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No 2 (2004)

Articles

The results of long-term permixon® treatment in patients with symptoms of lower urinary tractsdysfunction due to benign prostatic hyperplasia

Pytel Y.A., Lopatkin N.A., Gorilovsky L.M., Vinarov A.Z., Sivkov А.V., Medvedev A.A.

Abstract

The trial enrolled 155 patients (mean age 65 years) with documented benign prostatic hyperplasia and lower urinary tracts symptoms (LUTS) (IPSS > 6). All the patients received permixon m a dose 160 mg twice a day for 2 years. The data on 130 patients eligible for assessment were processed statistically by dynamics of IPSS, quality of life (QOL), index of sexual function (MSF-4), size of the prostate urodynamic and biological parameteers which were estimated in 6 (V6) 12 (V12), 18 (V18) and 24 months (V24). Clinical examination with registration of all side effects was made each 3 months. Permixon was found to noticeably reduce IPSS and QOL and increae maximal urine flow speed. The size of the prostate diminished insignificantly. Sexual function remained unchanged for 1 year and improved markedly within the second year (p = 0.001). Permixon had no effect on the level of prostate-specific antigen. Plasma hormones (testosterone, DHT, estradiol, LH, androstendion) did not change. Nine patients developed 10 side effects but they were unrelated to the treatment
Urologiia. 2004;(2):3-7
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Shortand long-term results of ureterosigmostomy with creation of Mintzpouch II and Hasan reservoir

Darenkov S.P., Sokolov A.E., Ochcharkhadzhiev S.B.

Abstract

The aim of the study was analysis of short- and long-term results of treating patients operated with intestinal replacement of the urinary bladder by Mintz pouch II and Hasan. Thirty-two ureterosigmostomies with creation of the reservoir from the rectosigmoid angle (17 Mintz pouch II and 15 Abol-Enein operations) were made from 1997-2002. The age of the patients ranged from 16 to 73, the follow-up was 12-72 months. The operation was indicated in infiltrative cancer of the urinary bladder, microcystis of various etiology, extrophy of the urinary bladder. Postoperative urine retention was observed in all the patients both in the day and night time. Renal function remained unchanged or improved in 93% patients. Quality of life was good. All the patients except two with recurrent attacks of pyelonephritis were socially adapted. Able patients resumed their jobs. Early after the operation one woman developed incompetence of the sutures of the reservoir anterior wall which required relaparotomy. Four patients died of local recurrence and/or distant metastases in different terms after surgery. Two patients had reflux with frequent attacks of pyelonephritis as well as a serious impairment of acid-base balance manifesting as hyperchloremic acidosis, the other two patients had late unilateral strictures of the intestinoureteral anastomosis which was reestablished. Thus, updated ureterosigmostomy significantly reduces the rate of complications and is a good alternative to heterotopic and ortotopic urine derivation in contraindications for the operations. Moreover, Hasan's operation allows implantation of delated ureters. In most cases, ureterosigmostomy with formation of reservoir from rectosigmoid angle provides good quality of life in adequate selection of patients.
Urologiia. 2004;(2):7-13
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Resistance of hospital urinaryinfection pathogens by the data of multicenter microbiologicalstudies UTIAP-I and UTIAP-II

Rafalsky V.V., Strachunsky L.S., Krechikova O.I., Eidelstein I.A., Akhmetova L.I., Babkin P.A., Gugutsidze E.N., IIyina V.N., Kogan M.I., Kopylov V.V., Malev I.V., Petrov S.В., Rafalskaya L.V., Furletova N.M.

