No 2 (2012)

A rise in efficacy of the treatment of acute infection affecting the lower urinary tract (LUTI) and prolongation of recurrence-free interval in chronic LUTI can be achieved only by an optimal antibacterial treatment. The study was made of 987 community-acquired strains of uropathogens from the patients living in 20 cities of the Russian Federation, Belarus and Kazakhstan (of them, 903 strains were from Russia). Enterobacteriaceae comprised 83.5%. E.coli infection of LUTI was found in 63.5% patients. The incidence of this infection was about the same both in uncomplicated and complicated cases (64.6 and 62.1%, respectively). Most active oral drugs against E.coli were phosphomycin (98.4%), furasidin (95.7%), nitrofurantoin (94.1%) and oralcefalosporins of the third generation (ceftibuten and cefixim). As to Enterobacteriaceae, only phosphomycin had activity against these bacteria above 90%, i.e. 91.5%. Furasidin and nitrofurantoin activity was 86.3 and 76.8%, respectively. From parenteral drugs, most active against E.coli were carbapenems (ertapenem, meropenem, imipenem. Strains resistant to them were not isolated. High in vitro activity was demonstrated also by cefoperason/sulbactam (97.4%), piperacillin/tasobactam (95.7%), cefalosporins of the third/fourth generation and amikacin (98.9%). Carbapenems were also highly active against Enterobacteroaceae. Empiric treatment of uncomplicated urinary infection should be performed with medicines which are not used for other indications.

It is known that recurrent nephroliths form in about half of the operated patients within 5 years after operation while 60% of all recurrences occur 3 years after removal of the primary concrement. To prevent recurrent nephroliths, it is important not only to detect metabolic disturbances but also to investigate chemical composition of uroliths. Mineral composition of 112 stag-horn concrements from patients living in the south of Russia was studied with x-ray phase analysis which showed that 62.9% concrements had mixed composition. Compared to patients with primary stag-horn nephrolithiasis, patients with recurrent one more often had calciumphosphate and calcium-oxalate concrements than urate concrements. Chemical composition of the concrements depended on features of the relief of the region where the patients live. Newly established mineral characteristics of stag-horn concrements in the citizens of south Russia should be taken into consideration both in surgical treatment and follow-up of such patients.

Fifteen females with various radiation-induced lesions of the urinary tract (urinary fistulas alone or in combination with uni- or bilateral ureteral strictures) received surgical treatment using isolated intestinal segments. The above surgical intervention reestablished natural urination in 9 patients. They were relieved from continuous urine leakage into the vagina and/or from nephrostomas. Heterotopic urine derivation was performed in 6 patients. Thus, restoration of natural urination in most patients with postradiation lesions can be performed only in usage of isolated intestinal segments. In some cases heterotopic urine derivation is indicated.

We studied preoperative correction of antihypertensive treatment in patients with urogenital diseases. The results of the study showed necessity of arterial pressure normalization in such patients especially before extracorporeal lithotripsy. Choice of hypotensive drugs after nephrectomy is specified.

The article is devoted to combined affection of the lower urinary tracts and genitalia in women with human papilloma virus (HPV) infection which manifests with persistent recurrent urethritis, pelvic pain syndrome. The colposcopic and urethrocystoscopic features, disturbed microcirculation of urethral and vaginal mucosa in virus infection promoting recurrences and persistence of HPV are discussed. Immunomodulators (inosin pranobex-groprinosin) are recommended for more effective treatment.

The study consisting of four visits included 69 patients with prostatic adenoma and concomitant chronic prostatitis. The patients received either monotherapy with an alpha adrenoblocker or combined treatment including phytodrug prostagut forte. The results of the study showed that the above combined treatment produces more pronounced and persistent improvement of urodynamic indices, leads to reduction of leukocyte count in the urine and prostatic secretion, upgrades quality of life. The absence of side effects allows recommendation of prostagut forte for treatment of presenile and senile patients with prostatic adenoma and associated pathology.

