No 2 (2005)

To compare the effects of urological, neurological and obstetricogynecological risk factors of urine incontinence (UI) in women, we made a questionnaire survey covering a representative sample of 4336 female residents of Moscow aged 25-74 years. We used standard epidemiological methods and unified criteria, descriptive statistics and modeling by means of logical regression in 6.12 version of SAS system. We revealed that chronic cystitis and other inflammatory urinary diseases provoke a 4-fold increase in the relative risk (RR) of Ul in women being higher than obstetricogynecological risk factors (RR 1.5-2.8) and neurological risk factors (RR 1.3-2.0). UI in many cases is of stress type, but in urinary inflammation a mixed type occurs 1.8 times more frequently. Thus, chronic cystitis and other urinary inflammatory diseases are essential UI risk factors in women.

Efficacy of surgical correction of stenosed pelviureteral segment (SPS) in 30 patients with hydronephrosis was analysed. Twenty three patients have undergone extended resection of the extrarenal pelvis together with SPS. Repair of the pelviureteral segment in these patients was made by Kuchere technique. Histologic examination of resected SPS detected advanced sclerosis of all the layers of the ureteral and renal pelvis walls in chronic mucosal inflammation. The operative technique is described. Postoperative complications were absent. The control examination upon discharge and 1-15 year follow-up results registered good functioning of the operated-on kidney with rehabilitation of the calyceal-pelvic structure. Plastic operation was successful due to creation of a wide anastomosis between the resected renal pelvis and the ureter with obligatory renal drainage using nephrostoma. In other 4 cases of SPS strictures graft plastic operations were made. Good functional results were achieved in 3 patients. The long-term results favour resections and creation of pelviureteral anastomosis by Kuchere.

Spontaneous retroperitoneal hemorrhages are a rare but severe complication of retroperitoneal organs and tissues disorders. For the last five years we treated 10 patients (7 females and 3 males) with spontaneous subcapsular or paranephral hematoma resultant from renal tumor rupture. Morphologically, 4 tumors were renal angiomyolipoma and 6 tumors - renal cell carcinoma. Most characteristic symptoms consisted in acute lumbar pain on the affected side (100%) and the absence of macrohematuria in all the patients. Marked hemodynamic disorders of a hypotonic type were observed in 50% patients (4 patients lost consciousness). Left kidney tumor ruptures were more frequent (70%). An accurate preoperative diagnosis was made in 70% cases with application of ultrasonic investigation, computed tomography, MR imaging. Of 4 patients with renal angiomyolipoma, conservative surgery (enucleation, enucleoresection) was conducted in 3(75%) patients. Of 6 patients with renal cell carcinoma, tumor removal with preservation of the kidney was feasible only in 1 (16.6%) patient, in the rest 5 patients radical nephrectomy was made. In 2 patients it was combined with venacavathrombectomy. Thus, patients with spontaneous rapture of renal tumors are characterized by absence of macrohematuria, prevalent location of the tumor on the left and in the middle segment of the kidney (90%), high diagnostic effectiveness of ultrasonography, no rise in local tumor recurrence consequently to rapture of the tumor tissue.

In 1988-2003 we operated 156 patients with various ureteral lesions. Of them 7 patients (6 males and 1 female, mean age 34-43 years)received kidney transplant (autotransplantation). Ureteral lesions were caused by previous surgery (n = 3), gunshot wound (n = 2), urolithiasis (n = 2). The follow-up results (for 15 period maximum) show that operative outcomes were satisfactory in 6 patients. One transplant was removed 7 days after the transplantation because of purulent pyelonephritis and necrosis of the ureter. The rest patients retain good function of the transplanted kidney and passability of the upper urinary tract. Thus, surgical autotranspiantation of the kidney performed in affected middle and low thirds of the ureter is an alternative to life-long nephrostomy and nephrectomy and has a good long-term prognosis in relation to function of a transplanted kidney.

