No 5 (2005)

To estimate the occurrence of positive surgical margins (SM) in conduction of radical retropubic prostatectomy and SM role in development of the recurrence, we studied 216 surgical patients with prostatic cancer aged 41 to 73 years. Stages T2a,b, ТЗа, Т1 and T3b were detected in 41.8, 35.6, 18.7 and 3.9% patients, respectively. A positive SM was verified in 68 of 193 (35.2%) patients. Of them, 36 (52.9%) patients had a focal (a single or short SM), while 32 (47.1%) patients had a long SM. The recurrence occurred in 31 (16.1%) cases, primarily in a long SM. In SM-free patients (group 1) one-year survival was 82% being very close to that in group 2 with a focal SM (83%). The differences between the groups were also minimal by three-year survival (75 and 73.6%, respectively). Thus, recurrence-free survival in the focal process and a short SM differs by three-year survival in the groups insignificantly. The period between month 12 and 24 is most risky in respect to recurrences in a short SM. Patients with a long SM had maximal number of prostatic cancer recurrences.

Enteroplasty of the urinary tract was made in 224 patients (175 male and 49 female, age 21-72 years): enteroplasty of the ureter (n = 25), augmentation cystoplasty (n = 38), replacement of the urinary bladder after radical cystectomy for cancer (n = 161). The grafts were made of the small intestine segments - 149 (66,5%), sigmoid - 45 (20%), stomach - 25 (11.2%), appendix - 3 (1.3%). Total postoperative lethality reached 2.7%. Early and late complications occurred in 26.8 and 32.2% patients, respectively. In half the cases complications were related to the derivation method. Fifty three reoperations were made, most frequent of them was percutaneous nephrostomy. Thus, use of gastrointestinal tract segments for replacement of the urinary tract provides adequate urine outflow from the kidneys, close to natural micturition. Introduction of advanced methods of urine derivation prevents formation of urinary fistulas and improves quality of the patients' life.

We compared efficacy of preoperative prophylactic antibiotic treatment (PPAT) with cyprofloxacine used orally (0.5 g), intravenously (0.4 g) and routine antibiotics in TUR of the prostate. A multicenter open randomized study covered 120 patients. PPAT efficacy was estimated by the rate of urinary infection . frequency and duration of antibiotic treatment in the postoperative period, hospitalization duration. All the patients were divided into three groups: 39 patients of group 1 received oral cyprofloxacine 90-120 min before TUR of the prostate, 38 patients of group 2 received intravenous cyprofloxacine 30-60 min before TUR, 43 patients of group 3 (control) received routine antibiotic prophylaxis. The following results were obtained: 24-48 hours after the operation no cases of UT in group 1, 11.5 and 11.6% in groups 2 and 3, respectively, (p = 0.048); 7 days after TUR - Ul in all the groups (2.6, 20, 23.3%, respectively): 14 days after TUR - Ul in 5.1, 28.6, 27.9% patients, respectively. Mean duration of hospital stay was 11.7 + 7.6 days in group 1. 12.1 ±8.1 days in group 2, 12.5 ± 7.8 days in group С (p > 0.05). Postoperative antibiotics were given to 16.7, 34.1 and 68.9% patients, respectively. Thus, cyprofloxacine in group 1 lowered Ul risk and postoperative antibiotics significantly, in group 2 it had no influence on UT rate but reduced postoperative antibiotics significantly.

The authors review epidemiology, classification, etiology and pathogenesis of erectile dysfunction (ED), its diagnosis and treatment with a focus on mechanisms of action and efficacy of the drug impase. Impase is the drug of superlow doses of affinitively purified potentiated antibodies to human endothelial NO-synthase. The drug regulates NO synthesis in the cavernous bodies, enhances an NO relaxing action on "their smooth muscles and blood flow in the penis under sexual stimulation. The drug demonstrated its high efficacy and safety in manv clinical trials. Impase trial performed in the Research Institute of'Urology in 2004 has found that impase is more effective in long-term administration, most of the examinees exhibited a clinical response only after one month of regular intake. The drug can be used both as the first-line monotherapy of ED and combined treatment of this disease. Clinical recommendations for practitioners on administration of impase are provided.

