No 1 (2013)

The estimation of functional parameters of the lower urinary tract in 116 patients with chronic cystitis and 51 patients with chronic nonobstructive pyelonephritis was performed. Urethral instability was revealed in 53 (45.68%) patients with chronic cystitis (mean age, 40.72 ± 14.45 years), detrusor overactivity - in 10 (8.62%, mean age, 45.55 ± 13.45 years) patients. Variations in detrusor pressure were 22.16 ± 15.8 cm H2O. Combination of urethral instability and detrusor overactivity was diagnosed in 26 (22.4%) patients of the study group (mean age, 65.16 ± 10.49 years). The maximum urethral pressure was 75.5 ± 21.44 cm H2O, variations in urethral pressure— 37.45 ± 17.44 cm H2O. Reduction in the maximum urinary flow rate less than 15 ml/s was detected in 47 (40.5%) patients. Signs of detrusor-sphincter dyssynergia were observed in 29 (25%) patients. After processing the urodynamic studies of patients with non-obstructive pyelonephritis, 20 (39.21%) patients with severe detrusor hypotension, 18 (35.29%) - with detrusor overactivity, 26 (50.98%) - with urethral instability were identified. Based on the results of the study, it was concluded that women's chronic inflammation in the bladder and kidneys may not be the cause but the consequence of functional disorders of the lower urinary tract infections associated with the disorders of the nervous regulation of these organs. Inflammation in the bladder wall against the background of dysfunction of the lower urinary tract, in turn, can support a dysfunction of the bladder and/or urethra. Drugs affecting the function of the sympathetic and parasympathetic elements of the autonomic nervous system can be used for the elimination of functional disorders of the lower urinary tract and improvement the functioning of these organs. Thus, the pathogenetic treatment of chronic cystitis should be based on the disruption of “vicious circle” dysfunction- inflammation. In view of these data, and due to the frequent detection of imperative and functional obstructive urination disorders, in addition, based on the neurophysiological concept of their occurrence, the use of α-adrenoblockers and M-anticholinergics agents is important in the treatment strategy with regard to patients with chronic recurrent cystitis and non-obstructive pyelonephritis.

The results of research on the clinical picture, features of manifestation, diagnosis, and treatment of patients with diverticular disease complicated by sigmovesical fistula are presented. The study included 31 patients (19 [61.3%] men, 12 [38.7%] women), aged 32-83 (55.6 ± 7.1) years. Diagnostic program included physical examination, laboratory blood and urine tests, endoscopic, radiological, ultrasound examinations. All patients underwent different interventions according to the severity and extent of the inflammatory process, the involvement of other organs of the abdominal cavity and the extent of diverticular lesions of the colon. Long-term results were assessed in all patients in a period of 5 months to 12 years, with a median follow-up 4.7 years. It is shown that the clinical manifestations of intestinovesical fistula did not match the severity of complications, and were subclinical. Timing for referral the patient to coloproctologist was 5 months after the occurrence of first clinical signs. In any case, conservative treatment has not led to spontaneous colovesical fistula closure. Average size of parafistulous infiltration on the wall of the bladder and perivesical tissue was 6.5 ± 2.4 cm. All the patients underwent different types of colon resection. Postoperative complications did not requiring recurrent surgery were detected in 5 (16.1%) patients. None of these has experienced recurrence complications of diverticular disease. For the optimization the treatment strategy, physicians should follow multidisciplinary approach immediately after revealing the patient with persistent bacteriuria, pneumaturia and fecaluria. The surgery is the method of choice in the treatment of colovesical fistula as a complication of diverticular disease.