Long-term results of conservative treatment of 153 patients with invasive cancer of the urinary bladder were studied retrospectively. The patients had stage T2 (n = 121, 79.1%), T3 (n = 26, 17%), T4 (n = 6, 3.9%). All the patients had transitional cell cancer. Gl, G2 and G3 tumors were registered in 104(68%), 35(24%) and 12(8%) cases, respectively. 88 (57.5%) patients received combined treatment, 65(42.5%) patients - only surgery. In the patients with a small invasive tumor of the urinary bladder subjected to surgery alone (TUR-vaporization), overall 5-year survival was 70.4%. In patients with advanced cancer of the urinary bladder who had received curative radiotherapy in case of superficial residual tumor had TUR-vaporization of the urinary bladder overall 5-year survival was 76.5%. In patients exposed to large-fraction (TFD 20-25 Gy) preoperative radiotherapy followed by TUR-vaporization, survival at this moment was 84.6%. Three-year overall and recurrence-free survival at stage T2 was 97.5 and 47.4%, respectively; at stage T3 and T4 overall 3-year survival was 57.1 and 26.6%, respectively. Thus, the conclusion is that transurethral electrosurgery in conservative therapy of patients with invasive cancer of the urinary bladder is a promising approach.

To evaluate efficacy of combined physiotherapy in patients with chronic prostatitis (chronic bacterial, chronic abacterial prostatitis), an open comparative trial was made by specialists of the Research Institute of Urology in 2003-2004 of the unit Andro-Gin. Before the treatment, a standard examination was made including analysis of case history and complaints, rectal palpation, questionnaire fillingin, prostatic secretion tests, PCR diagnosis, transrectal ultrasonic scanning and uroflowmetry. In group 1 (chronic bacterial prostatitis) given monotherapy with an etiotropic drag (ED) or combination of ED with Andro-Gin treatment, a significant improvement was achieved by the scale NIH-CPSI, Sorensen scale (p < 0.05). In group 2 (chronic abacterial prostatitis with inflammation) subgroups C,D,E patients showed significant improvement by the scales NIH-CPSI and Sorensen (p < 0.05). The highest symptomatic effect was recorded in the subgroup D in combined treatment with ED and Andro-Gin physiotherapy. In group 3 low NIH-CPSI scale score occurred due to alleviation of pain in subgroup F (p < 0.05), In subgroup G symptoms by the above scales did not change.Uroflowmetry featured moderate dynamics of the increment in maximal voiding speed. Voiding improved significantly in subgroup F in patients with chronic abacterial prostatitis in the absence of inflammation.

The aim of the study was assessment of clinical efficacy and safety of terazosine (setegis) in patients with benign prostatic hyperplasia (BPH) and concomitant cardiovascular disease. A total of 62 BPH patients with cardiovascular disease (ischemic heart disease, hypertension) having indications for alpha-adrenoblockers (mean age 74±11 years, 58-85) received terazosine in a dose 1-5 mg for 2 months. Clinical efficacy of terazosine was assessed by IPSS scale, residual urine, maximal voiding velocity. Safety of the drug was controlled by monitoring of arterial pressure, ECG, echo-CG. All the tests were made before therapy, on the treatment week 2, 4 and 8. The response was 90.3%. Overall symptoms score decreased by 37.0%, quality of life score rose by 23.8%. Amount of residual urine fell by 64.8%, maximal voiding velocity increased by 36.6%. Moderate effects of the drug (vertigo, weakness) occurred in 11.3% patients for 1 or 2 days after start of the therapy and were due to a moderate fall of arterial pressure in normotensive patients. Later artertial pressure stabilized, ECG registered no exacerbations of ischemic heart disease, no anginal attacks, no change in cardiac rhythm. Thus, terazosine (setegis) is effective and safe in BPH patients with cardiovascular disease. Pretreatment consultation of the cardiologist is desirable for correction of basic antianginal therapy.

To evaluate urodynamic parameters of the fetal lower urinary tracts in physiological pregnancy and without malformations, a monitoring of filling and voiding of fetal urinary bladder was made by the results of ultrasonic study of 76 fetuses at getation term 20-40 weeks. All the infants of the first year of life have undergone clinical examination of urination, 24-h monitoring of spontaneous voiding rhythms, ultrasonic measurements of residual urine. Normal urodynamic parameters of fetal lower urinary tract depending on gestation duration were obtained. These parameters can be used as prognostic criteria in diagnosis of intrauterine urinary disorders.