No 5 (2011)

Our study of efficacy of Prolit-septo phytotherapy following extracorporeal shock-wave lithotripsy (ESWLT) in patients with nephrolithiasis has demonstrated that Prolit-septo noticeably reduces the time of evacuation from the urinary tract of the destructed stone fragments as well as renal colic incidence and renal inflammation exacerbation.

A total of 86 females with interstitial cystitis (IC) aged 26-52 years with the disease history over 2.7 years were exposed to intravesical electrostimulation in combination with electromagnetophoresis of heparin-containing mixture of medicines. Relief of pain syndrome and elimination of central hypersensitization were achieved with local procedures on the urinary bladder (UB) alternating (every other day) with procedures of transcranial electrostimulation (TES-therapy, mesodiencephalic modulation). The above treatment proved effective: subjective assessment of pain lowered to "rare" in 60% females, urgency decreased 2-fold, mean effective volume of the bladder increased by 46.2%.

Unilateral incomplete proximal intracavernous falloprosthesis (UIPIF) was followed by US-dopplerography of the intact penis and penis in medical erection induced by E1 prostoglandin introduction into the intact cavernous body. UIPIF preserves 89-90% of functionally active cavernous tissue with effective blood flow. Investigation 2 months and more after operation demonstrated that systolic blood flow rate in the cavernous artery of the cavernous tissue around the endoprosthersis can reach values registered in normal erection. The conclusion is made that after UIPIF quality of sexual life of the patient improves due to creation of additional density and axial stability of the trunk of the penis.

Pain and abnormal spermatogenesis are among symptoms deteriorating quality of life in patients with chronic prostatitis. Rectal suppositories vitaprost have no side effects, relieve pain, correct spermatogenesis. The effect of vitaprost treatment persists for 3 months and longer. Prostatic arteries embolization with vitaprost suppositories as preoperative preparation is a good alternative to surgical treatment in patients with prostatic adenoma.

We studied diagnostic potential of saturational technique of prostatic biopsy in 1018 males with suspected prostatic cancer (PC). Primary transrectal multifocal prostatic biopsy under ultrasound control was made in all the examinees including 453 procedures with use of saturational technique. The age of the patients varied from 43 to 77 years (median 60 years). A total of 159 patients with diagnosed prostatic cancer have undergone retropubic radical prostatectomy. Saturational biopsy has detected prostatic cancer in 35.1% cases. This technique was employed in hard for PC diagnosis parameters: age median 60 years, PSA 11.9 ng/ml, PSA density 0.23 ng/ml/cm3, prostatic volume 59.7 cm3. The above variant of biopsy detects the highest proportion of localized PC stages, minimal incidence of positive surgical margin, perineural and perivascular invasions, minimal score by Glison/s scale. Thus, the saturational technique of biopsy can be the method of choice in patients under 65 years of age, in a PSA level under 10 ng/ml, PSA density under 0.25 ng/ml/sm3 and prostatic volume over 60 cm3.

Endoscopic ureterolithotomy was made in 38 patients who had concrements in the upper third of the ureter more than 1 cm in size. Operations were retroperitoneoscopic and laparoscopic in 20 and 18 cases, respectively. Five patients had recurrent stones, 7 patients had prior extracorporeal shock-wave lithotripsy, 2 patients failed contact ureterolithotripsy. In the rest cases endoscopic ureterolithotomy was a first-line treatment. A complete elimination of the stone was achieved in all the cases. Mean time of the operation in a retroperitoneoscopic approach was 149 min, in laparoscopic - 125 min. Mean blood loss was the same. Conversion was performed in one case in the group of retroperitoneal approach. Postoperative stay in hospital in retroperitoneo- and laparoscopic ureterolithotomy was 3 - 16 days. Laparoscopic ureterolithotomy produced a complication in one case - an insignificant injury of the colon. Urinous infiltration and pneumonia developed after retroperitoneoscopic ureterolithotomy in one and one case, respectively. Thus, endoscopic ureterolithotomy in large stones of the upper third of the ureter via retroperitoneal and transperitoneal approach is a safe, low-invasive and effective operation which provides complete stones elimination. Endoscopic ureterolithotomy should be done in uneffective first-line treatment. It is a leading method in the treatment of large and long-standing stones of the upper third of the ureter.

A total of 17 urolithiasis patients (12 males, 5 females aged 29-65 years, mean 47 ± 8.2 years) with pelvicoureteral segment stricture (PUS) received percutaneous surgical treatment in the clinic of urology and surgical andrology from 2005 to 2009. The treatment consisted in endopyelotomy combined with nephrolithotomy and/or contact lithotripsy. Bilateral concrements were detected in 4 (23.5%) patients. Of them, 1 (5.9%) had PUS strictures in both kidneys. Good short-term results were achieved in 14 (82.4%) patients, satisfactory results - in 2 (11.8%) patients, unsatisfactory - in 1 (5.9%) patient. After long-term follow-up examination (mean follow-up 14 months after the operation) of all 17 patients it was found that 14 (82.4%) patients improved PUS condition (by the data of excretory urography and multislice computed tomography). Urological complaints were absent in 16 (94.1%) patients.

The efficacy of various treatment of chronic pelvic pain syndrome in combination with bladder emptying dysfunction was comparatively analysed for 31 male patients. Statistics show that current schemes of medication including antibacterial, nonsteroid anti-inflammatory drugs, alpha-adrenoblockers are not highly effective in such patients. Transrectal microwave hyperthermia is effective in males with chronic pelvic pain syndrome but the response is short - 3 months maximum. The highest and the longest effect in patients with chronic pelvic pain syndrome in combination with bladder emptying dysfunction was achieved after injections of 100 units of botulinic toxin type A into the cross-striated sphincter of the urethra.