The study was aimed to evaluation the effect of different magnesium salts and their combinations with pyridoxine on a course of calciumoxalate nephrolithiasis, which was modeled by adding the sodium oxalate (3% of weight of the diet) and selective cyclooxygenase-2 inhibitor celecoxib at a dose 100 mg/kg body weight to a diet for 4 weeks. Starting from the 2nd week of the experiment, the animals had received one of the following compounds: magnesium L-aspartate, magnesium chloride, and their combination with vitamin B 6; magnesium sulfate and Magne B 6 (magnesium lactate and vitamin B 6) as comparators. 28 days after the start of the experiment, disorders progressed in the group receiving only celecoxib and oxalate-rich diet: the urine level of oxalate increased by 171% (р<0,0001), crystalluria had increased (up to 105 crystals in 10 μml of urinary sediment, р<0,0001), creatinine clearance decreased by 29%, compared to control (р=0,087). Increasing calcium/magnesium and oxalate/creatinine ratios in urine by 16 and 189%, respectively, was observed. In the renal parenchyma of animals treated with sodium oxalate and celebrex, calcifications with a volume fraction of 4% were identified, whereas these changes were absent in intact animals. According to the degree of correction of hyperoxaluria and elimination of calcium oxalate crystals, investigated salts showed similar efficacy, with the exception of magnesium sulfate, which less contributed the compensation of abnormalities in kidney and urinary. According to the data of morphological study, the volume fraction of calcifications was lowest in the groups receiving magnesium L-aspartate and Magne B 6.

Treatment of cystitis remains an urgent problem in urology due to its prevalence, physical and social disadaptation of patients, and not always satisfactory treatment results. The article presents the results of treatment of 40 women aged 41.5 ± 12.4 years with chronic cystitis. 20 patients received ozone therapy, 20 patients - ozone therapy in combination with а-adrenoblocker tamsulosin. Effectiveness of the treatment was evaluated using clinical data, data of bladder diaries, IPSS score, and uroflowmetry data. Dynamics of all the parameters in patients treated with ozone therapy in combination with tamsulosin was significantly higher in comparison with that in patients treated with ozone therapy only. As a result of the treatment, increased urine flow rate was accompanied by an increase in urination. Combination therapy with the use of ozone therapy and tamsulosin can be successfully and safely used in the treatment of patients with cystitis.

Overactive bladder (OAB) is found in 20% of patients with various disorders of urination, and the imperative urinary incontinence diagnosed in one third of these patients. The study was aimed to improvement the treatment outcomes in OAB women with imperative incontinence and obstructive urination disorders by using a combination of α1-adrenoblockers and PDE-5 inhibitors, and to evaluation of relationship between clinical and urodynamic manifestations of the disease. The state of the microcirculation of the bladder mucosa before and after treatment was also evaluated. We have examined and treated 40 women aged 17 to 69 years with disease duration ranged from 1 to 20 years. Patients received combination of a1-adrenoblocker alfuzosin (dalfaz) 5 mg at night and reversible selective PDE5 inhibitor tadalafil (Cialis) 5 mg daily in the morning for a month. After treatment, according to the uroflowmetry and cystometry data, the time of urination was reduced, urinary volume and maximum urinary flow rate, as well as cystometric capacity have increased; involuntary detrusor contractions in the bladder filling phase (spontaneous or provoked) became less, or absent. According to the results of ultrasound examination, residual urine volume has decreased. Laser Doppler flowmetry showed an increase of neurogenic tone in precapillary, bypass coefficient and microcirculation effectiveness index, increase in microcirculation index and the coefficient of variation, indicating an improvement of microcirculation in the bladder mucosa. As a result of treatment, the clinical effect was seen in 29 (73%) patients, urinary incontinence was noted only in 6 (15%) patients.

The efficacy and safety of vitaprost ® forte rectal suppositories 100 mg in 30 patients with benign prostate hyperplasia (BPH) were evaluated. It is proven, that the use of this drug positively affects both the subjective and the objective symptoms of BPH. Vitaprost forte® significantly reduces the clinical signs of the disease and improves quality of life, that is, reduces the severity of bladder outlet obstruction (according to the data of uroflowmetry, it increases maximum urinary flow rate), decreases the amount of residual urine. In addition, moderate reduction in mean prostate volume was revealed in BPH patients receiving vitaprost forte.

