No 6 (2004)

A retrospective one-stage epidemiological trial was made to investigate prevalence of urinary infections (UI), urolithiasis (UL) and benign prostatic hyperplasia (BPH) among rural population, to reveal latent or initial stages of these diseases and to specify preventive policy. 2330 rural one-year-olds and older children (n = 345, 14.8%) were covered by a screening examination forbacteriuria, leukocyturia, crystaluria and symptoms of the lower urinary tract caused by benign prostatic hyperplasia (BPH). UI, UL, BPH were detected in 7.0% (70:1000), 17.9% (179:1000) and 17.3% (173:1000), respectively. UI and UL ran a latent course. The former needed an antibacterial preventive therapy, the latter - prophylaxis of primary lithogenesis. Alpha-adrenoblockers were indicated for BPH patients. All the necessary therapeutic and prophylactic measures can be realized outpatiently by general practitioners

The aim of the study was to specify treatment policy in nephroptosis on the basis of characteristics of the onset, development and course of the disease. A total of 83 patients with nephroptosis were examined. The rotation angles of the kidney were summed using standard excretory urograms in clino- and orthostasis. Radionuclide nephroscintigraphy, rheorenography were made in 72 patients. Statistical processing employed correlation, cluster, discriminant analysis of the program Statistica. The method of estimation of the angles of rotation of the movable kidney in three planes was introduced. Grouping of patients by the sum of the rotation angles appeared more precise in reflecting disorders of intraorganic circulation in the kidney than skeletotopic distribution by the nephroptosis degree. Standard excretory urograms allow determination of the sum of the angle of rotation of the movable kidney and, finally, adequate conservative or surgical treatment method. Surgery can correct disorders of intraoring ganic blood flow by creating physiological position for the kidney raisto the due level and eliminating rotation.

To estimate the rate of positive surgical margin (SM) in radical retropubic prostatectomy and its role in emergence of prostatic cancer (PC) recurrence, we operated 216 PC patients aged 41 to 73 years. Most of the patients had clinical stages T2a,b (41.8%) or T3a (35.6%). Stages Tl and T3b were in 18.7 and 3.9% patients, respectively .A positive SM was Г registered in 68 of 193 patients (35.2%). Thirty six (52.9%) patients had a focal (solitary or short) SM, thirty two (47.1%) had a long SM. The recurrence occurred in 31 (16.1%) patients who, as a rule, had long SM. Recurrence-free one-year survival in 104 patients who had no SM reached 82%, in 34 patients with focal SM (group 2) it was 83%. Such three-year survival in group 1 and 2 was 75 and 73.6%, respectively. Thus, recurrence-free survival in organ-limited process and short SM differed little within 3 years. The period between 12 and 24 months of follow-up is most risky in relation to detection of recurrence in short SM. The group of patients with long SM had maximal number of recurrences.

The depth of drug penetration into the wall of the urinary bladder in intravesical ionophoresis (IVIP), IVIP influence on functional condition of the lower urinary tracts were studied on 15 female dogs. Functional condition of the lower urinary tracts was characterized by pressure in the urinary bladder, "volume-pressure" index, bioelectric activity of the urethra. The pressure was registered by electromanometry. Bioelectric activity of the urethra was studied with electromyography and tetrapolar rheography. The above indices were registered synchroneously on a multichannel recorder. Intraoperative cystomanometry was made in 7 tyopental narcotized animals. Samples of blood and vesicular tissue were taken for immunofluorescent study before and after IVIP. Medicines were accumulated best in mucous and submucous layers (0.03910.0012 and 0.0338±0.0050 mcm/mg tissue, respectively). After IVIP intravesical pressure was, on the average, lower in the same filling volumes as before IVIP. A mean amplitude of spontaneous fluctuations of pressure in the urinary bladder in its filling after IVIP was also lower than the baseline. After IVIP, pressure in the urinary bladder in voiding was much lower than before the procedure, maximal capacity of the urinary bladder and elasticity of the wall increased. Bioelectrical activity of the urethral wall was registered in the same mean pressure and capacity as before IVIP. Intensity of micturition after IVIP course decreased both at rest and in diuretic load with lasix. Time to micturition was increased with an increase in the number of procedures of IVIP. Thus, the experimental study showed pathogenetic validity of intravesical ionophoresis of medicines in the treatment of chronic recurrent cystitis

Stress urine incontinence was treated in 79 women with Burch laparoscopic colposuspension, 75 (94.9%) of them had chronic urinary infection. 42 females of group 1 received postoperative extracorporeal hemocorrection, 37 females of group 2 received conventional postoperative therapy. In group 1 the treatment reduced leukocyturia, bacteriuria was detected in 9 (21.4%) patients, recurrent incontinence occurred in 2 (5.9%) women. In group 2 leukocyturia enhanced, bacteriuria and incontinence recurrence were observed in 23 (62.2%) and 8 (23.5%) patients, respectively. The results of the study show that combined use of laparoscopic colposuspension by Burch and extracorporeal hemocorrection improves the results of the treatment of stress urine incontinence

Urinary incontinence (UI) is represented clinically by stress, urgent, mixed forms. Until recently, effective pharmacological treatment of stress UI was absent. Now, attempts are made to try duloxetin to raise efficacy of conservative treatment and quality of life in patients with stress and mixed UI. A large, double blind, placebo-controlled, randomized phase II trial provided data on efficacy of duloxetin in the treatment of stress and mixed UI in women. Duloxetin led to a decrease in the number of incontinence episodes, a rise in quality of life. It was rather effective in severe UI. Phase III trial of duloxetin in a dose 80 mg/day reduced the number of incontinence episodes by 50% in most of the patients and in some of them cured the patients.