No 3 (2013)

The article presents the results of the study aimed to evaluation of possible relationship between anatomical structure of the renal pelvis of the kidney, the size of the stone and the effectiveness of extracorporeal shockwave lithotripsy (ESWL) of stones in lower calices of kidney, defined as "stone-free state". ESWL was performed in 285 patients. Sizes of stones varied from 5 to 25 mm. With interval distribution of stone sizes, the greatest number of cases was detected with size of 5 to 12 mm. The destruction of stone required one ESWL session in 196 cases, and three sessions only in 12 cases. The total number of pulses per one stone did not exceed 9500, and more than 70% of the stones have been effectively destroyed with less than 3000 pulses. The result of treatment was assessed 3-4 months after the last ESWL session on the basis of ultrasound and X-ray examination using nominal (dichotomous) scale. In addition, for verification of significant (expected and unexpected) correlations, exploratory analysis of the correlation matrices of factors possibly affecting the discharge of stone fragments was performed. Positive treatment outcome was recorded in 212 (74,4%) patients. Residual stone fragments (≥ 5 mm) were identified in 73 (25,6%) patients; in 69 patients fragments corresponded to the initial localization and 4 fragments were located in the pelvis and calices of middle and lower segments of the kidney. Statistical processing found no association between the size of the stone and the number of ESWL sessions required for its destruction (P=0,4056). The analysis of relationship between the nature of the complications and size of stone revealed differences, but there were no significant differences in median test (p=0.1067). Based on exploratory analysis and correlations identified, in-depth evaluation was carried out on three factors: the size of the stone, length of lower calices neck, and pyelocaliceal corner. Width of lower calices neck as a statistically nonsignificant criterion was excluded from further analysis. A full-scale statistical analysis resulted in a number of conclusions that reflect the dependence of the efficiency of ESWL of stones in lower calices of kidney on size of the stone and a number of anatomical features of the renal pelvis system

The article presents the results of the examination and treatment of 60 women with chronic cystitis aged 20 to 80 years. The mean disease duration was 4,9 years (ranged from 6 months to 40 years). Immunomodulator Tilorone was included in the complex therapy of 30 patients of the main group. Besides the standard examination, immunological studies, including the definition of netrophil phagocytic rates in the patients were performed. It was revealed that the inclusion of immunomodulator in the treatment regimen of exacerbations of chronic cystitis contributes to an increase of index of activation of neutrophil phagocytic reserve, significant reduction in the frequency of exacerbations of the disease after the basic and preventive courses of treatment.

An open non-comparative multicenter study-observation according the program involving 190 patients (mean age - 62,3 ± 9,7 years) with benign prostatic hyperplasia (BPH) and severe urination disorders was performed. All of the patients received alfuzosin (dalfaz SR) 10 mg daily for 12 months. The primary criterion for evaluation of treatment effectiveness was the change of the total IPSS score. As secondary criteria, change of QoL score, total number of urination per day and subjective patient’s satisfaction with the treatment results were registered. Safety was assessed by recording the adverse events. The treatment led to the progressive decrease in the total IPSS score - from 16,4 ± 4,8 at baseline to 7,7 ± 2,6 at the final visit (P <0,001). The average QoL score has decreased by 67% - from 3,9 ± 1,1 to 1,3 ± 0,7 at the end of the study (P <0,001). In general, 94.2% of respondents positively assessed the results of treatment. The frequency of urination at night has decreased by 56%. Adverse effects (dizziness and slight fatigue) were recorded only in 1 (0,5%) patient. The present study has demonstrated a high efficacy and a favorable safety profile of dalfaz SR at a dose of 10 mg in the treatment of patients with BPH. Of particular note is the high proportion of patients who continued to receive the drug for 12 months, showing a good tolerability of dalfaz SR and high treatment compliance.

