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No 1 (2004)
- Year: 2004
- Articles: 18
- URL: https://journals.eco-vector.com/1728-2985/issue/view/6562
Articles
Nikolai Alexeevich Lopatkin is 80
Urologiia. 2004;(1):4-7
4-7
Margarita Fedorovna Trapeznikova
Urologiia. 2004;(1):7-9
7-9
Urology as a basic profession
Urologiia. 2004;(1):9-12
9-12
Diagnosis and treatment of urinary bladder cancer
Abstract
The authors present a retrospective analysis of the results of
transurethral conservative and radical operations in 125 patients with
invasive cancer of the urinary bladder (UB) treated in the Research
Institute of Urology throughout 1992-2002. Transurethral resection
(TUR) of the UB was made in 72 patients. Stages pT2a, pT2b, T3
and T4 were diagnosed in 23 (31.9%), 18 (25%), 14 (19.5%) and 17
(23.6%) cases, respectively. 53 patients with advanced invasive UB
cancer have undergone radical cystectomy varying by the method of
urine derivation. Stages pT2N0M0, pT3aN0M0, pT3bN0MO,
pT4aN0M0 and N1-2 were registered in 4 (7.5%), 13 (25%), 21
(40%), 7 (12.5%) and 8 (15%) patients, respectively. UB cancer recurrences
after TUR occurred in 12 (16.7%) patients with stage pT2a,
in 8 (11.1%) patients with stage pT2b. Three-year overall and recurrence-free
survival after TUR at stage T2 reached 97.5±3.2 and
47.4+2.8, respectively, at stage T3 and T4 - 57.1+4.3 and 26.6+3.4%,
respectively. Postcystectomy distant metastases to the lungs, bones
and iliac lymph nodes after treatment were detected in 3, 2 and 3 patients,
respectively. One patient had a local pelvic recurrence. For all
53 patients a 2-year corrected survival made up 68+12.0%. Thus,
transurethral electrosurgery is an effective treatment of invasive UB
cancer; the only radical surgical treatment for invasive UB cancer is
cystectomy.
Urologiia. 2004;(1):12-17
12-17
Vascular endothelium growth factor and insulin-like growth factors in prostaticcancer
Abstract
To study the levels of vascular endothelium growth factor
(VEGF), insulin-like growth factor of type I and II (IGF-I and IGF-II),
prostate-specific antigen (PSA) and their correlations in prostatic
cancer (PC) and benign prostatic hyperplasia (BPH), we examined
38 PC patients (mean age 66.6±5.5 years) and 80 BPH patients (mean
age 60.3+2.5 years). Serum concentrations of VEGF, IGF-I and
IGF-II were measured using kits made by R&D (USA), PSA by Boehringer
Mannheim (Germany). Sensitivity and specificity of the tests
were analysed by plotting the curves. The serum VEGF concentration
in PC patients was 518.9+60.7 pkg/ml, in BPH patients - 267.9+99.9
pkg/ml (p < 0.001). The IGF-I and IGF-II it was 178+19 and 136±9
ng/ml (p < 0.05), 400±31 and 351±23 ng/ml (p < 0.05), respectively.
The ratio of growth factor concentration to PSA concentration in the
blood serum in BPH patients was higher than in PC patients (p <0.01).
Sensitivity and specificity of PSA (4 ng/ml) made up 85.7 and
57%, VEGF (151.5 pg/ml) - 76.2 and 57.6%, IGF-I (157 ng/ml) -57.6
and 50%; IGF-II (392 ng/ml) - 57.5 and 50%, respectively. Sensitivity
and specificity VEGF/PSA was 85.7 and 70%; IGF-I/PSA -84.2
and 75%; IGF-II/PSA - 84.2 and 79.6%, respectively. Thus, the
ratio of concentrations of IGF-I, IGF-II and VEGF to PSA level in
blood serum has high sensitivity and specificity for PC detection.
Clinical implications of serum levels of VEGF, IGF-I and IGF-II
for prediction of PC course and detection is to be elicited
Urologiia. 2004;(1):17-21
17-21
Interstitial radiotherapy "1-125 Rapid-Strand" of local prostatic cancer
Abstract
Nikolai Alekseevich Lopatkin, Academician of the Russian Academy
of Medical Sciences, has contributed much to development of
prostatic cancer (PC) diagnosis and treatment in the Russian Federation.
