Nº 6 (2003)

The results of treatment of 850 patients with urinary bladder cancer (UBC) are analysed. Precise staging of the tumor should be made in the following order: suprapubic ultrasonic investigation (USI), cystoscopy and microcystoscopy, transrectal, transurethral USI. Indications for different treatments are outlined: typical and atypical papillary fibroepithelioma, papillary cancer in stage Tl should be managed with TUR after previous electrocoagulation; cancer in stage T23 - with urinary bladder resection and uni- or bilateral pelvic lymphadenectomy; total papillomatosis, multiple lesions in stage T3, in cases of recurrent cancer -with cystectomy including one-stage or multistage replacement of the urinary bladder by intestinal transplant. The only physiologically sound method of treating patients after cystectomy with ureterocutaneostomy and ureterocolostomy is creation of intraperitoneal intestinal urinary bladder with reestablishment of transurethral urination. Arguments against creation of artificial urinary bladder made of detubularized segments consist in the absence of advantages.

Biopsy material obtained from 310 patients with prostatic cancer (PC) was used in the study of the incidence rate of different PC histological types, of tumor cell immunophenotype and differentiation by Glison. The results of the study have shown that definition of the tumor histological type and tumor immunophenotype facilitates identification of tumors with the most malignant potential. Therefore, this definition should be included into the diagnostic complex in the study of PC. Choice of treatment policy should not be based only on differentiation of the tumor process by Glison. The decision should be made only after establishment of histogenesis and immunophenotype of tumor cells. The presence of neuroendocrine differentiation is an unfavourable prognostic factor.

In 18 of 487 patients (11 males, 7 females) operated for renal cancer, radical nephrectomy was made simultaneously with cholecystectomy (n = 14) and prosthetic repair of the abdominal aorta (n = 4). A transabdominal approach was used in all the cases. Duration of radical nephrectomies from the transabdominal approach varies from 95 to 180 min while simultaneous operations lasted from 130 to 228 min. Cholecystectomy increased duration of the operations by 25-55, aortic repair - by 60-90 min. Conduction of concomitant operations had no negative effect on the course of postoperative period or on the number of complications. 18 cases of simultaneous operations (radical nephrectomy and cholecystectomy or aortic repair) showed that there was neither increased number of complications nor duration of hospital stay. Cholecystectomy can be made from the same incision as radical nephrectomy whereas aortic repair demands the middle approach which is not convenient for performance of radical nephrectomy.

Chronic prostatitis affects 30-60% males and significantly deteriorates quality of their life. Clinical and experimental investigations have revealed changes in immune status in the onset and development of prostatic inflammation. As some other urologists, we made an attempt to determine the role of cellular immunity and immunoglobulins in the diagnosis of chronic prostatitis. The study was made in 30 patients with chronic abacterial prostatitis (mean age 42.5 years, duration of the disease 1.8 years). In addition to standard examination, all the patients have undergone analysis of the immune status and measurement of proinflammatory cytokines (TNFa and IL-12b) in biological media: blood serum, urine, ejaculate, prostatic secretion. The patients had moderate symptoms: IPSS - 10.4 scores, life quality index - 4.3 scores, on the average. Prostamol-uno was given to all the patients in a standard dose 1 capsule (320 mg) a day for 3 to 6 months. The results were processed statistically. A good effect of prostamoluno was registered in 26 patients, a satisfactory one - in 2. Two patients refused to take prostamol-uno because of lack of a prominent effect. The scores of IPSS lowered from 10.4 to 6.3 (by 39%), life quality improved by 42%. Ultrasound monitoring of the size of the prostate showed no significant changes in the size. Tolerance was good in all 30 patients. Side effects were absent. After 3 months of the treatment serum, urine, ejaculate and prostatic secretion cytokines changed. TNFa elevated while IL-ip level lowered almost to normal value. In 6 months both IL-ip and TNFa returned to normal values confirming stabilization of cytokine system and the end of inflammation. Cellular immunity did not change much. Thus, as inflammation in prostatic tissue is characterized by elevation of proinflammatory cytokines, in diagnosis of chronic prostatitis it will be valid to use markers TNFa and IL-ip as criteria of immune prognosis of prostatic exacerbation. Prostamol-uno does not induce changes in lymphocyte populations and impairment of immune status.

Gentos was given to 46 patients with chronic abacterial prostatitis. The results of the treatment were analysed for 39 of them. Compared to control group, efficacy of gentos was 64.5-71.8% versus 53.6%. It can be used both as monotherapy and in combination with other modalities. Side effects of gentos were not registered.

The paper reviews experience, specific features and outcomes of surgical treatment of 115 patients (60 males, 55 females) with long strictures and defects of the ureter. Renal and ureteral malformations, acquired strictures were detected in 14 (12.2%) and 101 (87.8%), respectively. The following reconstructive operations were made in 102 patients: ureterocalicoanastomosis by Neuvert (n = 3), specially designed original plastic repair of the lumbar ureter (n = 3), ureterolysis (n = 7), indirect ureterocystoanastomosis (n = 39), appendicoureteroplasty (n = 2), intestinal plastic reconstruction of the ureters and urinary bladder (n = 43), autotransplantation of the kidney (n = 3). Postoperative complications developed in 13 (11.3%) patients. No lethal outcomes occurred. Urinary tracts improved hemodynamics in all the patients. Recovery of ureteral passage in its long strictures necessitates atypical surgery. These were listed above. The proposed method of lumbar ureter replacement by mobilization and raising urinary bladder wall together with relevant ostium and pelvic ureter is perspective.

False and true hermaphroditism (FH and TH) are often encountered in surgery for hypospadia. A clinically validated classification of various types and variants of hermaphroditism is proposed. FH is divided into male FH and female FH. TH also falls into two categories: TH without anomalies of external genitalia and that with these anomalies. The latter category has three variants: 1) all genitalia of males or females and some genitalia of the other sex; 2) some female and male organs in various combinations; 3) all organs of both sexes. All TH variants are illustrated by 5 case reports. These patients were thoroughly examined and their sex was surgically corrected.