Pathological changes in the testes of animals of different age groups with the experimentally simulated cryptorchidism were evaluated. Animals were divided into 3 groups according to the time of fixation of testes into the abdominal cavity for a term of 2, 3 and 4 weeks. The changes were recorded at the time of bringing down the testes into the scrotum and at 14th and 28th day after bringing down. An assessment of pathological changes and the dynamics of the reparative capacity of testicular tissue in animals of different age groups at different stages of the study was performed. Experimental cryptorchidism leads to marked degenerative changes in the testes, up to the destruction of the elements of the testicular tissue in both groups. Comparative analysis of reparative capabilities revealed that potential of recovery of testicular tissue in young group of animals is much higher than that of mature animals.

The article presents the results of an epidemiological study of territorial and temporal characteristics of incidence of renal cell carcinoma in population of Siberia and the Far East, taking into account age and gender. In the average, regional incidence of renal cell carcinoma in men was 10,6 ± 0,1 %00; in women - 5,6 ± 0,1 %00. During the years 1994-2008, incidence increased by 1,4 times in male and female population. Based on the results of analysis, territories at-risk of renal cell carcinoma were identified - Omsk and Irkutsk regions. The incidence of renal cell carcinoma in child population was also evaluated. Peak incidence at the age of 4 years was revealed; in 2004-2008 it amounted to 1,72 ± 0,32 % 00, which in turn has led to the fact that renal cell carcinoma took 2nd place (13,2%) in malignant tumors in this age group after hematological malignancies. The highest incidence and its high growth in infants during the study period were revealed in Kamchatka, Amur and Sakhalin regions.

The experience of performing 44 partial nephrectomies using laparoscopic and lumboscopic approaches is presented. A comparative analysis of the effectiveness of different methods of hemostasis when performing nephron sparing interventions was conducted. It is shown that physical methods of hemostasis do not meet the necessary requirements, increasing warm ischemia time and the risk of intraoperative blood loss, and makes it difficult to visualize the boundaries of resection. Pilot study using histological assessment methods proved negative effects of high-frequency energy on parenchyma, which does not allow to recommend this method of hemostasis in nephron sparing surgery. We believe that currently ligature method in partial nephrectomy remains the only reliable and safe method for the achievement of final hemostasis.

The features of the normal anatomy of the balanus and distal urethra were evaluated. It was found that there is a physiological mechanism of stretching of distal urethra during urination owing to the scaphoid fossa, bridle and hippocrepiform-located corpus spongiosum of balanus. Based on these data, modified balanoplasty was proposed, which consisted in mobilization and increase the length of corpus spongiosum of wings of balanus by longitudinal incisions, followed by suturing wings of balanus with separate inside sutures on a short distance not above 3-5 mm and their dipping at a depth not above 1-2 mm. Between 2005 and 2010, 410 patients aged 1 to 18 years underwent surgeries. 90 (22%) patients underwent reoperation. Boys with glandular and coronal hypospadias (n=69) underwent MAGPI surgery. Patients with penile hypospadias (n = 243) underwent TIP-Snodgrass (n=72), onlay (n=23), Mathuie (n=123), and GTIP (n=25) surgeries. In children with scrotal and perineal hypospadias (n=98), method of transverse tubularized foreskin flap was used. All patients were arbitrarily divided into two groups. The study group consisted of patients (n=210) who underwent modified balanoplasty. The comparison group consisted of 200 patients who underwent conventional balanoplasty. Complication rate after hypospadias correction was reduced from 18 to 12% in penile hypospadias, and from 28 to 18% in scrotal and perineal hypospadias. It is shown that modified balanoplasty excludes formation of obstructive ring of corpus spongiosum in the distal urethra. The results of urodynamic examinations in follow-up period showed improvement of mean urinary flow rates.

The review of literature presents the current view of domestic and foreign authors on the frequency of infectious complications after kidney transplantation, their etiology, timing of emergence, and the spectrum of bacterial pathogens. Data on the effects of bacterial complications on the function of renal transplant and recipient survival are also demonstrated.