No 3 (2011)

We studied efficacy of hyperbaric oxygenation (HBO) in 8 patients with interstitial cystitis/painful bladder syndrome (IC/PBS). Mean age of the patients was 53 years (35-72 years), mean duration of the disease 7.5 years (6-17 years). Ulcerative IC/PBS was diagnosed in 7 of 8 patients. The patients received combined treatment: surgical (hydrobouginage of the bladder, electrocoagulation of bladder ulcer) and a HBO course in the postoperative period. The efficacy was assessed by clinical and morphological criteria (estimation of histamine level in urethral smears, proliferative activity of bladder mucosa epithelial cells). A HBO course consisted of 10 sessions (40 min, 2 atm). The treatment reduced the number of voidings for 24 hours, increased mean effective bladder volume, lowered a total score by L.Parsons scale, histamine content in urethral smears, stimulated proliferative activity of bladder mucosa epithelium. Thus, HBO proved its safety and effectiveness in combined treatment of IC/PBS.

A total of 151 patients with nephrolithiasis participated in the study of efficacy and safety of the drug prolit cepto in conservative treatment of nephrolithiasis patients, preoperative preparation and in postoperative period after extracorporeal shock-wave lithotripsy (ECSWL) or nephrolitholapaxy. It was found that combined treatment of nephrolithiasis complicated by secondary pyelonephritis with addition of prolit cepto raises efficacy in management of inflammation due to a positive action on microcirculation and urine bacteria. Administration of prolit cepto in nephrolithiasis patients exposed to ECSWL or nephrolitholapaxy reduces the risk of infectious and inflammatory complications, has a nephroprotective effect and improves the course of postoperative period.

The article analyses problems of diagnosis and treatment of neurogenic disorders of urination in the group of patients operated for prostatic pathology, the role of the conduction system of the corticospinal tract and conductive potential of perineal muscles in the above patients. Main standard electromyographic parameters were established by the data of examination of 7 controls - latency of the cortical and segmental evoked motor response, time of central motor conduction, amplitude of potentials of motor unities. Fifteen patients with prostatic diseases showed severe disorders of both corticospinal conduction and perineal muscular contraction. Patients with prostatic cancer or adenoma treated with different methods had denervation changes in pelvic inferior muscle in unaffected corticospinal conduction. Denervation changes after surgical treatment for prostatic cancer and delay of reinnervation, recovery of nervous control may be determined not only by the fact of operation but also by the course of the underling disease. Examination of the pelvic inferior muscles demonstrated that HIFU is a traumatic treatment of prostatic cancer because of extention of the physical impact beyond the prostate on muscular-nervous structures. These denervation muscular changes should be taken into consideration in assessment of the patient's condition and choice of treatment policy.

Prostatic adenoma gives rise to urodynamic disorders, affects not only sexual function and quality of men's life but also, indirectly, women's health. We have developed indications for concervative treatment of prostatic adenoma with transurethral radiowave hyperthermia (TRH). It was found that TRH has a positive early effect on a general somatic condition and prostatic function. Later, TRH improves working efficiency, emotional and social status of patients with prostatic adenoma and other parameters of their quality of life. TRH proved low-traumatic, safe, it can be performed without anesthesiological aid.

A total of 323 transcutaneous roentgenoendoscopic operations were made in 212 patients from January 2000 to December 2009 including 96 operations in 81 presenile and senile patients (87 and 9 operations, respectively). Transcutaneous nephrolithotripsy (TCNT) eliminated concrement from the kidney for one session in 59 (72.8%) patients. It proved to be the most sparing treatment in serious clinical situations and provided maximally complete evacuation of the concrement from the kidney. A total complication rate was 14.8%. All the complications were cured with conservative pharmacotherapy. TCNT has the same indications as open surgery, is a method of choice in presenile and senile patients with large, stag-horn and recurrent concrements of the kidney, impacted pelvicoureteral concrements, in impaired renal urodynamics and high bacteriuria. TCNT can be used as a second-line treatment in failure of extracorporeal shock-wave lithotripsy or in combination with it (sandwich-therapy) for complete concrement elimination.

The surgeons of the clinic at the chair of endoscopic urology operated 32 patients (18 males, 14 females, age 40-78, mean age 55±0.8 years) with renal carcinoma (RC) from 2007 to 2010: 31 patients had RC stageT1N0M0, 1 patient - T2N0M0, 12 patients had RC of the right kidney, 19 - of the left kidney, bilateral RC was in 1 patient. A laparoscopic transperitoneal approach was used in 14 cases. Indications for such approach were the following: size of the tumor 2.2-4 cm, location of the tumor in the upper anterior segment (n = 13), in the middle segment (n = 1). Ischemia was made in 5 patients. Resection of the kidney via a laparoscopic retroperitoneal approach was made in 11 patients. Indications were the following: size of the tumor 1.1-4 cm, posterior tumor location. Ischemia (17 and 24 min) was used in 2 cases, mean blood loss 118 ml (from 50 to 250 ml). Nine patients were operated with application of YAG:Nd laser (Lazurit) which resected an extraorganic tumor of a small size (1.1-2.2 cm) without ischemia and significant blood loss. Laparoscopic assisted resection of the kidney was performed in 9 cases. Hand assistance was indicated in large tumors (4.3 to 8.9 cm), posterior tumor location (n = 4), upper location (n = 2). One-stage bilateral resection of the kidneys in the middle segment was made in one patient. Hand assistance was also required in one patient for one-stage resection of two tumors of the right kidney. Laparoscopic resection of the kidney is indicated in bilateral tumor, in a single functioning kidney, in affection of the contralateral kidney, or disease with potential contralateral kidney affection. Indications for endovideosurgical methods of treatment need detailed specification and perfection. Choice of one of the above approaches should be based on tumor size and its location.

Improvement in diagnosis of prenatal congenital urinary malformations (CUM) resulted in increased detection of CUM cases among newborns. To facilitate medical care for CUM newborns, we have developed an objective method of CUM newborns' health assessment. We studied 40 case histories of newborns with prenatally detected CUM admitted to urological clinics (20 with diagnosis of poor health and 20 with moderate condition severity) and 40 CUM newborns examined outpatiently (moderate health hazard). The computer analysis of the available data has established 13 most informative diagnostic criteria: 4 sonographic criteria, 3 lab criteria and 6 physical exam criteria estimated by 4 points - from 0 to 4. The criteria were pooled to a table which was used as a scale to assess general health condition. After delivery, CUM newborn gets inpatient health assessment by a neonatologist using 13 criteria. According to the total score, the condition is assessed as satisfactory (0-5), moderately severe (6-11), severe ( > 12). Efficacy of such health assessment was proved in a population study of 312 prenatal CUM newborns. Grouping of such newborns helps design of programs of further examination and management.