No 2 (2011)

Transurethral stenting of the ureter was made in 130 patients (51 males and 79 females, aged 19-81, mean age 51.3 years) after contact ureterolithotripsy (n = 86), endoureterotomy (n = 13) and endopyelotomy (n = 31). All the patients received internal polyuretanic stents (size N 6 F) made by one company. The patients were randomized into two groups by the shape of the stent. Group 1 (n = 65) received a modified mono-pigtail stent made of the standard polyuretanic double-pigtail stent by cutting off 2-4 cm of the distal end and distal (vesical) curl. In group 2 (n = 65) stenting was made with standard double-pigtail stent. Questionnaire survey was made 2 weeks after stenting, 1 month before stent removal and 1.5 months after stent removal. In the postoperative period 12 patients of group 2 (18.5%) developed acute pyelonephritis resultant from vesicorenal reflux. In other cases pyelonephritis was managed by draining bladder with urethral catheter. In group 1 vesicoureteral reflux was absent, but in 3 cases (4.6%) there was an attack of acute pyelonephritis because of obstruction of the intramural (not intubated by the stent) part of the ureter with fragments of the crushed concrement. This attack required urgent ureterolithoextraction and removal of the stent in 2 cases, transcutaneous nephrostomy in 1 case. Mean postoperative stay in the hospital was 3.1±0.6 in group 1 and 6.7±1.2 (p = 0.001) days in group 2. The comparison of the stent-related symptoms 2 weeks after stenting and before stent removal showed that severity of the symptoms was significantly greater in group 2 vs group 1 (21.3 and 9.6, respectively). Thus, the proposed mono-pigtail stent reduces severity of stent-related symptoms 2.5 times and improves quality of life. Further prospective studies are planned for final assessment of efficacy of the modified stents and their influence on quality of life.

The course of recurrent urolithiasis was studied in 131 patients (64 females, 67 males, age 27-69 years). Before the start of 1-15-year follow-up the patients' condition was: after spontaneous elimination of the concrements, after extracorporeal shock-wave lithotripsy and/or percutaneous nephrolitholapaxy, after open surgical interventions, after surgery and spontaneous elimination of the concriments, after litholysis (patients with hyperuricemic urolithiasis). At the start of the follow-up 127 patients had no uroliths, 4 patients had bilateral concrements. The group of patients free of uroliths consisted of 33 patients with hyperuricemic urolithiasis, 52 - with calcium-oxalate, 42 - with magnesium-ammonium-phosphate form of the disease. As shown by follow-up ultrasound and x-ray examinations, each of these patients had 1 to 7 recurrent concrements. Infrared spectrophotometry and x-ray diffraction determined chemical composition of both primary and 352 recurrent concrements. The patients were also examined with biochemical, microbiological methods, urine clinical examination was made. Possibility, metabolic and microbiological evidence for changes in urolithogenesis type in patients with different forms of the disease were found. In hyperuricemic urolithiasis recurrent concrements can be calcium-oxalate and phosphate, in calcium-oxalate urolithiasis - phosphate. Transformation of magnesium-ammonium-phosphate urolithiasis into hyperuricemic or calcium-oxalate urolithiasis was observed. Changes in the form of the disease more frequently occur in hyperuricemic and calcium-oxalate urolithiasis than in phosphate one. Phosphate concrements form less frequently in patients with hyperuricemic urolithiasis. One kidney can simultaneously contain hyperuricemic or calcium-oxalate concrement while the contralateral kidney - phosphate concrement associated with uric urease producing infection.

A total of 656 female patients from Russia aged between 18 to 65 years with uncomplicated cystitis entered the international ARESC trial, of them 647 were eligible for final analysis. Positive cultural urine tests ( > 104 CFU/ml) were in 419 (64.7%) patients, 393 (93.8%) patients had monoinfection. The central laboratory of Genoa (to which the isolated samples were sent) has tested 416 uropathogens from 399 patients. The following pathogens were isolated: E.coli (72.6%), enterococcus (7.0%), Klebsiella pneumoniae (4.6%), Staphylococcus saprophyticus (3.6%), Proteus mirabilis (2.4%) and Staphylococcus aureus (1.7%). E.coli was most sensitive to phosphomycin (99.3%), mecillinam (97.3%), nitrofurantoin (94.7%), ciprofloxacin (87.4%). The lowest sensitivity was to ampicillin (42.1%) and cotrimoxasol (69.4%). As to the whole bacterial spectrum, the highest sensitivity was found to phosphomycin (96.5%), nitrofurantoin (85.6%) and citrofloxacin (82.8%), the less sensitivity - to ampicyllin (44.3%) and co-trimoxasol (70.1%). Phosphomycin, mecillinam (not registered in Russia) and nitrofurantoin showed activity in vitro and can be considered as drugs of choice for empiric therapy of cystitis. Because of high resistance of pathogens, co-trimoxasol (trimetoprim) and fluoroquinalones are not recommended as first-line treatment for uncomplicated cystitis in females.

Prostatic surgery is often accompanied with increased intra- and postoperative bleeding which is caused, among other reasons, by enhancement of general and local fibrinolysis due to mechanical impact on prostatic tissue in operation. We proposed to inhibit enhanced fibrinolysis with preparation of tranexamic acid tranexam and tried it in 53 patients with prostatic adenoma undergoing transurethral prostatic resection (TUR). The comparison of bleeding severity in surgery with and without tranexam administration before, in and early after prostatic TUR showed that tranexam significantly lowers blood loss.

The study is aimed at investigation of efficacy and safety of a combined effect of laser therapy and vibromagnetotherapy in complex treatment of patients with chronic urethroprostatitis in the presence of sexually transmitted infection (STI). A total of 35 males aged 20 to 51 years entered the study. They were divided into 3 groups. Group 1 received standard basic therapy, group 2 received basic and laser therapy, group 3 - basic treatment and laser plus vibromagnetotherapy. Effectiveness of the treatment was assessed by the evidence obtained from clinical, bacteriological, device and functional examinations. The results of the treatments were evaluated after 2 weeks of the follow-up. It is shown that patients of groups 2 and 3 achieved more pronounced improvement of clinical and laboratory indices, parameters of basal blood flow. Thus, physiotherapy, added to antibacterial treatment, is safe and effective in the treatment of chronic urethroprostatitis and STI.

The analysis of case histories of patients with chlamydial infection has detected some typical errors in management of patients: the absence of topical diagnosis, choice of antibacterial drugs and treatment duration do not satisfy standard recommendations both in uncomplicated and complicated disease. A standard approach to management of patients with Chlamydia infection will help to avoid situations when experts conclude on inadequate quality of medical care delivered by medical professionals.

The article analyses the most typical clinical situations in empirical treatment of pyelonephritis including situations with comorbid severe diseases: decompensated diabetes mellitus, chronic renal failure, HIV-infection. Choice of antibacterial medicines for empiric treatment of pyelonephritis is based on the results of the latest studies of antibioticoresistance of pyelonephritis pathogens as well as on specific features of pharmacokinetics and pharmacodynamics of antibacterial drugs.