№ 4 (2011)

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.

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.

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.

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.

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.

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.

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.