We treated 314 patients with local colorectal cancer (LCRC). Of them, 189 (60.2%) were males, 125 (39.8%) - females, age from 31 to 79 years (mean age 59.6±5.7 years). Combined surgery with resection of the affected urinary system components en bloc was made in 277 (88.2%) patients. Palliative urological care for obstructive lesions of the urinary system was delivered to 37(11.8%) patients. Surgical intervention was performed by a surgical team consisting of coloproctologists and urologist. Treatment of most of the patients was multimodal. As a result, it became clear that involvement of the urinary system in tumor process in LCRC patients must not entail rejection of combined surgery. Subtotal resection of the urinary bladder affected by a tumor in LCRC patients is functionally valid and oncologically radical. Efficacy of this intervention is confirmed by a satisfactory social adaptation - 18 (51.4%) of 35 followed up patients resumed their jobs. Resection of different parts of the urinary system has insignificant impact on postoperative lethality. Palliative urological care in urinary obstruction in LCRC patients improves quality of life and efficacy of conventional treatment. Treatment of such severe patients should be conducted with participation of the urologist who decides on optimal methods of urinary derivation, performs surgical reconstruction and follow-up of the patients after the operation.

Percutaneous nephrolithotripsy (PNLT) is widely used in surgical treatment of nephrolithiasis. The patient’s body position in this operation is, as a rule, prone. However, this position is often uncomfortable or even impossible for patients with obesity, bone diseases and deformations which sometimes occur in pulmonary, cardiovascular and other diseases. The aim of our study was to see how dorsal positioning of the patient during PNLT influences the results of this surgery. A total of 109 patients after PNLT for concrements of the upper urinary tract entered the study. They were divided into two groups: operated in the dorsal position (n=46, 42.2% - the study group) and operated in the standard prone position (n=63, 57.8% - the control group). The patients were matched by gender, age, size and location of the concrements, surgical procedure. Residual concrements were detected in 9(19.5%) patients of the study group, 7 of them were reoperated (PNLT, ureterolithotripsy, extracorporeal lithotripsy) while in the control group residual concrements were in 10 (14.9%) patients, 7 of them (10.4%) were reoperated. Thus, complete concrements evacuation from the upper urinary tract was achieved in 80.5 and 85.1%, respectively. Mean duration of the operation was 66.4 and 72.6 min, respectively; mean bed occupancy was 9.3 and 9.1 day, respectively. Complications in both groups consisted for the most part of postoperative hematuria and exacerbation of pyelonephritis. No injuries of the adjacent organs were registered. Thus, PNLT in dorsal position is an effective and safe treatment of nephrolithiasis, especially in patients with obesity, bone lesions and severe concomitant diseases.

The aim of the study was investigation of morphological changes in the urinary bladder and ureteral wall of dogs in response to contact electroimpulse impact (CEII); to develop recommendations for utilization of contact electroimpulse lithotripsy in humans. Effects of single-impulse CEII on the bladder and ureteral mucosa produced by an electroimpulse lithotripter were studied in 23 mature mongrel dogs. The morphological material was studied immediately after the impact, 1, 6, 14 days and 1, 3, 6 and 12 months after it. The 0.1-0.7 J electroimpulse impact resulted in fragmentary epithelial necrosis and aceptic inflammation within a muscular layer. An enhanced to 0.8 J impact caused local damage to all layers of the wall including adventitium while a 0.9-1 J impact caused ureteral perforation in 3 cases. Duration of morphological rehabilitation depended on the impact power and was optimal for 0.1-0.5 J impulses with complete mucosal repair to day 14 and complete morphological rehabilitation to month 6 after the procedure. In power 0.6-1 J mucosal recovery increased to 1 month while complete formation of the connective tissue finished after 1 year. None cases of development of ureteral strictures after CEII was observed in follow-up for 1 year.