No 3 (2012)

We estimated the efficacy of combined treatment and metaphylaxis of urate and mixed urolithiasis in 87 patients aged 18-87 years. The patients were divided into two groups: 68 patients of group 1 (the size of the concrements between 5-25 mm) have undergone parenteral litholysis of the drug trometamol N and metaphylaxis with biologically active additives prolit and urisan; 19 patients of group 2 have undergone extracorporeal shock-wave lithotripsy with parenteral litholysis and metaphylaxis by using biologically active additives prolit septo and urisan. Positive results were achieved in all the patients. In group 1 the concrements dissolved completely. In group 2 small fragments up to 4 mm eliminated after partial solution.

Excretory urography (EU), retrograde cystography (RC), static and dynamic pelvic MRT, renoradiography (RRG) were performed in 82 females with descent and prolapse of the internal genitalia. The above examination identified four degrees of the urinary bladder descent. The latter descent of the third and fourth degree caused ureteral obstruction in 48.1 and 87.1% cases, respectively, renal dysfunction in 81.5 and 100% cases, respectively. Static and dynamic pelvic MRT proved to be the most informative methods of examination of the urinary bladder and urethra in females with prolapse and descent of the internal genitalia.

Blocks of preparations from 22 patients with metastatic renal cell carcinoma on target therapy were studied. The patients were examined for mutations/methylation of VHL gene. The mutations were detected in 10(45.5%) of 22 patients, VHL methylation was found in 1 (4.5%) patient. Overall survival was 36.4 and 66.7% in the groups of patients with and without gene VHL alteration, respectively. Progression-free survival was 47.6 and 57.1%, respectively (p=0.619), relapse-free survival — 63.6 and 45.5%, respectively (p=0.682), progression was registered in 36.4 and 54.5%, respectively (p=0.682). Gene VHL inactivation had no effect on prognosis of the disease and results of anti-angiogenic therapy.

Assessment of long-term efficacy and complications of prostatic photoselective vaporization ( Green Light PV (tm) device, Laserscope®, 80W; laser cystoscope, Olympus) was performed in 40 patients with prostatic adenoma (PA) treated in 2005-2006. Mean follow-up was 30.6±16.6 (5.2-60.6) months, time of operation — 52.4 min, intraoperative blood loss — 52 ml maximum, duration of bladder draining with catheter — 1.15 days. For 12 postoperative months IPSS and QoL declined, then for up to 60 months these parameters went up. An 11-month postoperative follow-up recorded a 68.6% maximal decrease in prostatic volume (the size of the prostate decreased to 22.6 cm 3), but after 4 years this volume increased by 24.6% to 38.8 cm 3. Qmax increased more actively during postoperative year 1 and reached maximal value to postoperative month 36. Residual urinary volume fell to initial 95.7 ml to minimal 24.8 ml on follow-up month 12. Mean quantity of energy reached 206±94 (2.4619.0 kJ. Eleven patients had to take oral anticoagulants without any serious intra- or postoperative complications. Recurrent adenoma rose in 4 patients, urethral stricture — in 6.8% patients, cervical bladder sclerosis was found in 3.6% cases. Prostatic cancer development was not registered. Thus, prostatic photoselective vaporization is a safe and efficave procedure in PA treatment.

We compared efficacy and safety of mono- vs quasibipolar transurethral resection (TUR) for 198 patients treated with TUR. The patients were randomized into two groups by the TUR variant: monoor quasibipolar. Comparison of pre- and postoperative examinations data in the above two groups demonstrated: blood sodium decreased more in patients from monopolar TUR group, the absence of TUR-syndrome and less frequent and severe symptoms of obturator nerve irritation after quasibipolar TUR. Use of salt solution in quasibipolar TUR allowed us to avoid such a severe postoperative complication as TUR-syndrome. Thus, transurethral resection in physiological solution is an operation of choice in surgical treatment of prostatic adenoma and superficial cancer of the urinary bladder.