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No 1 (2004)

Articles

Nikolai Alexeevich Lopatkin is 80

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Urologiia. 2004;(1):4-7
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Margarita Fedorovna Trapeznikova

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Urologiia. 2004;(1):7-9
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Urology as a basic profession

Lopatkin N.A., Apolikhin O.I.
Urologiia. 2004;(1):9-12
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Diagnosis and treatment of urinary bladder cancer

Lopatkin N.A., Darenkov S.P., Chernyshev l.V., Martov A.G., Stupak N.V.

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
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Vascular endothelium growth factor and insulin-like growth factors in prostaticcancer

Trapeznikova M.F., Shibaev A.N., Yanshin A.A., Urenkov S.В., Mironova O.S., Kazantseva I.A., Kushlinsky N.E.

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
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Interstitial radiotherapy "1-125 Rapid-Strand" of local prostatic cancer

Sivkov A.V., Oschepkov V.N., Pataki K.V., Obukhova T.V.

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
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Metastases of renal carcinomato the adrenals

Trapeznikova M.F., Bogatyrev O.P., Bychkova N.V., Vorontsova S.V., Polyakova G.A.

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
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Current aspects of surgical treatment of benign prostatic hyperplasia

Kamalov A.A., Guschin В.L., Dorofeev S.D., Komlev D.L., Tokarev F.V., Efremov E.A.

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
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Surgical treatment for coral nephrolithiasis

Dzeranov N.K., Yanenko E.K.

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
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Extracorporeal shock-wavelithotripsy as monotherapy in coral nephrolithiasis

Trapeznikova M.F., Dutov V.V.

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
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Ureterocele and urolithiasis

Dutov V.V., Dolgov A.G.

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
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A comparative analysis of the results of open endoscopic operations in posteriorurethra obliterations in men

Trapeznikova M.F., Bazaev V.V., Urenkov S.B.

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
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Endoscopic and roentgenoendoscopic technologies in urology

Martov A.G., Guschin B.L., Merinov D.S., Ergakov D.V., Pavlov D.A., Shekhovtsov S.Y., Karaguzhin S.G., Lisenok A.A.

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
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Current aspects of childhood urology

Pugachev A.G.

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
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Vesicoureteral reflux into thehypoplastic kidney in children

Kolobova L.M., Sobolevsky A.B.

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
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Treatment of long ureteral obliterations after transplantation of thekidney

Perlin D.V., Alexandrov I.V., Grigoryev A.A., Yarovoi S.K.

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
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Ureteral stents inpatients with transplanted kidney

Urenkov S.В., Kulachkov S.M., Pasov S.A.

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
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