No 2 (2003)

Organ-saving operations (extended lymphadenectomy) were performed in 125 patients with renal carcinoma (RC) in the urological clinic of I. M. Sechenov Moscow Medical Academy between 1992 and 2002. In view of specific segment-by-segment lymph flow off the right and left kidneys, it is thought valid to remove paracaval and aortocaval lymph nodes in saving operations on the right kidney but in cancer of the left kidney it is recommended to remove paraaortic lymph nodes. Basing on the anatomical features, lymphodissection should be made from the eras of the diaphragm to bifurcation of the aorta. Metastases to the regional lymph nodes were diagnosed in 12 (9.6%) patients. In 8 of 12 patients with pN+ lymph node metastases were microscopic. Frequency of lymphogenic metastases directly correlated with the size and stage of the tumor, cancer cells differentiation degree. Metastatic involvement of the regional lymph nodes in renal cancer is an unfavourable prognostic factor as 5-year survival for the overall group of patients was 71.7% while for patients with pN+ it was 411%.

Prostatic cancer (PC) is a frequent finding in aged men. In fact, 3% of males have the chance to die of PC. Radical prostatectomy by the retropubic approach with pelvic lymphadenectomy was made in 97 males. The treatment was performed in the urological department of the MSMSU urological chair from 1995 to 2001. 69 patients followed up for 3-64 months after the operation were eligible for analysis of the outcomes. The patients had the following PC stages: Tl - 11 patients, T2 - 44 patients, T3 - 14 patients. Prostate-specific antibodies ranged within 2.9-67.8 ng/ml (the mean level 16.7 ng/ml). The results of the treatment were satisfactory in 65 (94.2%) of 69 patients. The operation did not take more than 2.5 hours, mean blood loss was under 870 ml. Adequate urination after the catheter was removed resumed in 41 (59.4%) of 69 patients. Active urinary incontinence was observed within one year after the operation in 25 (36.2%) patients, total incontinence - in 3 (4.3%) patients. 51% patients retained the erectile function after nerve-sparing operation. Most of the patients had an uneventful postoperative period. During the follow-up 3 patients died of acute myocarrdial infarction (n = 1), intestinal cancer (n = 1) and distant PC metastases (n = 1). A postoperative fall in the PSA level under 0.3 ng/ml occurred in 49 (71%) patients, under 2 ng/ml in 7 patients (10%). In 19% of patients with pT2-3 the PCA rose over 2.0 ng/ml. Radical prostatectomy is indicated for patients with local prostatic cancer (stage Tl or T2) and probable survival from 10 to 15 years and longer. A nerve-sparing, sphincter-sparing and ablastic variant of this operation is widely used world-wide and is a method of choice for therapy of patients with retropubic prostatic cancer.

The antiinflammatory reaction in patients with sexually transmitted urogenital infections (STUI) was assessed by the leucocyte count, causative agents, amount of lecitin particles and pH in prostatic secretion. Great amount of desquamated epithelial cells indicated natural death of epitheliocytes and tissue necrosis. These processes were traced in the course of different treatments. Standard therapy in combination with the antimicrobial drug (AMD) and URO-Biophon radiation (UBR) produced the highest effect in patients with chronic urethroprostatitis. This promoted reduction in the number of leukocytes, removal of epithelial cells, elimination of the microflora and an increase in the number of lecitin particles. Among patients with chronic urethritis effective levelling of the leukocytic reaction was observed in patients on the standard therapy or with UBR alone, or AMD alone. By the intensity of epithelial desquamation the result was highest in the control group. The highest microbiological disinfection effect was achieved in using combination of the above methods.

The results of surgical correction of 487 ureteropelvic segments (UPS) were studied in 455 patients (age 4 months to 15 years). Good results were obtained in correction of 477 (98.0%) UPS including 12 after reoperation. Postoperative follow-up lasted for 1 to 25 years. Anastomosis obstruction observed in 12 patients had developed within several postoperative months. In 3 patients it appeared 2-14 years after an effective UPS correction. The obstruction resulted from cicatricial transformation of the ureter and aduject fat witli or without obliteration of the ananstomosis or ureteral transformation into a rigid connective tissue tube unable to carry the functional load. One of the reasons of connective tissue transformation of the ureter may be urine leakage of the anastomosis. An individual reaction to the suture material (catgut) followed by scar process is also possible. Development of destructive changes many years after successful correction of UPS may arise due to inflammatory process ending in sclerosis. Some moments in pathogenesis of scar transformation of the ureter remains unknown and need further studies. Repeated correction of UPS was effective in all 15 patients. This intervention should be performed at least after 5-6 months after the failure of the first operation. To prevent the scar process, the patients must be followed up for many years and therapeutic methods should be perfected.

Basing on the results of a combined clinical and laboratory examination of 193 children treated in the Research Institute of Urology in 1992-1999, the authors studied causes underlying intermittent vesicoureteral reflux (IVR) in correlation with anatomo-functional changes in vesicoureteral anastomosis and severity of inflammation in the urinary bladder. They suggest a diagnostic algorithm of detecting IVR with assessment of gas cystography role in the diagnosis; give definition of IVR; describe therapeutic policy in accordance with functional state of the affected kidney and cause of IVR onset; analyse short- (6-12 months) and long-term (12-36 months) treatment results; outline methods of IVR prophylaxis to save and improve renal function.