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No 4 (2011)


Characteristics of hydronephrosis due to obstruction of the pyeloureteral segment combined with dorsal rotation of the kidney

Sizonov V.V., Kogan M.I., Sizonov V.V., Kogan M.I.


Rotation of the kidney is caused by its dystopia and abnormal blood circulation. Dorsal rotation of the kidney in normal position is a rare anomaly. We studied a clinical course, evidence obtained at renosonography, excretory urography, computed tomography, radionuclide investigation, anatomic variants of pyeloureteral segment obstruction in female patients with right-side hydronephrosis in the presence of dorsal rotation of the kidney before and after pyeloplasty. We made pyeloplasty for obstruction of the pyeloureteral segment in 266 patients in 2001-2009. Hydronephrosis was accompanied with dorsal rotation of the kidney in 21 (7.9%) cases. Surgical approaches to the pelviureteral segment are characterized. The dorsal approach is a good alternative to standard subcostal approach, provides good visualization in creation of anastomosis, significantly reduces distance from the skin cut to pyeloureteral segment and offers the best cosmetic result. In subcostal approach mobilization of the pelvis and pyeloureteral segment is preferable on the posterior surface of the kidney. A laparoscopic transperitoneal approach is not justified as it implies wide mobilization of the kidney, the anastomosis is created in extremely limited space.
Urologiia. 2011;(4):3-7
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Efficacy of uro-vaxom in recurrent infectious-inflammatory diseases of the urogenital system

Kul'chavenya E.V., Breusov A.A., Kulchavenya E.V., Breusov A.A.


Our study prospects of urovaxom in improvement of efficacy and prevention of recurrent urogenital infection. One capsule of oral vaccine uro-vaxom was given daily for a month to 127 patients: 23 males with chronic bacterial prostatitis/urethroprostatitis, 75 females with chronic cystitis, 29 females with urolithiasis complicated with secondary chronic pyelonephritis. Control examination was made each two months for a year. In signs of inflammation the patients received one more course of uro-vaxom for a month. It was followed by control examinations each three month for a year. We observed a 6-12 month "cold" period after one course of uro-vaxom in 86.7% patients. After the second course of immunoprophylaxis recurrent urogenital infection occurred 8 times less often. Thus, immunoprophylaxis of urogenital infection with oral vaccine uro-vaxom is highly effective, is well tolerated and, therefore, must enter the standards of medical care for patients with urogenital infection.
Urologiia. 2011;(4):7-11
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Choice of an optimal free graft for replacement urethroplasty in extensive urethral strictures

Loran O.B., Veliev E.I., Kotov S.V., Belomyttsev S.V., Loran O.B., Veliev E.I., Kotov S.V., Belomyttsev S.V.


Irrespective of the type and properties of a free graft in urethroplasty, survival of the graft depends on blood circulation in the nutrient bed. We made an experimental trial to study engraftment of free grafts of buccal and lingual mucosa on different types of the nutrient bed. Free flaps (78 buccal and 86 lingual mucosa samples) were taken from 52 male Wistar rats (300 to 470 body mass). Grafting was made on different types of nutrient bed - skeletal muscle, subcutaneous fat and penile tunica albuginea. Histological examination of the grafts was made 2, 4, 7 and 14 days after transplantation. The process of engraftment followed all the stages of nonspecific inflammation. The alteration stage (48 hours) is characterized by marked epithelial atrophy, necrosis of most of the cross-striate muscular fibers of the graft, necrotic alterations of the nutrient bed, primarily in the suture area. Excudation and emigration (2-4 days) - by continued necrotic changes with infiltration of the graft with neutrophilic leukocytes, edema of the upper layer stroma and infiltrate extention on the nutrient bed. Proliferation (day 7) - by attenuation of necroinflammatory processes, decline of leukocyte infiltration, formation of blood vessels in the subepithelial base of the graft. Regeneration (day7-14) - by recovery of the epithelial graft layer, development of granulation tissue in the submucosal base. The best engraftment was registered on transplantation on penile tunica albuginea (buccal graft - 93.4%, lingual one - 88.9%). Successful implantation on the muscle occurred in 90.7% for buccal and 87.9% for lingual grafts. On fat tissue buccal transplant failed in 19, lingual - in 23.8% transplantations. Thus, staging in interaction between different grafts and types of nutrient bed do not depend on characteristics of the bed and graft. Necroinflammatory changes in the buccal graft change for proliferative processes earlier than in the lingual one. Proliferative and regenerative processes develop earlier on penile tunica albuginea. Alteration and exudation are more pronounced on subcutaneous fat.
Urologiia. 2011;(4):11-16
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Low-invasive operations for correction of urinary incontinence in females

