No 5 (2003)

Our aim was to determine indications for urethrectomy in patients with muscle-invasive cancer of the urinary bladder (UBC) which is essential for choice of urine derivation. A total of 51 patients with invasive UBC at the age of 33-78 years (mean age 60 years) were treated: 7 patients with pT2bN0M0, 1 patient with pT2bNlM0, 18 patients with pT3aN0M0, 3 patients with pT3aNlM0, 14 patients with pT3bN0M0, 6 patients with pT4aN0M0, 2 patients with pT4bN0M0. Urethrectomy was indicated for men with involvement of the prostatic urethra (stage t4a) and urinary bladder cervix, multiple tumors of the bladder, pelvic lymph node lesions, detection of tumor cells by instant biopsy in the free urethral edge, poor differentiation of the tumor (G3) in combination with one of the above factors, emergence of urethrorrhagia late after cystectomy; for women with involvement of the bladder cervix and Lieutaud's triangle in combination with poor differentiation of the tumor cells (G3). Cystectomy was followed by urine derivation of the following type: uretero-ureteroanastomosis with nephrostomy (n = 2), ureterocutaneostomy (n = 3), Briker's operation (n = 22), ureterosygmoanastomosis with creation of sigmoid reservoir (method Mainz pouch II) (n = 21), Studer orthotopic plastic reconstruction (n = 2) and Hautmann plastic surgery (n = 1). Urethrectomy was made in 16 patients. One-stage operation was conducted in 14 patients (suprapubic approach - 8 males, perineal one - in 6 females). Delayed urethrectomy was made in 2 patients. Intra- and postoperative complications caused by urethral removal were absent. Corrected 2-year survival for all 51 patients was 70.8± 11.3%. Among the deceased were 2 patients who had undergone urethrectomy at the stage T2b and T4a 5 and 8 months after primary operation, respectively. Thus, we believe that urethrectomy must be made in the above indications and poor differentiation of the tumor cells (G3).

78 kidneys removed for cancer in 1999-2002 were studied for multifocal growth of the tumor. The results demonstrated a direct correlation between multicenter growth of renal cell carcinoma (RCC), size of the primary tumor and stage of the disease. Most of the additional foci were detected at the distance of more than 2.0 cm from the primary tumor, i.e. outside the safety zones in conduction of organ-saving operations. Frequent coincidence of a morphological type of the primary and additional tumors (70%), degree of cell differentiation (80%) and higher incidence of multifocality in infiltrative growth of the primary tumor support the existing hypophysis about the role of intraorgan metastasizing as the underlying cause of multifocal lesions. Also, the study confirmed low preoperative detection of multifocality: 1.8% preoperatively and 19.2% under investigation.

The efficacy of transrectal microwave hyperthermia (TMH) was investigated in 124 patients aged 20 to 55 years. Of them, 75 (60.5%) patients had chronic noninfectious and 49 (39.5%) patients infectious prostatitis. In addition to standard pre- and posttreatment examinations the following tests were made: bacteriological and biochemical tests of prostatic secretion, uroflowmetry, transrectal color dopplerographic mapping. The course of the treatment included 10 one-hour sessions of microwave hyperthermia, drug therapy and prostatic massage. Patients with both forms of chronic prostatitis exhibited disorders of prostatic circulation, activated lipid peroxidation, low concentration of catalase in the organ secretion, defective urodynamics of the lower urinary tracts. More pronounced changes occurred in noninfectious process. Microwave hyperthermia produced clinical improvement, recovery of hemodynamics in the prostate, structure and function of cell membranes in prostatic secretion, positive response of urodynamics. Thus, TMH generated on domestic equipment can be considered as one of the methods of pathogenetically sound treatment of noninfectious and infectious chronic prostatitis.

To study prevalence of mental disorders in patients with chronic pyelonephritis (CP), 50 CP patients were examined clinically and with special tests (fundus of the eye, EEG. AMPI, Luscher's test). The patients were diagnosed to have a wide spectrum of mental disorders: psychoorganic syndrome, paroxysmal disoders, hallucinations, obsessionsdepression, asthenic syndrome. The presence of psychoorganic syndrome, paroxysms, hallucinations point to developing organic disorders of the brain the severity of which correlates with the age. The depressions had a complicated genesis (psychogenic, somatogenic and organic). The results of the study can be used for design of therapeutic and rehabilitative measures improving quality of CP patients' life.

The paper presents experimental results of the study of kidney defense from normothermic ischemia and operative stress in interventions with stopping renal circulation. The antiischemic effect of emoxipin was studied in monotherapy and in combination with furosemide and verapamil. The above effect was found positive, especially in response to combined use of emoxipin, furosemide and verapamil.

In spite of some achievements in the field of oncourology, the problem of diagnosis and treatment of surface cancer of the urinary bladder (SCUB) remains urgent because of early recurrence and progression after TUR (50 and 30%, respectively). Repeated cystoscopy and biopsy early after surgery enable the physician to establish a real stage of SCUB (invasion into the bladder wall - criterion T and cell differentiation - criterion G). Early accurate staging of the disease allows design further policy of treatment. Early repeated cystoscopy and biopsy detected recurrence of transient cell SCUB in 51 (24.75%) patients. In 20 (9.7%) patients recurrent tumor located at the site of the previous operation. In other places recurrences were detected in 31 (15.05%) patients. Recurrent tumor was found in 23 (11.16%) cases at stage Та and 28 (13.6%) patients at stage Tl; in 15, 30 and 6 patients with high, moderate and low malignancy grade (22.06, 24.79 and 35.29%, respectively). SCUB progression developed in a total of 15 (7.28%) patients: by T criterion (Tl-T2a) in 9 (4.37%) patients and by criterion G (G2-G3) in 6 (2.91%) patients. Thus, early repeated cystoscopy and biopsy detect early residual and recurrent SCUB facilitating design of further treatment policy.