No 4 (2010)

Serum, tumor and renal parenchyma levels of VEGF and VEGFR2 were compared in patients with renal carcinoma (RC) with reference to basic clinicomorphological characteristics of the disease. VEGF and VEGFR2 were estimated in 37 RC patients and 57 healthy controls (serum levels only). VEGF and VEGFR2 were detected in all the samples. Their concentrations in the serum were the same in the patients and controls. The tumor tissue contained more VEGF than renal parenchyma. In unfavorable clinicomorphological features the tumor contained higher content of VEGF, higher VEGF/VEGFR2, lower VEGFR2. Thus, angiogenic factors studied closely correlate with clinicomorphological characteristics of renal carcinoma: primary tumor size, stage of the disease, tumor differentiation, tumor pseudocapsule invasion.

Surgical treatment was given to 45 patients with overactive bladder: transurethral detrusorotomy was made in 21 patients (group 1), bladder hydrodilation (BH) was made in 24 patients (group 2). Detrusorotomy was performed by transurethral median cut of the bladder posterior wall by needle electrode leading to destroyment of intramural sympathic and parasympathic nervous fibres. Hydrodilation of the bladder was made under intravesical pressure equal to systolic arterial pressure with 2 min exposure. On day thirty after the operation regress of the lower urinary tract symptoms was registered in 20 (95.2%) patients of group 1 and 11 (45.8%) patients of group 2. Urge to voiding (UV) disappeared in 90.5% patients of group 1 and in 45.8% of group 2 (p < 0.05), the number of patients with miction pain reduced 6-fold and 1.9-fold, with UV - 8.5 and 1.2-fold, respectively (p < 0.05). The number of diurnal mictions in group 1 decreased 3.2-fold vs 1.9-fold in group 2. The bladder size in urgency in group 1 patients increased 2.5-fold, the pressure fell also 2.5-fold. In group 2 these parameters changed only 1.2 times (p < 0.05). Cystometry recorded recurrent detrusor overactivity in 13 (54.2%) patients after hydrodilation and only in 3 (14.3%) - after cut of the bladder wall (p < 0.05). Thus, transurethral detrusorotomy in overactive bladder resistant to conventional treatment is much more effective than hydrodilation. The operation is low invasive and is well tolerated. Simple performance and good short-time results are advantages of this technique.

We treated 40 women aged 49-80 years (mean age 63.6±1.5 years) with overactive bladder (OB). All the patients used suppositoria vitaprost forte once a day before going to bed for 30 days. Miction was assessed before treatment, on treatment day 15 and 30, 30 days after the treatment course. The patients responded to questionnaires on disturbance and discomfort because of miction disorders and kept diary records on miction 3 days before visit to a doctor. The treatment lowered the number of imperative urges by 46%, episodes of urgent incontinence - by 69%. Dyscomfort due to imperative symptoms reduced 2.1-fold, anxiety - by 70%, effects of bladder symptoms on everyday life - by 48%. Satisfaction with treatment results reached 74%. One month after vitaprost forte treatment the subjective and objective miction improvement continued. After the treatment we observed a 20-40% increase in bladder capacity in different urges. This is explained by reduced detrusor ischemia which plays an important role in OB pathogenesis.

Sixty eight postmenopausal women with chronic recurrent cystitis received local antibacterial treatment consisting in bladder ionophoresis and vaginal exposure to estrogens and vibromagnetic action of RECTOMASSAGER attachment and AMUS-01-INTRAMAG device. This local treatment proved superior to systemic one as 1-year follow-up registered a 3.1-fold reduction in recurrence rate vs control patients.

A study was made in the urological clinic of I.M. Sechenov Moscow Medical Academy with participation of 96 patients (mean age 48.24±9.19 years) with erectile dysfunction (ED) associated with hypogonadism. The patients were divided into three groups. Group 1 (n = 30) received 1 intramuscular injection of testosterone undecanoate. Group 2 (n = 34) received on-demand monotherapy with vardenafil for 6 weeks. Group 3 (n = 32) received combined treatment with the above modalities in the same doses and duration. Before and 6 weeks after treatment the patients responded to IIEF-5 questionnaire. All the patients showed a significant improvement of the erectile function. Overall AMS score after the treatment rose more in patients of groups 1 and 3 (p < 0.001). In group 2 the changes were weaker but significant (p = 0.005). The domain of psychological AMS symptoms reduced insignificantly after treatment in group 2 (p = 0.535), but significantly in groups 1 and 3, respectively (p = 0.013 vs p = 0.001). Androgenic deficiency regressed in groups 1 and 3 but enhanced in group 2 (p = 0.001). Domain of sexual symptoms of the AMS scale reduced more significantly in patients of groups 2 and 3 (p < 0.001). Percentage of patients satisfied with the treatment results was 68.85, 70,6 and 90,6% in groups 1, 2 and 3, respectively. Thus, combined treatment of erectile dysfunction in patients with hypogonadism (parenteral testosterone undecanoate and vardenafil) is more effective than monotherapy with androgen-containing drugs or inhibitors of phosphodiesterase of type 5.

A total of 55 patients aged 20-59 years with recurrent chronic bacterial prostatitis (RCBP) entered a trial of immunomodulator panavir. The study group consisted of 40 patients. They were given standard treatment and panavir. The control group (n = 15) matched by all the studied characteristics received standard treatment only. Blood count, bacteriological characteristics of prostatic secretion, immunological status, subjective parameters were studied. RCBP patients were diagnosed to have marked disorders of interferon status. The addition of panavir to standard treatment of RCBP patients significantly improved treatment results. Therefore, panavir is recommended as an adjuvant in combined RCBP treatment.