N. A. Lopatkin headed specialists from the Research Institute
of Urology who were the first in Russia to introduce into clinical practice
the method of interstitial radiotherapy (brachitherapy) of local
prostatic cancer (PC). A total of 58 PC patients 42 to 76 years of age
were treated. They had stages TlbNOMO (n = 5), T2aN0M0 (n =36),
T2bN0M0 (n = 11), T3aN0M0 (n = 6). Staging was made by
the'data of finger rectal examination, transrectal ultrasonography,
NMR tomography, radionuclide osteoscintigraphy. Mean PSA was
2.5-36 ng/ml in the size of the prostatic gland 14.96-52.76 cm3. All
the patients received neoadjuvant hormone therapy. Four patients one
year or more before the radiotherapy had TUR of the prostate. Brachitherapy
was made under peridural anesthesia which allowed implantation
of 40-120 sourses with activity of 0.38-0.35 mCi for 20-45
min. A total dose was 120-160 Gy. Mean hospital stay was 4 days.
Spontaneous urination recovered within 6 postoperative hours. The
procedure was well tolerated, complications arose on postimplantation
day 2-8. We attribute complications to inadequate calculation of
the doses at the stage of the method introduction. A short follow-up
(3 years) is not long enough to allow conclusions about the efficacy
of the method. Within 3 years biochemical recurrence occurred in 4
(6.9%) patients on months 14-26 (stage T2b and 2-T3). Four patients
were lost for follow-up. Thus, brachitherapy efficacy depended much
on adequite selection of the patients and planning of the procedure
by the results of previous volumetry. The procedure is safe and reproducible.
The studies will be continued.
Urologiia. 2004;(1):21-25
21-25
Metastases of renal carcinomato the adrenals
Abstract
The aim of the study was assessment of diagnosis and surgical
treatment of adrenal metastases (AM) of renal carcinoma (RC). 10
cases of RC AM have been analysed. Bilateral metastases were diagnosed
in 2 patients, ipsilateral in 5 patients, contralateral in 3. Three
patients had synchroneous metastases, seven had metachroneous
ones. AM were detected 8 months to 14 years after after operation
on the kidney. Non-invasive dynamic control over the retroperitoneal
space after nephrectomy for RC using advanced visual methods (ultrasonography,
x-ray and resonance magnetic CT) not only detects
AM but also determines metastatic genesis of the tumor. Thus, significant
verification of RC AM, especially of metachronous origin,
requires the study of the findings obtained at clinical, laboratory, ultrasonic,
radiation examinations as well as comparison of histological
structure of the removed kidney tumor and the adrenal. Early diagnosis
and removal of a solitary adrenal metastasis of RC provides prolongation
of the patient's life and survival of patients with RC late
stages.
Urologiia. 2004;(1):25-30
25-30
Current aspects of surgical treatment of benign prostatic hyperplasia
Abstract
A retrospective analysis was made of the treatment results for the
last 5 years of 879 patients with benign prostatic hyperplasia (BPH),
214 (24.3%) of whom had undergone transvesical adenomectomy
while 665 (75.7%) had undergone transurethral resection (TUR) of
the prostate. Adenomectomy had rather high effectiveness but was less
safe than endoscopic intervention (higher lethality, more frequent development
of myocardial infarction, pulmonary artery thromboembolism,
postoperative hemorrhage). Patients operated for BPH are at
risk of postoperative urethral stricture and sclerosis of urinary bladder
cervix. Prebladder and postoperative stress urine incontinence appear
only after open operations in BPH
Urologiia. 2004;(1):30-34
30-34
Surgical treatment for coral nephrolithiasis
Abstract
262 cases of coral nephrolithiasis (CN) treated for the last 5 years
(mean age 51.6 years) have been analysed. Of them, 46 (17.9%) patients
have undergone 2 to 4 operations, 14 (5.4%) patients had bilateral
nephrolithiasis. Open surgical interventions (section nephrolithotomy,
pyelonephrolithotomy) were performed in 31 and 106 patients,
respectively. All of them had a severe form K-3 or K-4. Extracorporeal
shock-wave lithotropsy (ESWL) was conducted in 72
(27.5%) patients with coral concrements K-l, K-2.'Mean number of
the procedures per a stone was 4.2. Transcutaneous puncture nephrolithotripsy
(TPNT) was made in 53 (20.2%) patients (K-2, K-3).
The results of the treatment were assessed at discharge and 12 months
after it. The efficacy of the treatment was judged by completeness of
the stone elimination, postoperative complications and interventions
to correct these complications. Open operations eliminated the stones
completely in 71.2% patients, in combination with ESWL - in 91.6%,
TPNT - in 78%, in combination with ESWL - in 94.5%. Efficacy of
ESWL as monotherapy + stent reached 68.1%. Open operations entailed
complications in 41.6% (of them 68.5% in section nephrolithotomy),
TPNT - in 18.2%, ESWL - in 16.3%. Coral nephrolithiasis
should be treated by skilled specialists in clinics furnished with modern
facilities, combination of which minimizes traumatic complica-
tions and raises treatment efficacy.