Abstract

Aim. To study causative agents and sensitivity of E-coli strains isolated from adult outpatients with uncomplicated urinary infection (UI) in different regions of Russia. Material and methods. A multicenter prospective epidemiological study included adult patients with uncomplicated infections of the upper or lower urinary tracts. MPK of antibiotics was established by dilution in agar according to NCCLS recommendations, 2000-2002. Results. Among UI causative agents, E.coli was most frequent (85.9%). K. Pneumoniae, Proteus spp., Staphylococcus spp., P. Aeruginosa, Enterococcus spp.occurred much less frequently (6, 1.8, 1.6,1.2, and 1.0%, respectively). E. Coli UI was highly resistent to ampicilline (37.1%), cotrimoxasol (21%),maximal resistance being in St-Petersburg (51.9 and 31.5%, respectively). Such oral antibiotics as norfloxacin and ciprofloxacin, cefuroxim, amoxicillin/clavulanat, nitrofurantoin were maximally active against E. Coli (4.3, 2.4, 2.6 and 1.2%, respectively). Conclusion. High resistance of E.coli, which is the chief causative agent of uncomplicated UI, to ampicillin, cotrimoxasol was detected. Fluoroquinolones, amoxicillin/clavulanat, nitrofurantoin, cefuroxim have high microbiological activity. On the basis of the pharmacokinetic, safety and other evidence it is concluded that drugs of choice for therapy of uncomplicated UI in Russia are oral fluoroquinolones
Urologiia. 2004;(2):13-17
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Misdiagnosis in purulent pyelonephritis

Sinyakova L.A.

Abstract

Most frequent errors in diagnosis of purulent pyelonephritis have been analysed. It is shown that only a total of data obtained on the disease history, clinical symptoms, results of laboratory tests, ultrasound or x-ray symptoms of purulent pyelonephritis enable making an accurate diagnosis and choice of adequate treatment policy.
Urologiia. 2004;(2):17-20
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Combined therapy of interstitial cystitis with the device AELTIS-SYNCHRO-02-"YARILO"

Kalinina S.N., Molchanov A.V., Rutskaya N.S.

Abstract

Multiple modality therapy of interstitial cystitis (1С) - the disease characterized by nicturia, pelvic pains, imperative pollakiuria - is considered. As 1С nature is not well known, its treatment remains empiric. Among the underlying causes, most probable are autoimmune, allergic, infectious, neurological, vascular. Therefore, the treatment should be multi-modality. Most usable now is combined chemotherapy. Perspective is also 1С treatment with medicines in combination with physiotherapy (electromagnetolaser AELTIS-SYNCHRO-02-YAR1LO"). Endovesical electrophoresis can be also applied
Urologiia. 2004;(2):20-23
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OPYT PRIMENENIYa SPAZMEKSA V KOMPLEKSNOM LEChENII INTERSTITsIAL'NOGOTsISTITA U ZhENShchIN

Klochikhin O.Z., Volkov D.Y., Vostokova E.I., Zhulina N.I.

Abstract

Efficiency of interstitial cystitis (1С) treatment of female outpatients is shown. Combined treatment of 1С was supplemented with the drug spasmex which has a peripheral anticholinergic and direct antispastic actions. It quickly relieves irritative symptoms, improves quality of life, shortens temporary disability and lowers the cost of the teatment.
Urologiia. 2004;(2):23-26
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Penis-saving treatment of penile cancer

Matveev V.В., Khalafyan E.A., Volkova M.I., Gurary L.L., Romanov V.A.

Abstract

Conservative penis-salvage treatment provides a complete local effect in 55% cases, preservation of the penis in 51.4% patients without a fall in long-term specific and recurrence-free survival compared to penectomy and can be recommended as an alternative to penis amputation in patients with stages Tis-T2. Removal of a penile tumor raises efficacy of salvage treatment and insignificantly increases survival. Application of surgical treatment only is associated with a high rate of local recurrences. Chemoradiotherapy in penile cancer is significantly more effective vs each method alone. Radiation in a total focal dose more than 60Gy improves local control over the tumor. Most effective are schemes of chemotherapy based on bleomycin. Polychemotherapy has no advantages over monochemotherapy with bleomycine.
Urologiia. 2004;(2):26-31
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An expandedtechnique of transrectal prostatic biopsy

Pushkar D.Y., Govorov A.V., Bernikov A.N.

