No 3 (2004)

The article presents medicoecological estimation of quantitative relations between monsoon climate and urolithiasis primary morbidity in the Primorsky Territory.Quantitative estimation of the climate was performed by V. I. Rusanov (1973) who calculated daily meteorological data for 1 p.m. throughout 1991-1999. Primary urolithiasis morbidity for this period of time was provided by regional health department. The data were processed by methods of medical mapping and paired correlation analysis. In the Territory, mapping revealed the same location of the zones with high frequency of discomfortable weather of class V and VI causing chilblain in positive air temperatures and zones with elevated primary urolithiasis morbidity in children and adults. Correlation analysis confirmed mapping results and determined significant negative correlations between frequency of relatively comfortable moment weather classes II-IV and morbidity of children and adults, positive correlation between frequency of discomfortable class VI and adult morbidity. Thus, high frequency of days per year with discomfortable classes of moment weather in low positive air temperatures may be one of the factors of urolithiasis risk in population of the Primorsky Territory. Climatic factors should be taken into consideration in planning primary prophylaxis of this disease in the Primorsky Territory

To improve metabolism and reduce activity of pyoinflammatory reactions in complicated infection of the kidneys, we studied pharmacological potentialities of perfluorocarbon emulsion perfluoran. Correlation between oxygen unbalance, development of cell membrane pathology and activity of pyoinflammatory affection of the kidneys was studied in 67 patients with acute obstructive pyelonephritis complicated by urosepsis. It was found that surgical manipulations aiming at recovery of urodynamics and normalization of hemodynamic indices of the kidney are accompanied by development of reperfusion syndrome of the affected and contralateral kidney. Use of perfluoran in this situation promotes rapid compensation of gas transport disturbances, stabilization of the equilibrium in the system prooxidants-antioxidants, regress of pyoinflammatory reactions, earlier recovery of functions of a more affected kidney and antiischemic protection of the contralateral organ. Antiischemic and membranestabilizing actions of perfluoran make this drug adequate for use in patients with complicated renal infection.

We assessed how bilateral microsurgical varicocelectomy alters semen quality in a large cohort of infertile men with bilateral varicocele. By means of bilateral testicular biopsy, we have investigated the spermatogenesis failure in several biological men groups and determined whether it can change the patient's candidacy for assisted reproductive technology procedures (ART). Materials and methods. From 1993 until 2003 in the urology and andrology department of St. Antoine hospital (1993-1994), the Tenon hospital (1994-2003) and hospital Saint Louis (1997-2003), 956 patients with varicocele were consulted and operated for primary or secondary sterility. Bilateral varicocele was observed in 219 patients. Our study included 198 patients with clinical palpable and infraclinical (ultrasonic doppler scanning) bilateral varicocele who underwent microsurgical bilateral varicicolectomy with bilateral testicular biopsy. Mean patient age was 34.5 (range 19 to 65) years. Varicocele has been classified into 4 stages. All the patients underwent a complete physical examination, including supine and standing scrotal examination, as well as testicular volume determination using a standard orchidometer. Complementary investigation included: the hormone status (FSH, LH, testosterone), semen analyses (carnitine, LDHx, fructoze, zinc). On the basis of the total motile sperm count 198 patients were divided into 5 biological groups: 10 azoospermia and oligospermia extreme (0-1) x 106/cc - 83 patients (41.9%); 2) oligospermia severe (1.1-5) x 106/cc) - 37 patients (18.7%); 3) oligospermia moderate (5.1-10) x 106/cc) - 36 patients (18.9%). To measure the sperm quality, the spermogram was studied 3, 6 and 12 months after the operation. On the basis of testicular biopsy we defined the following spermatogenesis groups: normal spermatogenesis - 9 cases, hypospermatogenesis - 141 cases, maturation arrest (early-6, late-20), Sertli cell only syndrome (SCOS) - 17, tubular and peritubular sclerosis -5. The correlative analysis between the FSH classes and azoo- and oligospermic subsets (83 patients) shows that azoo-oligospermic area as a whole represents only 2 patients (2.4%) in the low FSH class, 46 (55.4%) in the normal FSH range class II, 39 (46.9%) patients in the high FSH class III. All the patients were divided into 4 groups according to the type of ART for which they qualified including 0 to 1.5 million/ml (intracytoplasmatic sperm injection-ICSI) - 79 patients, 1.5 to 5 million/ml (in vitro fertilization-1VF) - 33 patients, 5 to 20 million/ml (intrauterine insemination - IUI) - 47 patients and 20 million/ml or greater sperm (spontaneous pregnancy candidates)- 39 patients. Results. Postoperative sperm concentration increased significantly compared to the one before the varicocelectomy. In the group of our patients the results were the following: of 198 patients 105 (53.1 %) improved the spermogram, 44 (22.2%) worsened the spermogram, the spermogram was not changed in 49 (24.8%). In the first biological group of 83 patients, 42 (50.6%) improved the spermogram that enables using several methods for this difficult group (ICSI, IVF) for assisted reproductive technique (ART). The total amount of motile sperm per ejaculation increased from (0.09+0.030) x 106 before varicocelectomy up to (8.9+1.3) x 106 afterwards. In this group the testicular biopsy shows different variants of spermatogenesis disturbances, respectively. As for biological groups 3, 4 and 5, the observed spermogram improvements sharply increased the patients' liability to spontaneous pregnancy and make them intrauterine insemination candidates. Conclusions. Microscopic varicocelectomy has minimal morbidity and recurrence and may be beneficial for certain patients. Making simultaneous biopsy in patients with azoospermia and severe oligospermia makes it possible to distinctly define the extent of spermatogenesis disturbances and to elaborate adequate treatment policy. The drastic improvement of the sperm quality after varicocelectomy increases the ART chances for spontaneous pregnancy