The aim of the study was examination of cause-effect relationships between PADAM, extragonadal production of androgens and high proliferative activity in aged men. The study group included 15 patients aged between 53 and 79 years with prostatic cancer (n = 5), urinary bladder cancer (n = 5) and cancer of the rectum (n = 5). Control samples of tissues of the prostatic gland, urinary bladder and rectum were obtained from dead bodies of men at the age between 18 and 29 years killed in the accidents at the age from 18 to 29 years. Testosterone levels in the tissues of peritumor zone of the prostate, in tumor tissue of patients with cancer of the prostate, urinary bladder and the rectum were higher than in blood serum. In prostatic cancer, testosterone in the tumor tissue was higher than in the tissues of prostatic peritumor zone. The values of Histochemical score AR of the peritumor zone in prostatic cancer patients were higher than those of the control group. It was detected that ER, PR, bcl-2, Ki-67 and p53 in prostatic tissue of young controls were absent while in patients with prostatic cancer these factors were expressed in the peritumor zone. In cancer of the urinary bladder, peritumor zone showed expression of PR, bcl-2, Ki-67 and p53, while no such expression was in the controls. ER, bcl-2, Ki-67 and p53 were registered in the peritumor zone of patients with cancer of the rectum but the controls had neither ER, bcl-2 norp53 while Ki-67 expression in rectal cancer was higher than in the controls. The results of the study suggest that testosterone production by some tumors and tissues of the peritumor zone accompanied with high proliferative activity and dysregulation of the cell cycle is secondary to PADAM. These changes arise to compensate testicular deficiency and are manifestations of metabolic syndrome (X-syndrome). In this situation immune system fails to utilize all atypical cells.

A comparative analysis of diagnostic examination of 130 men with isolated congenital erectile penile deviation (EPD) aged 14-22 years (mean age 17 years) has demonstrated that true EPD can be determined objectively only at adequate erection. Therefore, the diagnosis should be based not on subjective opinion of the patient but on the results of artificial pharmacological erection or viagra-test in combination with visual erotic and genital stimulation. Vacuum erection test is not justified. In patients with congenital EPD rigidity depends much on correlation between perfusion volume and functional volume of the penis (cavernous volume). The problem of congenital EPD can be formulated as the problem of "long penis". Measurements of the penis in the group of 54 patients with congenital EPD registered a low penile coefficient in 67% cases while a mean length of the penis in all the examinees was longer than a mean standard one and was about 13 cm in relaxed condition. EPD patients often suffer from asthenodepressive disorders deteriorating the copulative function. Psychotherapy and medication of the depressive syndrome result in stabilization of the psychological condition improving quality of life 1.3 times. Thus, an integrative diagnostic and therapeutic approach, due selection of the patients for operative correction of penile deviation can improve quality of the treatment aimed both at correction of erectile malformation and psychosexual adaptation of the patients.

A total of 135 patients with chronic prostatitis have undergone rehabilitation in Belokurikha health resort. Of them, 35 patients of group 1 received basic therapy (nitrosiliceous baths, therapeutic exercise, massage of the prostate, psychotherapy); 40 patients of group 2 received basic therapy plus rectal tampons with sulphide mud from the lake Gorkoye of the Altai Administrative Area; 60 patients of group 3 were given basic therapy plus rectal lavage of the prostate location with nitrosiliceous thermal water of Belokurikha health resort. Treatment efficacy was assessed by scales of the symptoms and sexual disorders, ejaculate tests, testosterone levels, immune status, results of doppler vascular mapping of the prostate. The highest effect was achieved in group 3 (87.3% response). This therapy relieves inflammation, stimulates a sexual function, improves hemodynamics in the prostate, raises the number and motility of spermatozoa, corrects immune disorders, normalizes testosterone concentration in the blood. In group 2 the response was obtained in 81.6% patients. This treatment improves hemodynamics, raises the number of spermatozoa. In group 1 the effect was observed in 60.4% patients, it manifested with an insignificant improvement in prostatic hemodynamics, spermatogenesis, hormonal and immune systems.

We studied cytomembranes of the interstitial tissue of renal medullary layer obtained by lifetime biopsy of renal tissue in the course of pyelolithotomy in 46 patients with urolithiasis and secondary pyelonephritis. Biopsy structure was controlled with histological methods using standard staining. Basic phospholipids and cholesterol fractions in renal tissue cytomembranes were assayed at thin layer chromatography. The findings show significant changes in a nephron cytomembrane lipid phase in patients with urolithiasis and secondary pyelonephritis. There was a structural rearrangement of lipid biolayer of renal tissue cell membranes in response to microbial inflammation. Thus, use of membrane-stabilising drugs are grounded in patients with secondary pyelonephritis and urolithiasis.

Two cases are analysed to show possibility of severe erectile dysfunction (ED) treatment with long-term and regular intake of phosphodilesterase-5 (PDE-5) vardenaphil. A 39-year-old patient had cavernous fibrosis due to intracavernous introduction of vasoactive medication. Vardenaffl was taken in a dose 20 mg in the evening for 6 months. At control examination ED relieved to a mild degree. Further intake of vardenaphil on demand is recommended. The other man 22 years of age had a severe erectile dysfunction after hip bones fracture and subsequent reconstruction of the urethra. He received vardenaffl in a dose 10 mg in the evening for 3 months. After the treatment ED improved to a mild degree and further on-demand intake is recommended.