№ 6 (2009)

We studied efficacy of transcutaneous nephrolithotripsy (TNLT) in patients with urolithiasis and anomalous upper urinary tract. For two years we performed TNLT in 148 patients with complicated forms of urolithiasis and anomalous kidneys (age 18-86, 76 females and 72 males). The examination for urolithiasis has found different anomalies of the urinary tract in these patients: double pelvis and ureter (9 cases - 6.1%), lumbar dystopy of the kideney (59 cases - 39.9%), horseshoe kidney (12 cases - 8.1%), solitary cyst of the kidney (43 cases - 29.0%), parapelvic cysts (25 cases - 16.9%). Extracorporeal shock-wave lithotripsy (ESWL) was conducted as first-line treatment in the other 139 patients with nephroliths under 1.5-2 cm in size who had the following anomalies of the urinary system: a solitary kidney (n = 14), double pelvis and ureter (n = 26), anomalous position of the kidney (n = 46), anomalous shape of the kidney (n = 20), simple and parapelvic cysts (n = 33). A total of 154 TNLT were performed in 148 patients. Transcutaneous interventions were most frequent in the treatment of coral (31.3%) and pelvoureteral (14.6%) concrements, one-stage operation was made in 143 patients. Transcutaneous puncture nephrostomy as the first stage was made in 5 patients. The concrements were removed by one operative intervention in 132 (89.2%) out of 148 patients. Exacerbation of pyelonephritis as a postoperative complication was treated conservatively in 12.5% patients. Residual fragments were diagnosed in 16 patients. Of them, 11 patients had multiple and 5 patients had coral concrements. Residual fragments were removed in 14 patients either by renephroscopy or by ESWL. Treatment of 139 patients with concrements less than 1.5-3 cm in size consisted in 197 ESWL sessions. In combination of anomaly and urolithiasis the number of lithotripsy sessions per one patient was 1.8 ± 0.2. The least number of ESWL sessions per one patient was conducted in patients with lumbar dystopy of the kidney (1.3 ± 0.45), the greatest number in horseshoe kidney (3.8 ± 0.8). Evacuation of the concrements after ESWL depended on the type of anomaly and concrement location. It was 61-69% in patients with anomaly of the shape and position of the kidney, in cystic anomalies is was 89-91%. Open surgery was indicated in 7 patients who needed plastic surgery of hydronephrosis (4) and obstructive megaureter (3). Thus, low-invasive operations provide high efficacy of urolith removal in patients with anomalies of the urinary tract and can replace traumatic open operations.

Efficacy and tolerance of furamag and norbactin were compared in a prospective controlled trial with participation of 82 females aged 18-60 years with acute uncomplicated cystitis. All the women were divided into two groups. Group 1 (n = 42) received norbactin (norfloxacin) in a dose 400 mg twice a day for 7 days. Group 2 (n = 40) was given furamag in a dose 50 mg 3 times a day for 10 days. The results were evaluated 2 weeks after the treatment. The comparison of the treatment results showed that a new nitrofuranic drug furamag has significantly higher clinical and bacteriological efficacy: acute cystitis was cured in 95% patients, eradication of the infective agent occurred in 96.4% patients, tolerance was good in 97.5% patients. Sensitivity of the agents causing acute cystitis to nitrofurans reached 98.2% while to norbactin - only 86%.

The aim of our study was assessment of efficacy of PLFT technique on ProstaLund CoreTHerm unit in nanagement of acute urine retention in patients with prostatic adenoma. We treated 31 patients with prostatic adenoma (age 58-97, mean age 74 years, volume of the prostatic gland from 32 to 188 ml); 11 patients had suprapubic fistula, 8 carried urethral catheter for acute urinary retention. All the patients were inoperable because of a high surgical-anasthetic risk. All of them were exposed to PLFT for 9-15 min. Efficacy of the treatment was assessed by recovery of physiological urination, by IPSS tests and quality of life (QoL). PLFT destroyed 15 ± 5% prostatic tissue in each of the treated patients. The procedure was well tolerated. Physiological voiding was achieved in all the cases. Such complications typical for TUR as urethral stricture, vesical stenosis, urinary incontinence were not registered. On month 6 after the treatment QoL was assessed by the patients as 1-2 points, Qmax exceeded 15.2 ± 1.9 ml/s. Thus, PLFT is a highly effective and save treatment of prostatic adenoma and can be recommended as a standard management of patients with acute urinary retention at high surgical risk.

Thirty patients with a documented diagnosis of prostatic adenoma were treated with vitaprost forte (100 mg rectal suppositoria) for 60 days. Treatment efficacy was assessed after therapy and for two months with a 30-day interval. It is shown that the drug can be used as monotherapy. Its efficacy was proved by improved urodynamics of the lower urinary tract, reduction of prostatic size. A therapeutic effect after the drug discontinuation points to a complex organotropic action of the drug. Side effects were not registered. Vitaprost forte is recommended for treatment of patients suffering from prostatic adenoma with mild and moderate symptoms.

We studied 137 males (mean age 68 ± 8.6 years) with suspected prostatic cancer who had undergone transperineal biopsy of the prostate (12 tissue samples). The biopsy was made under local anesthesia either as paraprostatic block (n = 76, group 1) or paraprostatic block in combination with block of the sexual nerve (n = 61, group 2). Pain intensity was evaluated with visual analogue scales. Induction of anesthesia was more painful in group 2, three other stages - in group 1. Mean pain at biopsy was significantly (p < 0.001) lower in group 2. Thus, addition of sexual nerve blockade to standard paraprostatic block increases efficacy of anesthesia in conduction of transperitoneal biopsy of the prostate.

We have performed a trial with participation of 60 males aged 23-52. Of them, 30 had secretory male iufertility (SMI) and obesity. The control 30 patients were healthy volunteers. The protocol was performed by two stages. Stage 1 included: investigation of a clinico-laboratory status, of correlation between a sorption function of erythrocytes, endogenic metabolic intoxication (EMI) and spermogram parameters, concentration of serum testosterone in SMI patients. Stage 2 consisted in treatment of the intoxication by reducing body mass. All the infertile men were obese; 30% of them had low glucose tolerance, 46.7% had stage 2 hypertension, 23.3% - seasonal allergic symptoms. The level of organic substances on the surface of erythrocytes in infertile men was higher than in the controls (p < 0.01). A negative correlation was seen between spermogram parameters and organic substances content on erythrocytic surface (p < 0/05), concentration of serum testosterone and the above substances (p < 0.01). The loss of fat tissue by 7-14 kg by infertile men resulted in a positive trend in spermogram parameters and the level of serum testosterone (p < 0.01).

A total of 273 lithotripsies were made from March 2008 to February 2009 in an urgent urology department. Of them, 85 patients had concrements in the kidney pelvis, 117 - in the ureter and 61 - in the calyx. Lithotripsy was made in renal failure caused by two-sided block in 6 cases, in acute pyelonephritis in 29 cases in which lithotripsy was performed after preliminary stenting, sanation and elimination of suppuration. In the process of lithotripsy, to provide access to the concrements, laser beam was used to dissect the kidney neck cyx in 18 cases and ureteral strictures in 4 cases.