Pushkar' D.Y., Kasyan G.R., Gvozdev M.Y., Lynova Y.L., Kupriyanov Y.A., Pushkar D.Y., Kasyan G.R., Gvozdev M.Y., Lynova Y.L., Kupriyanov Y.A.


We compared efficacy of surgical treatment of urinary incontinence in women depending on the size of the synthetic sling and technique of its installation. From January to September 2009 we made 75 operations with synthetic suburethral slings: TVT-SECUR (TVT-S) - group 1 (n = 35) and TVT-О- group 2 (n = 40). The sling was installed in U position in 14 patients of group 1 and in H position in 21 patients. The control examinations included questionnaire survey, cough stress test (in bladder volume more than 150 ml), vaginal investigation, uroflowmetry, in urgency - complex urodynamic examination. A total of 32 patients of group 1 and 40 patients of group 2 were examined postoperatively. A positive result was achieved in 20(62%) and 38(95%) (p = 0.0006) patients of group 1 and 2, respectively. Quality of life was assessed as good and very good by 22(68%) and 37(93%) patients of groups 1 and 2 (p = 0.0105), respectively. The control examination after 6 months of follow-up showed good result in 7 (53%) and 13(68%) patients of group 1 (subgroups U and H, respectively). Reoperation for urinary incontinence was made in 4(30%) patients of subgroup U and 1(5%) - of subgroup H. Thus, surgical treatment of urinary incontinence in women according to TVT-0 technique is more effective than in TVT-S surgery, but minisling TVT-S is more effective in patients with bad somatic status and in H position.
Urologiia. 2011;(4):16-20
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Combined lumbosacral and vaginal physiotherapy in the treatment of overactive bladder in postmenopausal women

Neymark B.A., Neymark A.I., Raygorodskiy Y.M., Tishchenko G.E., Gol'braykh G.E., Neimark B.A., Neimark A.I., Raigorodsky Y.M., Tischenko G.E., Golbraikh G.E.


Efficacy of combined application of physical factors including lumbosacral magnetotherapy and vaginal vibromagnetic impact is shown in 48 postmenopausal women (mean age 62.5±1.6 years) with overactive bladder (OAB). Choice of this combination is explained by a multifactorial OAB pathogenesis and degenerative spinal diseases often encountered in postmenopausal women (70.8% in this study). The exposures of the spine and the bladder (vaginal) were made one after the other with duration of the first stage 10-15 min, of the second - 5-7 min, the course consisted of 10-12 procedures. The results of the treatment were assessed by urination rhythm, volume, number of incontinence episodes. Quality of life was evaluated according to special questionnaires. Trophic function of the spinal cord and innervation of the bladder were studied by n. tibialis conduction measured by electroneuromyography (ENMG). The following results were obtained: reduction of urinations for 24 hours by 36.9%, urgent episodes - by 44%, urgent incontinence - by 59.7%. Voiding volume significantly increased (by 26%). A total score of anxiety related to OAB fell by 51.3%. M-response amplitude in ENMG rose 1.5-fold, while velocity of the impulse conduction along the n. tibialis enhanced 1.2-fold. The technique was accomplished with AMUS-01-Intramag device and attachment to it Rectomassager made in Russia.
Urologiia. 2011;(4):20-24
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Zidena treatment of erectile dysfunction due to stress-induced arterial hypertension in locomotive teams

Neymark A.I., Mel'nik M.A., Razdorskaya M.V., Neimark A.I., Melnik M.A., Razdorskaya M.V.