Abstract

To compare diagnostic value of transrectal prostatic biopsy in obtaining samples of tissue from different sites in patients with various levels of prostate-specific antigen (PSA) and prostate size, we made primary transrectal biopsy of the prostate in 486 patients. The patients were divided into 7 groups by the number of punctures at biopsy (from 6 to 18). Among the patients with PSA under 20 ng/ml in the number of tissue biopsy samples 18, a rise in prostatic cancer detection rate (PCDR) was 16.6%. In PSA above 20 ng/ml, a statistically significant maximal rise in PCDR occurred in the increase of biopsy number from 6 to 12 (by 9.3%). The number of local cancer forms in patients with PSA < 20 ng/ml among all the detected cases rose from 70% (biopsy from 6 sites) to 92.3% (biopsy from 18 sites). Among the patients with PSA < 20 ng/ml and the size of the prostate > 50 sm3, a significant rise of PCDR increased from 20 to 33.3% in an increase of the puncture number from 6 to 12. In the group of patients with the same PSA level and prostate > 50 cm3 PCDR improves in biopsy from 14, 16 and 18 sites (from 12.1 to 27.7%, 28.5 to 33.3%, respectively). Standard biopsy is insufficient for adequate PCDR, it is necessary to obtain samples of tissue from a large number of sites with puncture of peripheral zone of the prostate. Transrectal biopsy of the prostate according to the extended method improves PCDR, primarily, in local cancer.
Urologiia. 2004;(2):31-33
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Extracorporealshock-wave therapy in the treatment of Peyronie's disease

Neimark A.I., Astakhov Y.I., Sidor M.V.

Abstract

The authors analyse the results of treatment of 28 patients with Peyronie's disease using extracorporeal shock-wave lithotripsy (ESWL) performed on Dornier U15 lithotriptor. A total of 2-6 sessions were made, maximal number - 12. The efficacy was controlled by clinical indices and ultrasonic investigation (Doppler mapping of the blood flow). ESWL proved to be efficient in the treatment of Peyronie's disease (PD), primarily, in patients with early disease before appearance of severe fibroplastic alterations. Less plaque vascularization by energetic Doppler mapping due to ESWL is an important diagnostic criterion of PD treatment efficacy. Conservative treatment is not indicated in marked deformities and plaque calcification, erectile dysfunction. Moreover, any injection into the tunica albuginea, especially complicated by hematomas may be a damaging factor which triggers fibrous inflammation. Such patients should be treated surgi- cally. If the patient is interested in immediate results or is not interested in continuation of sexual life, the treatment is prognostically uneffective. Thus, ESWL is an effective, safe method of PD treatment but requires further study and accumulation of clinical experience.
Urologiia. 2004;(2):33-36
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Impase in therapy of erectile dysfunction

Knyazkin I.V., Zezyulin P.N., Smorchkov A.A., Filippov S.V., Bykov N.M., Rylchikov I.V.

Abstract

Efficacy of impase in therapy of sexual dysfunctions of vascular genesis was studied in 38 male patients aged 35-68 years. The drug was taken for 2 months. The control was conducted with ultrasonic dopplerography. Impase showed high efficacy in therapy of vascular sexual dysfunctions especially in the group of patients aged 35-50 years with initial values of maximal systolic speed at least 15 cm/s.
Urologiia. 2004;(2):36-38
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Prolit in the treatment and prophylaxis of nephrolithiasis

Borisov V.V., Koptev V.V., Enaleeva S.K., Demerza Y.A.

Abstract

In the course of prolit treatment there was a spontaneous evacuation of small concrements from renal calyces and ureters in 11 (27.5%) patients, dilution of the concrements and reduction in size of the latter were observed in prolit combination with blemaren (2 patients-5% and 7 patients -17.5%, respectively). Overall response was 50% while that to cyston - 16.7%. Diuretic, anti-inflammatory and plastic actions of prolit manifested in 100% patients with disappearance of salts from urinary sediment, abatement of microhematu- ria and mild leukocyturia. Thus, prolit is a highly effective food additive in the treatment of nephrolithiasis and opens new perspectives in the treatment of urolithiasis.
Urologiia. 2004;(2):38-40
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Modification of the test "pressure-flow" for evaluation ofdetruzor contractility in the absence of urination

Arustamov D.L., Akilov F.A., Rakhimov N.M., Khodzhimetov T.A.

