No 6 (2005)

The results are given of subtotal transurethral resection (subtotal TUR) in 21 patients with prostatic cancer (PC) operated in 19982004. The patients had contraindications to radical treatment. The aim of the surgical intervention was maximal possible removal of the prostatic tissue to the prostatic capsule that improves results of adjuvant hormonal and radiotherapy. Postoperative follow-up lasted from 6 months to 6 years. The control groups consisted of 20 patients subjected to palliative prostatic TUR and 24 PC patients given only hormonal or radiotherapy. Subtotal transurethral prostatectomy and TUR of the prostate were successfully made in all the patients. The number of postoperative complications and reoperations was less in patients after subtotal transurethral prostatectomy than in those after palliative TUR. The treatment reduced blood PSA levels in all the groups but the progress of this reduction depended on the treatment method. The group after subtotal transurethral prostatectomy achieved maximal PSA lowering after 2 months after surgery. The follow-up registered distant metastases in 19.04% patients of the study group and 20 and 29.4% in the control groups. One-year survival was 80.95, 80, 83.3%, respectively; 3-year survival was 80, 45.5 and 77.8%, respectively. Thus, combined treatment of prostatic cancer (subtotal transurethral prostatectomy and maximal androgenic blockade) rapidly corrects urination without deterioration of survival parameters compared to hormonal therapy alone.

The results of 526 transrectal prostatic biopsies are available. Mean age of the patients was 64.6 years, mean level of PSA - 10.4 ng/ml, mean size of the prostate - 56 cm3. Biopsy was made in visualization of the prostate in the sagittal projection (ultrasound devices Bruel&Kjaer 1846 and Kretz Voluson 730). Application of Brael&Kjaer Medical 2102 Hawk provides visualization of the prostate during biopsy both in sagittal and cross projection. Double visualizafrcm sVgTiVnraTffiy improved detectabiiity of prostatic cancer in patients with PSA 4-10 ng/ml. In biopsy of the top and peripheral zone there was lengthening of prostatic tissue fragments, reduced fragmentation of the columns, less frequent blank shots of the biopsy gun. The data obtained supports the importance of isolated placement and marking of prostatic tissue fragments in biopsy and allow to recommend wide clinical use of ultrasonic facilities with biplanic sensors providing online sagittal and cross visualization of the prostate.

The aim of the study was elaboration of a new minimally invasive but effective alternative method of BPH treatment. The experiments were carried out on 46 male dogs divided into two equal groups. 10 ml of Prostalyser-1 solution (natrii chloridi 9.5 g, dimethylsulfoxidi 0.5 g, aquae destill. Ad 1000.0 g) was given in a single injection into the prostates of the first group of animals. The same volume of Prostalyser-2 solution (spiritus ethilicus 96% - 76.5 g, DMSO 0.5 g, aq.destill ad 100.0 g) - into the prostates of the other group, respectively. The temperature of the solutions was +80°C. Within the first 2 months, essential disorders were observed in the cellular Na-pump, membrane permeability system, there were lobular and diffusive necroses in prostatic alveolar epithelium and a decrease of the prostate weight by 68-66%. This condition of the prostate persisted for 4-6 months. Prostalyser-1 and Prostalyser-2 solutions can be recommended as very prospective substances for chemical destruction of the prostate in case of BPH.

We studied 164 patients with Peyronie's disease, 34 of whom have clinical symptoms of erectile dysfunction. Dopplerography has detected alterations of penile hemodynamics in 71.8% cases. Vein occlusive dysfunction prevailed (54.8%). Dopplerographic signs of venoocclusive dysfunction were seen also in patients with minor erectile disorders (55.4%). The analysis of absolute values of the systolic velocity peak allowed us to consider values in the range > 25 but < 35 cm/s as borderline or suboptimal, corresponding to subclinical period of venoocclusive dysfunction. Dynamic cavernosometry results served the basis for criteria of subclinical venoocclusive dysfunction characterized by threshold intracavernous pressure 50 mm Hg, coefficient of 30-s reduction of intracavernous pressure from 1.75 ± 0.93 to 2.1 ±0.8 mm Hg and supporting perfusion velocities under 29.2 + 15 ml/min. Characteristics of hemodynamic status and penile geometry help an optimal choice of deviation correction in patients with Peyronie's disease.

We studied diagnostic potentialities of conventional clinical, device, x-ray and ultrasonic methods including current Doppler technology in differentiation of serous and purulent stages of acute pyelonephritis (AP) in 50 patients (mean age 25.5 ± 5.5 years). Energetic dopplerangiography (EDA) showed the highest diagnostic significance. EDA was highly informative in renal carbuncle and total purulent destruction of the kidney and low informative in serous and apostematous AP, renal abscess. Conventional ultrasonic, x-ray, clinical and device investigations as well as impulse dopplerography and color Doppler mapping of blood flow are of secondary importance in AP.