Thirty train drivers with erectile dysfunction (ED) and arterial hypertension were examined : physical examination, blood count, urinalysis, penile laser Doppler flowmetry (LDF). ED severity was assessed by Loran-Segal questionnaire of male copulative function (MCF) and international index of erectile function (IIEF). Zidena® was used in a dose 100 mg 30 min before coitus twice a weak. Examinations have detected mild and moderate ED, spastic disorders of penile microcirculation. MCF significant improvement (p < 0.05), rise of IIEF score were seen after 30 days of zidena treatment. A positive trend was observed after 15 days of treatment. LDF registered a significant (p < 0.05) improvement of microcirculation. Tissue hypoxia and ischemia lowered, blood inflow in the system of microcirculation increased. A passive mechanism of blood flow regulation, vasodilation almost corresponded to physiological standards. Administration of zidena in patients with stress-induced hypertension has improved libido, quality and duration of erection, penile microcirculation due to better tissue perfusion with blood, reduction of ischemia and blood congestion in the venules. Duration of coitus increased.
Urologiia. 2011;(4):25-28
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Correction of compliment system failure in patients with chronic prostatitis

Teodorovich O.V., Shatokhin M.N., Mykolaenko T.V., Konoplya A.I., Krasnov A.V., Mavrin M.Y., Meshanin N.V., Teodorovich O.V., Shatokhin M.N., Mykolaenko T.V., Konoplya A.I., Krasnov A.V., Mavrin M.Y., Meshanin N.V.


The aim of the study was detection of local and systemic changes in the complement system in patients with chronic abacterial prostatitis (CAP) and chronic bacterial prostatitis (CBP) and to assess a relevant corrective efficacy of the hardware and software complex Andro-Gin (KAP-ELM-01 Andro-Gin). Before treatment, blood plasma of CAP patients contained elevated concentrations of all studied components of the compliment system and factor H but subnormal concentration of C1-inhibitor. Locally, all the compliment indices were high including C1-inhibitor and factor H except component C5. Initial blood plasma compliment fractions in CBP patients were elevated but regulatory proteins concentrations were low. Local compliment components C3, C4, C5 and C5a and factor H were significantly higher. Standard treatment of CAP partially corrected the level of C3, C3a, C4 components, locally normalized concentration of C3 component and corrected C4 component, while in CBP standard treatment normalized concentration of C3 component and reduced C3a, C4, C5 and C5a components, locally normalized the levels of C3, C4 components, corrected concentration of C3a, C5, C5a components, raised regulatory factors. Combination of the standard treatment with Andro-Gin unit compared to standard treatment alone, in CAP corrected plasma concentrations of C3, C3a, C4 compliment components and significantly raised levels of regulatory factors, locally - partially normalized the level of factor H. In CBP additional use of Andro-Gin more significantly improved concentrations of C3a and C5a components , locally - C5a component, raised significantly concentration of regulatory factors C1-inhibitor and factor H. Thus, KAP-ELM-01 Andro-Gin administration in CAP and CBP patients promotes more effective correction of systemic and local disorders in the compliment system, the improvement being more pronounced in CBP.
Urologiia. 2011;(4):29-32
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Current approaches to treatment of non-gonococcal urethritis in men

Kondrat'eva Y.S., Neymark A.I., Kondratyeva Y.S., Neimark A.I.


The study was made of 50 men suffering from non-gonococcal urethritis caused by mixed pathogenic and opportunistic urogenital infection. Clinical characteristics of urethritis in relation to infection pathogen are shown. The results of clinical and laboratory examinations were considered in choice of antibacterial therapy. Safocid, a combined antibacterial medicine, demonstrated its clinical and microbiological efficacy in the treatment of patients with non-gonococcal urethritis of mixed etiology.
Urologiia. 2011;(4):32-37
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Erectile dysfunction: choice of a treatment method

Myagkov Y.A., Yudin V.E., Ivanov V.N., Sergienko N.F., Vasil'chenko M.I., Myagkov Y.A., Yudin V.E., Ivanov V.N., Sergienko N.F., Vasilchenko M.I.