The medical records of 60 patients who underwent surgery to remove the lung metastases of T1-4N0-2 kidney cancer were retrospectively analyzed. The age of patients ranged from 31 to 70 years. Synchronous lung metastases were diagnosed in 20 (33.3%) cases, metachronous — in 40 (66.7%). 53 (88.3%) patients had lesions in one lung, and 7 (11.7%) patients — in both lungs. Solitary metastases were present in 41 (68.3%) patients, multiple — in 19 (31.7%). In 69.4% of cases, the size of lung metastases was more than 2 cm. Metastasis at other sites at the time of surgery on the lungs were present in 1 patient (supraclavicular lymph nodes). The primary tumor was removed in 56 (93.3%) of 60 patients. All 60 patients underwent removal of lung metastases (radical — 53 [88.3%]). One patient underwent a radical supraclavicular lymph node dissection. All tumor lesions were removed in 50 (83.3%) patients. Median follow-up period was 20 (3-155) months. Perioperative complication rate was 6.6%; no deaths caused by complications of treatment were registered. Histologically, metastases of renal cell carcinoma were verified in all removed lesions from the lungs; 3 (5%) patients had mediastinal lymph node metastases. Five- and 10-year overall, specific and recurrence free survival rates were 36.3 and 19.1%, 38.9% and 27.2, 20.4 and 11.7%, respectively. Univariate analysis demonstrated an adverse effect of pN + category, bilateral pulmonary lesions, the presence of mediastinal lymph nodes metastases and non-radical removal of malignant lesions of the lung on the specific survival. Multivariate analysis confirmed a significant effect of radical surgery on the survival.

The results of research on the effectiveness of monoport laparoscopic surgery for kidney disease are presented. Operations using LESS method (Laparo-Endoscopic Single-Site Surgery) were performed in 21 patients, including 14 nephrectomies and 7 cyst resections. In five cases, nephrectomy was performed due to terminal hydronephrosis, in two cases — due to presence of arteriolosclerotic kidney, in seven cases — due to renal cell carcinoma (T1a-bN0M0). "Pain DETECT" questionnaire was used for assessment of pain symptom. Maximum longitudinal size of a removed organ was 14 cm, the average volume of intraoperative blood loss - 80 ml. Duration of monoport laparoscopic radical nephrectomies ranged from 125 to 230 min (mean duration, 164 min). The time for renal cyst resection ranged from 40 to 120 minutes. Moderate intensity pain was observed in all patients but only at the first day after surgery. The average hospital stay was 4 days. The length of postoperative skin scar varied from 2.5 to 6.0 cm. Early and late postoperative complications were not observed. During follow-up period 6 to 8 months, tumor or cyst recurrence were not registered.

The widespread introduction of percutaneous nephrolithotomy has led to a significant narrowing of the traditional indications for surgery for staghorn calculi. We analyzed the efficacy and safety of percutaneous nephrolithotomy, depending on the stage of staghorn nephrolithiasis. In a period of 2008—2011, 120 patients with staghorn calculus underwent percutaneous nephrolithotomy. Data from spiral computed tomography were used in planning the surgical approach. In the preoperative period, staghorn calculi SN1-SN2 were diagnosed in 31.7% ofpatients (Group 1), and complex forms of stones corresponding SH3-SN4 — in 68,3% (Group 2). The between-group analysis showed that the average time of surgery was significantly (р<0,01) higher in patients in Group 2, the same group reported more frequent blood loss requiring to stop operation, as well as hyperthermia, hypotension during surgery, but the difference was not significant compared to Group 1 (р>0,05). Conversion to open surgery was required in 2,6 and 2,7% of patients in Group 1 and Group 2, respectively. Application of PNL allowed to completely remove SN1—SN2 calculi in 94,7% of cases in Group 1, but similar result was achieved only in 63.4% of cases in most difficult group of patients with SN3—SN4.

Retrospective analysis of results of the most frequently used methods of urethroplasty: urethroplasty using tubularized dissected urethral area (TIP), urethroplasty using tubularized dissected urethral area with inset the free flap of the foreskin (GTIP) and Mathieu surgery in patients with coronary, distal and middle hypospadias (in primary and recurrent surgery), was performed. From 2005 to 2010, 300 patients aged 7 months to 19 years underwent the surgery. There were no early postoperative complications in any patient, with the exception of early accidental removal of the catheter in 4 patients. Long-term results of one-stage correction of hypospadias were followed-up during period of 6 months to 4 years. Late complications included urethral fistula and stenosis. Analysis of the results of operations led to the conclusion that the TIP urethroplasty with Snodgrass modification can be performed as either primary or recurrent surgery in case of normal size of balanus and urethral area. However, in case of changes in the urethral area, scarring and small sizes of balanus, appropriate surgery is Mathieu operation.