of patients with prostate cancer. In this disease, this surgical intervention is considered an operation of choice. Despite the achieved validity of standardization measures in the implementation of radical prostatectomy, the results of its implementation in medical organizations with ambiguous capabilities and licensed permits for the participation of their employees in the process   of providing medical care to the male population of different subjects of the Russian Federation may differ significantly. This is especially evident when evaluating the activities of medical organizations specialists in large administrative centers of cities with a population of more than 1 million. The purpose of the study to evaluate in comparison the effectiveness of the implementation of radical prostatectomy in patients with prostate cancer by specialists of oncourological departments of medical organizations with an ambiguous status in the regulation of administration in the provision of oncourological medical services. The results of the implementation   of the radical prostatectomy in 2010–2023 in the medical institutions of two subjects of the Russian Federation (Kuban and St. Petersburg) have been studied. The indicators of the male population in these regions are comparable. The clinical data on the effective ness of radical prostatectomy in 2,591 patients of Krasnodar Regional Clinical Hospital No. 1 and 1,178 men hospitalized for RCT in   St. Luke's Clinical Hospital of St. Petersburg were evaluated. It is taken into account that in matters of organization of planning and implementation of the volume of urological care for men, these medical institutions differ in the level of authority in the administration of regional urology services. There were no significant differences in the examination data of patients from both the Head Medical Institution of the region (Krasnodar Regional Hospital) and St. Luke's City Specialized Hospital of St. Petersburg (in terms of age parameters, features of the clinical course of the oncological process, completeness of the examination, and other characteristics). The parameters of the effectiveness of surgical treatment of prostate cancer patients in the analyzed medical organizations in providing medical care to the majority of patients were regarded as positive (87.9 and 95.9 % respectively) It is obvious that the implementation of radical prostatectomy in urban specialized hospitals in administrative centers of regions with a million inhabitants with a   minimum frequency of negative consequences of surgical interventions with a positive effect on the course of the oncological process   is possible not only in purely Head multidisciplinary medical organizations., as it is practiced in the regions of Russia with a relatively small population. In the administrative centers of the so-called million-plus regions, their medical staff consists of qualified specialists using scientifically based individual approaches in urology, with sufficient experience, and with proper technical equipment (including and modern surgical robotic complexes), the performance of radical prostatectomy is permissible in medical institutions that are not formally affiliated with the Main institutions of the regions, but are certified and accredited for oncourologic al activities. Taking into account the high incidence of prostate cancer in men, as well as the priority of using surgical methods in providing medical care to patients with this disease, in specialized medical organizations in Russian megacities with a well-developed healthcare management system, It is advisable and acceptable to carry out radical prostatectomy outside the head medical regions by employees of regional scientific and production institutions with methodological control over achieving the proper quality and safety of medical activities of the Main and Leading specialists of Regional Health Authorities in the field of medical specialty (urology).

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