The 15-year clinical experience with falloendoprosthetic operations (FEPO) in patients with erectile dysfunction is reviewed including algorithm of diagnostic examination, prostheses of different generations, indications and contraindications for falloendoprosthetic surgery. The results of 117 FEPO are outlined with special emphasis on 19 cases of postoperative complications. The conclusion is made that FEPO is most effective in erectile dysfunction by the presented criteria of the erectile dysfunction treatment efficacy.
Urologiia. 2011;(4):37-41
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Elective simultaneous operations in presenile and senile urological patients

Leshchenko I.G., Yakovlev O.G., Lazarev I.Y., Shatokhina I.V., Leschenko I.G., Yakovlev O.G., Lazarev I.Y., Shatokhina I.V.


Surgeons of Samara Regional Veterans' Hospital made elective simultaneous operations in 229 presenile and senile patients. Surgery was performed in the urological department in 1995-2010. It is shown that over 12% patients of urological geriatric departments need elective situltaneous operations, of them 8.7% are mild, 78.6% - moderate and 12.7% - severe. The results of simultaneous operations in 133 patients and staged operations in 60 control patients (adenomectomy and Vinkelman) differed insignificantly (p > 0.05). Such achievement was realized due to advanced prophessional education of all medical personnel of the department, introduction of new techniques in examination and treatment: accurate definition of absolute and relative contraindications for simultaneous surgery, effective preoperative preparation, low-invasive operations, different variants of non-endotracheal anesthesia. In addition to a positive clinical effect, new technology of simultaneous operations reduces 2.3-fold economic costs vs staged surgery, improves significantly quality of life of the above patients.
Urologiia. 2011;(4):42-45
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Combined treatment of chronic prostatitis of chlamydial etiology

Shperling N.V., Vengerovskiy A.I., Shperling I.A., Mironyuk D.V., Bezmenova M.A., Kalayda E.V., Shperling N.V., Vengerovsky A.I., Shperling I.A., Mironyuk D.V., Bezmenova M.A., Kalaida E.V.


Clinical efficacy of cycloferon (solution for injections) in combination with azitromycin was studied in males with newly diagnosed chronic prostatitis of chlamydial etiology and silent urogenital chlamydial infection. Administration of cycloferon in recommended regimen promotes clinical recovery and prevents recurrences. High clinical efficacy of cycloferon results from immunotropic activity of the drug which normalizes immune response and leads to elimination of the pathogen 3-6 months after the end of the treatment.
Urologiia. 2011;(4):45-49
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Approaches to more effective radical prostatectomy

Apolikhin O.I., Katibov M.I., Apolikhin O.I., Katibov M.I.


In search of ways to improve the results of radical surgical treatment of patients with prostatic cancer (PC), we analysed the results of examination and treatment of 130 patients with local PC performed in 2000-2010 years. All the patients have undergone retropubic radical prostatectomy (RPE). Of them, 25.4% received neoadjuvant hormonal therapy. Follow-up median was 53 months (16-122 months). We also estimated direct and indirect costs of RPE. Erectile dysfunction after RPE was registered in 93.1% patients, urinary incontinence - in 20% patients, anastomosis stricture - in 22.6%. Five and 10 year recurrence-free survival was 80 and 72%, respectively. Total (direct and indirect) costs of one PC patient's surgical treatment (RPE) reached 140891,29 roubles. Our calculations show that certain measures taken in practical activity of the urologists can reduce direct costs by about 25%. Thus, our study demonstrates that it is possible to avoid unjustified expenses and achieve good outcomes in surgical treatment of PC.
Urologiia. 2011;(4):49-55
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Administration of vitaprost plus for prevention of infectious-inflammatory complications of transurethral prostatic resection in patients with prostatic adenoma

Nozdrachev N.A., Neymark A.I., Neymark B.A., Nozdrachev N.A., Neimark A.I., Neimark B.A.