Abstract

The aim of the study was design and validation of the test for examination of detrusor contractility in the absence of urination. The method consists in registration of detrusor pressure in maximal speed of urinary flow in the course of artificial urination using Foley's catheter. Urethral resistance was modeled by raising drainage up to 40 cm above the level of the symphysis which was adjusted and found optimal in 48 of 179 examinees. The method allowed to select patients with infravesical obstruction (IVO) and normal detrusor contractility (n = 36) as well as patients with hypocontractility without IVO (n =12). The test "pressure-flow" in artificial urination evaluates detrusor contractility in patients unable to urinate. The test distinquishes patients with normal detrusor contractility and those with different degree of its impairment. This is important in assessment and prognosis of deficient urination.
Urologiia. 2004;(2):40-44
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Retroperitoneoscopic operations in cystic lesions of the kidneys

Zakhmatov Y.M., Kornev A.I., Otvetchikov I.N., Trofimov K.S.

Abstract

In 1997-2002 retroperitoneoscopic dissection of renal cyst walls (RDRC) was made in 21 patients. Computed tomography, excretory urography, retrograde ureteropyelography were conducted in 14, 3 and 2 patients, respectively. Ultrasonic investigation was made in all the patients before and after operation. Dissection of the cystic walls was successful in 20 of 21 patients, material for cytological and histological examinations was also obtained. Advantages of endoscopic operations are now obvious, so RDRS is perspective in cystic lesions of the kidneys and its usage will increase
Urologiia. 2004;(2):44-47
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Endoscopic nephropexy

Aboyan I.A., Grachev S.V., ShiranovA A.В., Mitusov V.V.

Abstract

In line with new prospects, introduction of laparoscopic technique in nephropexy gave rise to some problems. One of them - postoperative rotation of the kidney (RK). Upper-pole endovideosurgical nephropexy (EVSN) with prolen net performed in the diagnostic center "Zdoroviye" in 90 patients has demonstrated that late after surgery 9 (10%) patients had pains provoked by RK and abnormal renal circulation confirmed by dopplerography. In 1998 specialists of the diagnostic center "Zdoroviye" developed a novel method of EVSN providing elimination of the ptosis and RK. A total of 88 patients have been operated since. 67 patients with nephroptosis and RK have undergone nephropexy with a splitted flap of the prolen net, 21 patients without RK - standard nephropexy. Long-term postoperative follow-up showed that only 3 of 88 patients failed to retain normal velocity of the major renal blood flow, though they improved this velocity noticeably. Thus, a differentiated approach to EVSN based on dopplerographic examination of the major renal blood flow brings about improved treatment results in nephroptosis
Urologiia. 2004;(2):47-50
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Use of gas-free lateral retroperitoneoscopy from an open mini-approach for adrenalectomy

Tsukanov Y.Т., Tsukanov A.Y.

Abstract

The aim of the study was assessment of efficacy of gas-free lateral retroperitoneoscopy from the open miniapproach for adrenalectomy. Arguments are given for location of the mini-cut in the anterior segment of the 10th intercostal space and analysis was made of operative space parameters in retroperitoneoscopy from open mini-approach. The wound aperture 5.0 cm in size and 15.0 cm in depth is good as it provides the diameter of the monofocal zone 16.0 cm and bifocal zone 4.0 cm. If the size of the wound increases to 7.0 cm, the above parameters rise to 20.0 and 7.9 cm, respectively. Such visualized space is sufficient for adrenalectomy. Variants of the intervention are proposed depending on the side and kind of the lesion. A total of 21 patients with various adrenal pathology were operated. The operation lasted for 114.7+1.5 min. Overall blood loss reached 22.0±3.2 ml, transfusion _ 137.811.0 ml. The intestinal function normalized on day 1-2. In the postoperative period mean number of narcotic analgetics injections made up 4.9±1.5. Body temperature returned to normal on day 5.3± 1.6 after the intervention. The length of the scar was 4.210.6 cm. None lethal cases were registered. Conversion to the classic open procedure had to be made in four cases. Gas-free lateral retroperitoneoscopic adrenalectomy from open mini-approach is minimally invasive operation. In well selected cases this is a safe and effective alternative to conventional and endovideoscopic gas surgery
Urologiia. 2004;(2):50-54
pages 50-54 views

Pathogenetic mechanisms of infectious-inflammatory and thrombohemorrhagic complications oftransurethral prostatic resection

Malyshev A.V., Vasilyev Y.V.