Effects of low-molecular heparin flaxiparin on prevention of thrombotic complications after radical prostatectomy were studied in two groups of patients with localized formes of prostatic cancer at stages Tic, T2a, T2b and T3a. Group 1 received non-fractionated standard heparin in a dose 5000 units 4 times a day for 10 days. Group 2 was treated with flaxiparin in a dose 0.3 ml (7500 U anti-Xa) twice a day s.c. for 10 days. After therapy no thromboembolic complications were observed. In group 2 removal of the urethral catheter was conducted 4-5 days earlier than in group 1. This reduced hospital stay from 29 to 20 days. Flaxiparin accelerated growing vessels in the zone of urethrourethral or urethrovesical anastomosis resulting in improvement of microcirculation and preventing strictures in the anastomotic zone. Thus, low-molecular heparin prevents thromboembolic complications, reduces hospital stay and duration of rehabilitation after radical prostatectomy.

Experiments on 8 rabbits have demonstrated that mucosa of the urinary bladder freely transplanted into the subcutaneous fat or under the muscular fascia is engrafted with unaffected normal histological structure and revascularized with vessels invading from the adjacent tissues. Urethroplasty with a vesical mucosa graft was made in 10 dogs with experimental urethral stricture (4 animals), urethral fistula (5 animals) or a combination of urethral stricture and fistula (1 animal). A positive result with reestablishment of normal urethral passability and elimination of urinary fistula was achieved in 9 animals (follow-up for 1 year). One dog died of an unknown cause. Urodynamic examination of the dogs in long-term follow-up reported normal urethral resistance to urinary flow.

Retropubic colposuspension (RC) is one of leading surgical treatments of stress enuresis in women. A low-traumatic method of RC with application of special surgical instruments is proposed. Retropubic urethrocervicopexy and low-invasive colposuspension were made in 27 and 17 women, respectively. 25 women have undergone endoscopic operations. Postoperative complications were minimal in endoscopic and low-invasive interventions. Long-term results were similar to literature data. Low-invasive colposuspension is an effective and low-traumatic treatment of stress enuresis in women