The study of efficacy and safety of the drug vitaprost® plus (rectal suppositories) in its use for prevention of infectious-inflammatory complications after transurethral resection (TUR) of the prostate for adenoma included 55 male surgical patients with prostatic adenoma (PA). The patients were randomized into two groups matched by age, symptoms and clinical data. The control group consisted of 20 patients (group 1), the study group - of 35 patients (group 2). TUR of the prostate was made in both groups, but patients of group 2 were given additional prophylactic treatment - vitaprost® plus, one suppository before going to bed 2 days before surgery and for 8 days after TUR, the course lasted for 10 days. Postoperative blood and urine samples showed inflammatory changes more often in group 1, free of infection bacterial tests were more often in group 2. Renal microcirculation in group 1 after TUR evidenced for functional depression on perfusion intensity and renal ischemia and congestion. These changes persisted on postoperative day 8, being a potential cause of renal inflammation and ascending pyelonephritis. Group 2 patients exhibited insignificant postoperative microcirculatory disorders in the kidneys and were not registered on postoperative day 8. Infectious-inflammatory complications in group 1 patients were registered much more frequently than in group 2 patients. Thus, vitaprost® plus can be recommended for prophylaxis of infectious-inflammatory complications of TUR in PA patients.
Urologiia. 2011;(4):55-60
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The role of ultrasonography in diagnosis of cryptorchidism in children

Yusufov A.A., Rumyantseva G.N., Pykov M.I., Yusufov A.A., Rumyantseva G.N., Pykov M.I.


Complex preoperative ultrasonic investigation of the inguinoscrotal area and abdominal cavity was made in 265 patients with cryptorchidism aged 1 to 14 years. The data of this investigation allowed development of an original technique of differential diagnosis of testicular retention and ectopy. Informative value of ultrasonic investigation in diagnosis of testicular ectopy and retention reached 100%. Examination of 44 children with unpalpable testes diagnosed abdominal cryptorchidism in 42 (65.6%) patients. In 10 (15.6%) patients testicular visualization failed. Testicular aplasia was diagnosed in 12 (18.8%) patients. Assessment of morphofunctional condition of the retained gonade showed that all the children had deficiency of testicular volume and abnormal intratesticular blood circulation.
Urologiia. 2011;(4):60-64
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Hormonal therapy of prostatic cancer: current status

Veliev E.I., Okhrits V.E., Veliev E.I., Okhrits V.E.
Urologiia. 2011;(4):64-68
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Replacement hormonal therapy in men: practical aspects

Gamidov S.I., Shcherbakov D.V., Tazhetdinov O.X., Pavlovichev A.A., Iremashvili V.V., Gamidov S.I., Scherbakov D.V., Tazhetdinov O.K., Pavlovichev A.A., Iremashvili V.V.
Urologiia. 2011;(4):68-74
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A giant recurrent urethro-vesico-vaginal fistula with a 44 year history with a complete prolapse of the urinary bladder

Komyakov B.K., Stetsik O.V., Rodygin L.M., Komyakov B.K., Stetsik O.V., Rodygin L.M.
Urologiia. 2011;(4):74-76
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A giant prostatic adenoma in unaffected quality of the patient's life

Parkhomenko O.V., Parkhomenko O.V.
Urologiia. 2011;(4):77-77
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Oral mucosa transplantation in extended urethral stricture

Kotov S.V., Belomyttsev S.V., Kotov S.V., Belomyttsev S.V.
Urologiia. 2011;(4):78-82
pages 78-82 views

Surgical treatment of nephroliths of the fused kidney

Dzhafar-zade M.F., Martov A.G., Teodorovich O.V., Dzhafar-zade M.F., Martov A.G., Teodorovich O.V.
Urologiia. 2011;(4):82-84
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