Urologiia. 2004;(1):34-38
34-38
Extracorporeal shock-wavelithotripsy as monotherapy in coral nephrolithiasis
Abstract
278 patients with coral nephrolithiasis were examined in 1990-2003.
Extracorporeal shock-wave lithotripsy was made in 46 (16.5%)
patients with 48 coral stones (mean age 48.2+18.3 years) as a basic
treatment. The length of the concrement was 4.9+1.8 cm, width
3.8± 1.4 cm,a relative area 19.72+13.01 cm2. All the patients have initially
undergone internal drain of the kidney by a catheter (n = 13)
or stent (n = 33). Each lithotripsy session included, on the average,
28821318 impulses (17-19 kV). The number of high-energy impulses
per a session comprised 342±23. A total number of the sessions
reached 3.4±1.55. Initial destruction of the concrement requires
1.6+0.6 sessions in 10144+1081.2 impulses per one patient including
1436196.6 high-energy impulses. One procedure comprises 2-3 sessions
of lithotripsy with a 5-7 day interval. The results were assessed
at discharge after the first session and 6 months later, the degree of
stones elimination from the kidney, complications, manipulations to
manage the complications. At discharge after 3 lithotripsy sessions recovery
was achieved only in 3 out of 46 (6.52%) patients. Six months
later the fragments eliminated in 26.1% (12 of 46 patients). Mono-Hthotripsy
caused complications in 13 patients. Additional manipulations
made up 65.2%. Inefficacy of explorative treatment necessitated
conversion to open intervention in 6 (13.1%0 patients. The use
of extracorporeal lithotripsy as a monotherapy in coral nephrolithiasis
is now limited.
Urologiia. 2004;(1):38-43
38-43
Ureterocele and urolithiasis
Abstract
We studied 51 patients with true ureterocele (primarily, orthotopic
and unilateral - 84.3 and 82.3%, respectively) combined with
urolithiasis. Mean age of the patients was 41.9±2.0 years, size of ureterocele - 20.7±1.3 mm
and mean concrement area - 1.4±0.2 cm2.
In adult patients with orthotopic or heterotopic disease urgery consisted
of perforation (n = 5) or dissection of ureterocele wall (n =38).
Endoscopic operations were indicated in small and middle sized
ureterocele (less than 30 mm in size), unaffected contractility of terminal
ureter, moderate urodynamic disorders of the upper urinary
tracts, normal function of the kidney and no pyelonephritis exacerbation.
Endoscopic section of ureterocele wall combined with ureterolithoextraction (n = 26),
contact ureterolithotripsy using Ho:YAG
laser or ultrasound (n = 19). Open surgery (ureterocystoneostomy by
Politano-Leadbetter was made in orthotopic ureterocele over 30 mm
in size and in marked urodynamic disturbances of the upper urinary
tracts (n = 6). At discharge, a complete elimination of the stones in
ureterocele patients was 81.6%. Effective use of extracorporeal shockwave
lithotripsy of nephroliths within 2 months after removal of ureterocele
raised this percent to 87.7. Thus, choice of surgical policy in
ureterocele complicated by urolithiasis depends on its size, variant of
combination of this defect with the concrement, anatomofunctional
state of the upper and lower urinary tracts, age of the patient and presence
of pyelonephritis.
Urologiia. 2004;(1):43-47
43-47
A comparative analysis of the results of open endoscopic operations in posteriorurethra obliterations in men
Abstract
Endoscopic recanalization of posterior urethra (PU) obliteration
(a novel method) was compared to open reconstructive-plastic operations.
242 patients with PU and vesicular cervix obliterations entered
the study. 93 patients of group 1 have undergone open reconstructiveplastic
operations, 149 patients of group 2 were operated endoscopically
(endoscopic recanalization under transrectal ultrasonic control).
Before surgery the patients were examined using standard tests, sonourethrography
and intraoperative transurethral ultrasonic investigation were added.
Recurrence rate in group 1 and 2 was 29.1 and
16.8%, respectively. The following complications were observed in
group 1: acute pyelonephritis (22.5%), enuresis (14%), orchoepididymitis (9.7%),
urinary fistulas (5.4%). The patients needed longterm
postoperative immobilization (10-16 days, mean 14.8+1.1 days).
After endoscopic recanalization under transrectal ultrasonic control,
group 2 patients developed acute pyelonephritis (4.8%), orchoepididymitis (4%),
orthostatic enuresis (4%), short-term urethral fever
(85.9%). Bed regime in this group was necessary for 1-2 days (1.3±0.4
days). Mean postoperative hospital stay was 2.5-fold less in group 2.
