No 5 (2009)

We performed subcutaneous bypass draining (SBD) of the upper urinary tract (UUT) in 12 patients (3 males, 9 females, mean age 64 years) in 2006-2008. Ureteral obstruction was caused by a tumor in 11 patients, one patient had extended obliteration of the left ureter after resection of the abdominal aorta aneurysm and two plastic operations on the UUT. All the patients with ureteral tumor obstruction had only one functional kidney. For SBD of the kidney we used Detoure stent in 2 cases, the nephrovesical bypass - in the rest cases. Surgery was made in the lateroposition of the patient which provided sumaltenous establishment of the renal and vesical ends of the stent. The kidney was also drained by the nephrostoma in 8 patients. The nephrostoma was removed after antegrade pyelography and pyelomanometry. Intraoperative complications were not registered. Suprapubic urine leak in 3 patients previously given radiotherapy was stopped by a long drain of the bladder. Obstruction of the distal stent part by a progressive tumor was diagnosed in 1 patient 3 months later. The bypass was removed and a nephrostomic drainage was made. The nephrovesical stent was changed in one case 5 months after SBD. Upon 6-32 month follow-up 3 patients died of cancer progression, the rest are still alive. Thus, SBD is indicated if stenting, ureteral endoprosthesis, constant nephrostomic drainage are impossible. In some cancer patients with ureteral obstruction in UUT drainage SBD is a method of choice with promising short- and long-term results.

Thirty three urolithiasis patients (13 males, 18 females aged 29-77 years, 2 children, duration of the disease 1-17 years) received food additive urisan in combined treatment of urolithiasis. Blood and urine biochemistry was studied by 11 parameters to evaluate renal function and lithogenesis before and after intake of urisan. Standard treatment was combined with intake of 2 capsules (1100 mg) of urisan twice a day at meal for 2-3 weeks. The data were processed statistically. It is shown that urisan contributes to intensification of renal filtration function, to reduction of hyperuricemia and urine pH, intensification of uric acid excretion, continuation of inflammation remission, attenuation of proteinurea in urolithiasis patients with exacerbation of chronic pyelonephritis.

Ectopia of the urethral opening (female hypospadia) often causes chronic recurrent cystitis in women because of a retrograde delivery of urogenital infection from the introitus and vagina to the short wide urethra and urinary bladder. Etiologically, cystitis develops due to pathogenic vaginal microflora: Chlamydia trachomatis, Mycoplasma genitalium, Ureaplasma, urealyticum, Gardnerella vaginalis, Candida, E. coli and other gram-negative bacteria. In 64 female patients aged 16-57 years with female hypospadia (FH) the diagnosis was made by O'Donnel-Hirchhorn symptom. Identification of urinary and vaginal microflora was made using polymerase chain reaction. Radical treatment of chronic recurrent cystitis in FH is surgical - transposition of the distal urethra and its opening in the typical place with pre- and perioperative anti-inflammatory therapy according to the pathogen or with drugs having combined antimycotic and antiprotosoic properties. One of such drugs safocid demonstrates a rapid therapeutic effect in mixed urogenital infections causing chronic recurrent cystitis in women.

Overactive bladder (OAB) is observed in such brain diseases as stroke, hypoxic ischemic encephalopathy, Parkinson's disease (PD), multiple sclerosis (MS). Trospium chloride (spasmex) was used in OAB patients with MS (n = 87), stroke (n = 83), encephalopathy (n = 47) and PD (n = 36) in doses from 15 to 45 mg/day in 2 to 36 month courses. The response with minimal side effects was achieved in 94% patients. In addition to basic effects, trospium chloride relieved spastic constipation in patients with stroke, hypersalivation in PD and anal incontinence in MS.

The compression-decompression method was used in the treatment of vasculogenic erectile dysfunction in 42 patients. The barotherapeutic urological unit (ABTU-01) Andromed was used. The alternation of compression and decompression of cavernous bodies stimulates synthesis and maximal realization of biological effects of nitric oxide the abnormal synthesis and release of which due to endothelial dysfunction are among the leading causes of erectile dysfunction. The efficacy of the method was 90-93%, duration of the effect - from 7 to 12 months depending on the kind of vascular disorders.

Combined treatment with doxasozine and finasteride was performed for 7.26 months in 38 patients with large-size prostatic adenoma (89.54 ± 11.64 cm3). The study group of 38 patients given the above combination benefited from the treatment (18 patients avoided surgery, TUR of shorter duration with removal of a less amount of tissue and less blood loss was conducted in 20 patients). Bladder draining with the urethral catheter was also shorter in the study group. The control group (28 patients with large prostatic adenoma) received surgical treatment alone. Long-term results were good in both the groups. Thus, combined treatment with doxasozine and finasteride can be the first-line treatment in patients with large prostatic adenoma.

We performed a pilot study of PDE-5 inhibitors efficacy in the treatment of diabetic genital neuropathy. A total of 16 diabetic males (type 1 diabetes mellitus) having erectile dysfunction with symptoms of genital neuropathy entered the trial. These patients received tadalafil for 3 months. The results were assessed with sexological questionnaires and dynamics of genital neuropathy symptoms. Tadalafil treatment was found effective.

A total of 97 patients (59 males, 38 females, age 26-88 years) with cancer of the urinary bladder (pTa, pT1, pT2) were initially examined with white-light cystoscopy, then narrowband cystoscopy (Narrow Band Imaging, NBI) with application of videofibrocystoscope Okympus. A total of 147 procedures were performed. Videofibrocystoscopy in white light has detected 18 recurrent tumors (sensitivity 0.12 tumor/operation). Narrowband videofibrocystoscopy has detected 17 more recurrencies (sensitivity 0.24 tumor/operation). A histological recurrence was confirmed at standard cystoscopy in 17 of 18 cases (specificity 94%), at narrowband fibrocystoscopy - in 30 of 35 cases (specificity 86%). The above pilot experience with narrowband videofibrocystoscopy has demonstrated that this technique has much higher contrast and acutance of imaging as well as sensitivity vs standard rigid cystoscopy in white light.

В статье на основании литературных данных, многолетнего опыта лечения больных мочекаменной болезнью в стационаре и их динамического амбулаторного наблюдения (обследования и консервативного лечения) кратко изложены достижения в диагностике и лечении заболевания, представлены современные основные положения этиологии и патогенеза уролитиаза. Приведены принципы и схемы диетотерапии, консервативного медикаментозного лечения и профилактики камнеобразования при всех формах заболевания и установленные авторами наиболее эффективные медикаментозные средства. Разработана и изложена оптимальная методика обследования и наблюдения больных мочекаменной болезнью