Abstract

The role of hemostatic disorders and alterations in urine proteolytic activity in pathogenesis of infectious-inflammatory and thrombohemorrhagic complications of prostatic transurethral resection (PTR) was studied. Hemostasis and urine proteolytic activity were investigated with biochemical and coagulological tests in 54 patients with benign prostatic hyperplasia (BPH) before and after PTR. Significant hypercoagulation in early postoperative period found in the examinees promoted formation of inflammation-related contaminated dense protein products which serve a sourse of permanent reinfection. The patients had low proteolytic activity of the urine caused by renal dysfunction as a result of abnormal urodynamics in this disease. Thus, hemostatic disorders and subnormal proteolytic activity of the urine are essential factors in pathogenesis of infectious-inflammatory and thrombohemorrhagic complications of PTR. The conceptual s cheme of postoperative complications pathogenesis in BPH patients subjected to PTR is proposed.
Urologiia. 2004;(2):54-59
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Surgical correction of primary nonrefluxing megaureter in childrenand its long-term results

Cheskis A.L., Vinogradov V.I., Leonova L.V., Al-Kadi К.М.

Abstract

Correction of primary non-reflux megaureter (153 ureters) was made in 136 patients aged 3 months to 14 years. Bilateral disease was in 17 patients. Non-reflux non-obstructive megaureter was in 113 cases, obstructive in 40 cases including association with ureterocele in 23 cases. Resection of distal ureter with its neoimplantation into the urinary bladder according to the antireflux technique was made in 146 patients, endovesical electroperforation and resection of ureterocele were made in 5 and 2 patients, respectively. Good results were obtained in 88.3% (135 ureters), satisfactory in 2.6% (4 ureters), unsatisfactory in 9.1% (14 ureters). After effective correction of megaureter, the treatment should be focused on adequate therapy of pyelonephritis pressent in 90% examinees, on improvement of urodynamics and stabilization of sclerotic process in renal parenchyma. The patients need long-term follow-up and more effective treatment.
Urologiia. 2004;(2):59-65
pages 59-65 views

Role of urodynamics correction incombined therapy of children with urinary infection

Danilova T.I., Danilov V.V.

Abstract

The authors propose differentiated complexes of therapy of children with urinary infection. These complexes include medicines (Mcholinolytics, antihypoxic drugs and drugs improving microcirculation) and low-invasive therapy. Clinical experience is reported for 4 boys and 40 girls with microbial-inflammatory urinary diseases. Standard urodynamic tests were made in all the patients before and after the course of therapy. Three variants of driptan effects on the urinary bladder were identified: M-cholinolytic, spasmolytic and mixed (larger volume and lower intravesical hypertension). Some of the patients experienced standard endoscopic reflux correction with the use of synthetic hydrophilic gel. Control urodynamic examinations 3 months after the treatment showed that functional disorders were reduced. Treatment efficacy was assessed with home flowmetry. Thus, combined therapy of microbial-inflammatory diseases with parallel correction of lower urinary tracts urodynamics by M-cholinolytics improves treatment results. Courses of antibacterial and uroceptic therapy should be followed by non-invasive monitoring to reveal urodynamic disorders, define dysfunction type and perform an additional treatment with mediators in combination with physiotherapeutic procedures.
Urologiia. 2004;(2):65-70
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A case ofurethral transposition and vaginoplasty in the presence of urogenital sinus in women

Derevyanko I.M., Derevyanko T.I., Ryzhkov V.V.

Abstract

A case of female false hermaphroditism is reported in a 30-year-old woman with urogenital sinus. This woman has undergone vaginoplasty and urethral transposition. The latter is not usually made in women with urogenital sinus. This leads to the position of the external urethral ostium in the depth of the newly formed vagina and, finally, to ectopia of the external urethral ostium or hypospadia. The result is that such woman suffers all life from urethritis, cystitis and vulvovaginitis.
Urologiia. 2004;(2):70-71
pages 70-71 views

A rare form of testicular teratoma

Simchenko N.I., Bazylev P.L., Bykov O.L.
Urologiia. 2004;(2):71-72
pages 71-72 views

Renal resistance to ischemic damage and cell mechanisms of adaptation

Kirpatovsky V.I., Kazachenko A.V., Yanenko E.K.
Urologiia. 2004;(2):72-78
pages 72-78 views
pages 78-79 views
pages 79-81 views

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