No 1 (2009)

We have examined composition of uroliths (qualitative and quantitative x-ray tests) and measured 24-h excretion of electrolytes (Cl-, NO2-, NO3-, SO42-, PO43-, cytrate, isocytrate and uric acid) using ion-exchange chromatography with a conductometric detector. We revealed correlations between ion characteristics, their concentration in the urine before and after treatment and composition of disintegrated uroliths and clinical data. This allowed us to identify some urinary ions which indicate activity of urolithogenesis, predisposition to urolithiasis, production of certain uroliths, reflect some processes running in patients with urolithiasis. We give concentrations of some urinary ions which can be considered normal and deviations which may indicate urolithogenesis.

Transurethral pyelocalycolithotripsy (TUPCL) was made in 87 patients (36 males and 51 females, age 7-82 years) with solitary uroliths from April 2007 to April 2008. Of 51 pelvic and ureteropelvic nephroliths, 24 (47%) had the size of 0.5-1 cm, 22 (43%) - 1.1-2 cm, 5 (10%) - over 2 cm. Nineteen stones of the upper segment calyx were of less than 1 cm in size, 6 (32%) - 1.1-2 cm, 4 (21%) - more than 2 cm. Nine stones of the middle segment calyx were less than 1 cm in size (44%), 4 - 1 to 2 cm (44%). One patient had the stone of more than 2 cm in size. Transurethral contact pyelolithotripsy was performed in all 87 patients. The rigid ureteropyeloscope was employed in 64 (74%) cases, fibropyelocalycolithotripsy was made in 23 (26%) cases. Indications for TUPCL were failure or aftereffects of extracorporeal pyelolithotro[sy (50 cases, 65%), suspected stricture under the stone (10 cases, 12%), ligature stones (7 cases, 6%). Pelvic stones were detected at diapevtic ureteropyeloscopy in 11 (17%) patients suspected of calycopelvic papillary tumor. In 8(9%) patients nephroliths were destructed with the electromechanic probe (Medline, Russia), pneumatic contact lithotripsy was made in 22 (25%) cases (Lithoclast Master, EMS, Switzerland), Ho laser lithotripsy was made in 41 patients (WaveLight Laser Technologie AG, Germany) with a 365 mcm waveguide in 14 (17%) cases and a 600 mcm waveguide in 27 (31%) cases. Pyelocalycolithoextraction was conducted in 16 (18%) patients. Elimination of the nephroliths was achieved in 71 (81.6%) patients. This shows that TUPCL is effective and comparable by efficacy with such methods as extracorporeal lithotripsy, percutaneous nephrolitholapaxy. Rigid ureteropyeloscopy eliminated nephroliths in 53 (83%) patients, fibropyeloscopy - in 18 (77%) patients. The experience of the authors and literature data allowed them to formulate indications for TUPCL: cacycopelvic nephroliths up to 2 cm in size in their location in the pelvis and upper segment calyx and up to 1 cm in size in their location in the calyces of the middle and lower segments irrespective of renal dysfunction degree and dilation of the calycopelvic system in failure or contraindications for extracorporeal lithotripsy and percutaneous nephrolitholapaxy. In nephroliths more than 2 cm in size TUPCL can be used as a method of choice in patients with morbid obesity, anomaly of the kidneys, upper urinary tract and the spine, hemostatic disorders. In large calycopelvic stones the patients should be informed about possible staged treatment or extracorporeal lithotripsy in the postoperative period.

Active substance of vitaprost® is a complex of water-soluble biologically active peptides isolated from bovine prostate. The prostatic extract has an organotropic action in relation to the prostate. As all peptide bioregulators, prostatic extract has antiaggregant and anticoagulant properties, enhances synthesis of antihistamine and antiserotonine antibodies, improves microcirculation in the prostatic gland. This accounts for its ability to reduce edema in prostatic inflammation. This clinical trial demonstrated that vitaprost® tablets decreases twice probability of chronic prostatitis exacerbation, of development of secondary exacerbations. A prophylactic intake of vitaprost® relieves symptoms of chronic prostatitis, first of all pain (discomfort), improvement of quality of life by NIH-CPSI, including exacerbation and significantly reduces size of the prostate. Vitaprost tablets can be effectively used prophylactively in chronic prostatitis for reducing probability of the disease exacerbations and their severity.

Currently available three highly selective and effective PDE-5 inhibitors (sildenafil, tadalafil and wardenafil) are comparable by PDE-5 inhibition and selectivity of action on PDE-5 but their differences in activity, interaction with food and alcohol, biological half-life and other characteristics make their use individual for certain clinical situations. Our trial with participation of 575 patients (mean age 57.73 ± 12.33 years) with arteriogenic erectile dysfunction and great number of vascular risk factors has shown that wardenafil was most popular among our examinees as it is more effective and begins acting faster. Further studies in optimization of the above drugs administration may perfect treatment of erectile dysfuncion.

The study of urodynamics, microcirculation, bacterial contamination and metabolism in 119 patients after intestinoplasty of the urinary bladder has shown that postoperative management of the patients including less aggressive surgery, phytotherapy with prolit, use of agents improving microcirculation decreased the number of late postoperative complications after intestinoplasty of the urinary bladder: acute and chronic pyelonephritis from 15.8 to 6.4%, urolithiasis from 40.3 to 16.1%, urinary bladder dysfunction from 21.1% to 6.5%, metabolic acidosis from 3.5 to 1.6%. Due to this approach it was possible to prevent progression of the stricture of urethrovesical anastomosis.

Extracorporeal shock wave lithotripsy (ESWL) was performed in 1451 children with urolithiasis aged from 7 months to 16 years. A total of 2464 sessions were made. Low-energy impulses in ESWL were effective in 98.8% children with concrements up to 2.0 cm in size and in 98.8% of those with stones larger than 2.0 cm. We believe that main factors of high efficiency of ESWL in children are: more friable structure of stones, small depth of stone location, faster evacuation of the stone fragments. ESWL with low energy impulses is highly effective and is not accompanied with traumatic complications. Renal parenchyma is not affected.