The conclusion is made that endoscopic recanalization under transrectal
ultrasonic control has advantages over open reconstructiveplastic
surgery: less frequent pyoinflammatory complications, enuresis,
the absence of such complications as impotence, short penis,
formation of urinary fistulas.
Urologiia. 2004;(1):47-54
47-54
Endoscopic and roentgenoendoscopic technologies in urology
Abstract
Present-day urology in the Russian Federation combines achievements
of classic surgery with innovations of the last two decades which
radically changed approaches to treatment of many urological diseases.
Wide introduction in clinical practice of low invasive endoscopic
and roentgenoendoscopic (endourologic) techniques is a standard for
urology progress worldwide. N. A. Lopatkin, academician of Russian
Academy of Medical Sciences, contributed much to advances of domestic
urology. He has organized endourological service as a basis of
further technological progress, introduction of low-invasive methods
alternative to traumatic open surgical interventions
Urologiia. 2004;(1):54-57
54-57
Current aspects of childhood urology
Abstract
Basing on the results of modern investigations applied preoperatively,
postoperatively and for 20 years of follow-up in more than
36000 children with urogenital diseases, the author believes that further
progress of childhood urology should advance in the scope of
general urology. He proposes basic principles underlying decision
making on the treatment of urological diseases in different age groups.
It is shown that many open and endoscopic interventions used in the
adults are converted into pediatric urological practice disregarding
pathogenetic and compensatory features in urological diseases in children.
Basing on specific features of the course of compensatory processes
in various age groups of children, new terms of corrective operations
are proposed.
Urologiia. 2004;(1):57-60
57-60
Vesicoureteral reflux into thehypoplastic kidney in children
Abstract
Reconstructive plastic operations were conducted in 54 children
aged 1 to 14 years. The children were followed up for 1 to 17 years.
In 40 patients reflux into the hypoplastic kidney combined with
anomaly or another disease of the contralateral kidney, in 10 patients
- with infravesical obstruction. The examination included clinical and
laboratory tests, ultrasound diagnosis, x-ray, radionuclide investigation,
uroflowmetry, on demand cystoscopy. Assessment of surgery results
was made by function of the hypoplastic kidney and growth of
its parenchyme, urodynamics, clinical symptoms of pyelonephritis. A
good result was achieved in 41%, satisfactory - in 39 and unsatisfactory - in 20% patients.
Thus, timely surgical elimination of vesicoureteral reflux
enables effective treatment of chronic pyelonephritis,
produces a positive action on urodynamics and renal parenchyma
growth.
Urologiia. 2004;(1):60-63
60-63
Treatment of long ureteral obliterations after transplantation of thekidney
Abstract
Ureteral ischemia is one of the causes of obliterations arising after
kidney transplantation. Reureterocystoanastomosis does not solve the
problem of ischemia. Ureteropyelostomy with the recipient's ureter
is the most effective open surgical intervention. Choice of operation
is made with consideration of specific features of blood supply. If the
use of own recipient's ureters is impossible, pyelocystostomy with
Boari flap is indicated for allograft's rescue
Urologiia. 2004;(1):63-65
63-65
Ureteral stents inpatients with transplanted kidney
Abstract
The aim of the study was to determine indications for application
of ureteral stents for draining urinary tracts of the renal transplant,
after low-invasive surgical interventions, for timing drainage, prevention
and correction of complications. Ureteral stent insertion for
management of urological complications after transplantation of the
kidney was made in 36 patients (25 of them haf ureteral stricture, 11
had ureteral necrosis). Low-invasive operations were made in 28 patients,
open reconstructive plastic operations were conducted in 12
patients. According to 6-12 follow-up of the stented patients, recurrent
ureteral stricture was detected only in 4 patients (11.1%). The
stricture was corrected transcutaneously by antegrade ureteral stenting.
It is concluded that stenting of the urinary tracts of the transplanted
kidney in the treatment of urological complications - necrosis
and ureteral stricture - in the course of low-invasive roentgenoendoscopic
and open reconstractive-plastic operations raises treatment efficacy
and prevents recurrent stricture.
Urologiia. 2004;(1):65-70
65-70
Review of the book by L. G. Managadze,N. A. Lopatkin, O. B. Loran, D. Yu. Pushkar, S. P. Darenkov, N. L.Turmanidze, R. Gogenfellner. Surgical Urology. Classic Treatment and Innovations. - M., Meditsina, 2003
Urologiia. 2004;(1):70-72
70-72