No 1 (2011)

We studied effects of water regimens on crystallization efficacy in experimental nephrolithiasis on 3 groups of Wistar male rats with initial experimental nephrolithiasis (ethylene glycol model). The animals were on free, limited and supernormal liquid intake regimen. For 3 weeks each 3-4 days we estimated 24-h diuresis, urine concentration of calcium, phosphate and oxalate ions. After 3 weeks we made a morphological examination of the kidneys. We found that limited drinking leads to an increase in urinary concentrations of oxalate- and phosphate ions which stimulate enhanced formation of calcium-containing concrements. More water intake considerably reduces oxalate and phosphate concentrations in the urine resulting in reduction of the number and size of calcium deposits in renal tissue. Thus, low liquid intake leads to intensification of urine oversaturation causing formation of renal concrements. Much liquid intake weakens oversaturation and reduces the number and size of calcium deposits in the kidneys.

A prospective multicenter randomized trial enrolled 104 females aged 18-55 years with acute un-complicated cystitis. The patients were randomized into two groups: 49 patients of group 1 received cefixim in a single dose 400 mg/day for 5 days; 55 patients of group 2 were given ciprofloxacin in a dose 250-500 mg twice a day for 5 days. Clinical and microbiological assessment of efficacy and safety was made before treatment and on treatment day 8 and 28. Significant differences were found between groups 1 and 2 in parameters of bacteriological and clinical efficacy. Eradication of the agent and persistent bacteriological response was seen in 95.9 and 100% patients of group 1, 66 and 100% patients of group 2, respectively. Complete and partial response was observed in 55.1 and 75.5% patients of group 1, 37.3 and 58.1% patients of group 2, respectively. Thus, cefixim in a single dose 400 mg/day for 5 days has a higher microbiological efficacy than ciprofloxacin in a dose 250-500 mg twice a day. Side effects occurred less frequently in the treatment with cefixim.

A randomized trial of efficacy and safety of vitaprost plus and vitaprost forte has been made in 70 patients with prostatic adenoma comorbid with chronic bacterial prostatitis. The patients were randomized into two groups: group 1 patients received vitaprost plus in rectal suppositoria for 1 months, then vitaprost forte for 2 months; group 2 patients (control) received gentos and lomefloxacin per os. Short- and long-term results were evaluated in 3 and 6 months. By all parameters group 1 achieved better treatment results than controls. Immediate positive response was observed in 97.1% patients, long-term positive effects were observed in 85.7%. Total points of prostatic adenoma symptoms reduced by 37%, chronic prostatitis - by 55%, residual urine diminished by 66%, Qmax increased, quality of life improved by 45%, sexual function enhanced. Size of the prostate decreased by 7.4 cm3, leukocyte count in prostatic secretion fell 6-fold, eradication of prostatitis causing agent was achieved in 3 m onths in 80% patients. Side effects and complications were not registered. Thus, vitaprost plus and vitaprost forte are highly effective and safe for treatment of patients with combination of prostatic adenoma with chronic bacterial prostatitis.

Patients with prostatic adenoma combined with chronic prostatitis were found to have abnormal content of proteins in peripheral blood erythrocytic membrane, erythrocytic sorption, concentration of nitric oxide stable metabolites, endotheline-1 and lipid peroxidation products in blood plasma before and after transurethral resection of the prostate. Different dosage forms of the drug longidase were tested for efficacy in correction of impairment of structural and functional properties of erythrocytes, endothelial dysfunction and lipid peroxidation in the above patients.

Laser (holmium) enucleation of the prostate (LEP) for infravesical obstruction caused by prostatic adenoma up to 60 cm3 in size was made in 42 patients in the Moscow city urological hospital N 47 from January to July 2009. Transurethral resection (TUR) of the prostate was made in 42 matched controls. All the patients from both groups have undergone the same standard clinical and laboratory examination before the treatment, 1, 3 and 6 months after it. Duration of surgery was shorter in the TUR group (42.4±26.1 min vs 74.8±39.7 min). Washing system operated longer in the TUR group (23±7 vs 10±5 h). The LEP group patients stayed in the hospital for much shorter time (3.1±1.2 days vs 4.6±1.8 days). No significant differences between the groups by basic postoperative parameters were found 1, 3 and 6 months after the operation. Postoperative complications were rare in both groups. Hemorrhagic complications were absent in the LEP group. This makes it possible to recommend LEP for patients with coagulopathy. Trauma of the bladder occurred in 1 case of LEP because of a complicated technique of LEP and the absence of conventional endoscopic reference points characteristic for TUR. Thus, our initial experience with transurethral LEP in comparison with TUR leads us to the conclusion that LEP is effective and safe in surgical treatment of patients with prostatic adenoma. Further gain of experience with LEP conduction may make this method alternative to open adenomectomy.

Urgent arrest of bleeding is often required in hemangiomas. Endoscopic photocoagulation withNe YAG-laser was applied in the department of urology of the Central Children's Hospital in Moscow to arrest bleeding in 5 children (2 boys and 3 girls aged 3-12 years) with hemangioma of the bladder in 1998-2009. In 3 cases the tumors were solitary (up to 5 cm), in 2 cases (multiple small 1-3 cm). The intervention was performed in the presence of hemorrhage in 3 children. One girl had intensive bleeding in photocoagulation and urgent resection of the bladder was made. Immediate hemostasis in hemorrhage was achieved in 2 of 3 patients. After a single procedure, 2 children had no bleeding for 1 and 5 years, respectively, but they retained endoscopic picture of angiomatosis. One boy after 4 sessions of photocoagulation performed with intervals 6-13 months has no manifestations of hemangioma for 4 years. A girl with multiple hemangioma undergoes photocoagulation for recurrent macrohematuria each 8-26 months. Another girl operated for bladder hemangioma has no endoscopic signs of the tumor recurrence for 2 years. Thus, photocoagulation of bladder hemangioma is an effective method of hemostasis but probability of a late recurrent bleeding after photocoagulation is higher than in open interventions. Therefore, long-term follow-up is needed and repeated endoscopic investigations with prophylactic impact on thin-walled or erosive sites of hemangioma should be made.