No 4 (2003)

Present-day medical facilities for treating patients with cancer of the urinary bladder in the Russian Federation (RF) are insufficient. In 1998, urological cancer in RF was managed only in 31 specialized departments working in 24 of 89(27%) administrative units of the RF. In the other 65 (73%) units only urologists deal with diagnosis and treatment of urinary bladder cancer. These nonspecialized departments lack special equipment and personnel. Therefore, effective management and organization of medical care for urinary bladder cancer can be achieved on the basis of standardization of diagnostic and therapeutic methods and definition of stages in treatment policy. This helps to outline priorities in financing health services.

Seventy five patients (48 females, 27 males) at the age of 17 to 78 years (mean age 54.6 years) were radically operated on for locally advanced tumors of the small pelvis organs in the Cancer Research Center of Georgia in 1987-2001. The urine was derived continently on the skin into a detubulized small intestinal reservoir. Invagination valvular device was created in 31 patients, non-invagination (the original technique) - in 44. Conversion of ureterocutaneostomas according to the original technique was made 6-7 months after radical operation in 4 of them. The ureters were transplanted using the antireflux (67) and direct (8) methods. 1-10 follow-up data are available for 52 patients. 4 patients with invagination valve developed postoperative and 2 patients delayed (6-9 months) incontinence. In patients with the original valve incontinence was only in one patient. The difference between the results of antireflux and direct transplantation of the ureters was statistically insignificant.

The trial conducted in the Primorsk Regional Cancer Hospital of Vladivostok and P. A. Herzen Moscow Research Cancer Institute studied effectiveness and tolerance of cyproteron acetate (CA) monotherapy and maximal androgenic block (MAB) (CA+surgical or CA+drug castration). A total of 70 patients with localized, locally advanced and generalized prostatic cancer entered the trial. They were divided into three groups: group 1 (54.3%) patients received CA monotherapy - 300 mg/day, group 2 (27.1% patients) was exposed to MAB by surgical castration and received CA in a dose 200 mg/day, group 3 (18.6% patients) were exposed to MAB by drug castration and received 200 mg/day CA. The results obtained show that CA monotherapy and MAB have similar effectiveness in favourable prognostic signs. С A monotherapy was less toxic than CA combination with castratio.

An immunochemical study of prostatic secretions in 97 patients with urethritis and iirethroprostatitis has detected a significant rise of lactoferrin level in mixed infections (trichomonads+chlamydia and trichomonads+uroplasma - 17 patients) versus control (14 healthy males) and group as a whole. In the control group a mean lactoferrin level was 5l.2±8.4 mg/1 (12 mg/1-67.3 mg/1), in the group as a whole 106±41.5 mg/1 (19.5 mg/1 to 334.8 mg/1) in patients with mixed infection 221.25 (102.9 mg/1 to 334.8 mg/1). The assessment of diagnostic significance of the immunochemical test for lactoferrin in detection of mixed infections in urethritis and iirethroprostatitis has shown that in threshold level of 150 mg/1 the test's specificity was 87.5%, sensitivity 94.1%, effectiveness 88.65%, prognostic value of positive result 61.5%, of negative result 98.59%; in threshold level 200 mg/1 the respective values were 100, 52.9, 91.75, 100 and 90.9%. Practical application of the proposed immunochemical test in detection of mono- and mixed infection is discussed.

Nephrolithotomy results are available for 63 patients with coral and multiple nephroliths operated in 1990-2002. These patients underwent 64 operations (one patient with bilateral nephrolithiasis had 2 consecutive nephrolithotomies within a month). The sites preferable for transverse nephrolithotomy are described and validated. Ligation of the renal artery with pharmacological antiischemic protection of the kidney with lasix and verapamil was performed in 40 cases.

Overactive urinary bladder (HAUB) is encountered in 16-20% patients with various voiding disorders. Etiologically, detrusor hyperactivity can be neurogenic and idiopathic. We studied efficacy of the antimuscarine drug spasmex in patients with imperative voiding disorders and compared its efficacy and tolerance with those of driptan and detrusitol. 193 female patients with imperative voiding disorders were examined. Spasmex given in a dose of 5 mg 3 times a day for 12 weeks produced a good effect in 56 patients: increased the effective capacity of the urinary bladder, reduced the number of voidings and episodes of incontinence for a day. A 3-month course of spasmex proved highly effective as shown by the patients' subjective response and positive changes in objective evidence. Being equally effective with detrusitol and driptan, spasmex is much superior to oxibutynin in safety.

To analyse the results of treatment of isolated and concomitant urogenital injuries, a retrospective analysis was made of 608 case histories for patients treated in 1986-2000. Of them, 530 patients were males, 78 were females, the age ranged from 16 to 70 years, most of the patients were 20 to 50 (71.2%) years of age. Most frequently the injury was inflicted by beating. Fall from the height, transport accidents ranked second among the causes of injury (17 and 14.3%, respectively). Stab and gunshot injuries occurred in 4.4 and 8% cases, respectively. Ultrasound and x-ray methods were employed for examination. An isolated injury was found in 481 patients, the rest had urogenital injury and skeletal (53%), craniocerebral (25%), abdominal (20%) lesions. 29 patients had a severe concomitant wound: urogenital injury combined with abdominal, skeletal, cranial lesions. Surgery was performed in 267 patients. The rest patients received conservative treatment. Most of the operations were made on the kidney and urinary bladder because of rupture. In some patients these interventions were conducted during laparotomy and were combined with abdominal intervention (44 cases). 25 patients with the compound injury underwent 2-stage operations. 552 patients were cured. 56 (9.2%) lethal outcomes were due to progression of traumatic shock. This low percent of lethality may be explained by an optimal choice of treatment policy in the above patients.