№ 1 (2010)

Renal function in patients with stag-horn nephrolithiasis was assessed after two surgical treatments - percutaneous nephrolitholapaxy (PCNL) and pyelonephrolithotomy. The function of the operated and contralateral kidneys was studied early and late after operation by parameters of blood biochemistry, Doppler investigation of renal parenchyma, dynamic nephroscintigraphy. Stabilization or improvement of blood biochemical indices was observed in 58(70%) patients. A secretory renal function late after surgery (from 6 months to 2 years) evidenced for improvement or stabilization of renal function (according to radionuclide test) in 71 (85.5%) patients. Integral parameters of renal blood flow were physiological or improved versus preoperative ones. PCNL was made in patients with deficient secretion less than 70%, 35(87.5%) patients were diagnosed to have stabilization or functional improvement. After open intervention functional improvement took place in 11(25.6%) patients, stabilization of renal function occurred in 25(58.1%) patients. Tubular secretion deterioration was seen much more frequently in patients after open intervention. PCNL is less invasive surgical intervention than pyelonephrolithotomy as this technique produces milder surgical trauma and does not result in intraoperative renal ischemia. PCNL is the most effective surgical modality in stag-horn concrements of the kidneys and significantly expands potential of low-invasive treatment of such patients.

The article presents the data on surgical treatment of 126 patients with hypospadias (a total of 343 operations). This experience gave rise to classification of complicated forms of hypospadias proposed by the authors.

Simultaneous surgical treatment of females with genital prolapse and stress urinary incontinence using Gynecare Prolift, TVT techniques with use of mesh, colpo-urethrosuspension with threads corrected static disorders of the genital organs in 96.7 ± 3.3% cases, resulted in adequate continence in 93.3 ± 4.6% operated patients. A 1.5 to 8 month postoperative follow-up registered adequate urination (no residual urine, complete continence) in 93.3 ± 4.6% patients.

The study of changes in the immune status of patients with chronic bacterial prostatitis demonstrated changes in immunological parameters reflecting depression of the immune system (subnormal levels of interferon alpha, gamma, sIgA, functional activity of neutrophils, high concentration of IgA, IgG, IgM). Thus, combined treatment of chronic bacterial prostatitis must include administration of immunomodulators.

Comparative efficacy of spinal anesthesia (SA), epidural anesthesia (EA) and spinal-epidural anesthesia (SEA) during surgery was studied in 72 urologic patients aged from 66 to 92 years. By the method of anesthesia the patients were divided into three groups: SA was used in group 1 (n = 24), EA - in group 2 (n = 27), SEA - in group 3 (n = 20). The efficacy of anesthesia was assessed by parameters of central hemodynamics, sensorial and motor characteristics. The results of the comparison of the anesthesia method showed that SEA combines advantages of EA and SA and is a useful technique for urologic geriatric surgery as it is characterized by a rapid onset, complete analgesia, absence of toxicity of local anesthetics, adequate muscle relaxation of the spinal block; catheterization of the epidural space extends the area of anesthesia, prolongs the time of anesthesia and provides continuous postoperative analgesia. No cases of postdural puncture headache were observed.

The aim of our trial was to investigate correlation between the size of the prostate and probability of cancer detection with transperineal biopsy. Transperineal 12-sample biopsy of the prostate was made in 203 men aged 48-58 years (mean age 68.0 ± 8.6 years) suspected of having prostatic cancer (PC). Total detection of cancer was 33.5%. PC patients had higher levels of PSA, more frequent alterations at rectal palpation and transrectal ultrasound investigation, while mean size of the prostate was the same in cancer and cancer-free patients. Differences in PC detection rate in patients with different sizes of the prostate were statistically insignificant. Use of sextant biopsy could not detect PC in 15 males (22.1%) cases. Thus, there is no correlation between the size of the prostatic gland and diagnostic value of transperineal biopsy obtaining 12 tissue samples. The above data do not support the necessity of extended biopsy in patients with large prostate.

A total of 58 children (age from 6 to 14 years) suffering from nocturnal enuresis (NE) were divided into two groups. The study group received basic therapy (driptan dose was reduced to 2.5 mg twice a day) in combination with transcranial bitemporal magnetotherapy (TcMT). The control group received placebo TcMT and basic therapy. It is shown that addition of TcMT to reduced basic therapy lowered the score of imperative voiding symptoms 1.3-fold, number of enuresis patients 1.7-fold, volume of the bladder 6.8 months after the treatment 1.9-fold, corrected vegetative status and activity of the subcortical nervous center in 24% children according to cardiointervalography versus the controls. Thus, TcMT improves clinical effect in NE patients in 2-fold reduction of pharmacological burden.