No 5 (2013)

Over the last two decades, marked increase in detection of incidental or asymptomatic renal cell carcinoma (RCC) in developed countries was observed. The study included 268 patients aged from 25 to 92 years with RCC, which underwent evaluation and treatment in urology clinic MRSRCI for the past 5 years. There were no significant differences in the frequency of histological types of RCC between incidental and symptomatic tumors. Among incidental neoplasms with clear- cell structure, tumor with small size — up to 4 cm (T1a stage) and moderate to high degree of differentiation (G 1-2 according Fuhrman) were predominant. Papillary variant of RCC was detected at a higher stage of the disease and characterized by a high degree of nuclear atypia, which indicates its high malignant potential. Chromophobe RCC was usually diagnosed at T3 stage. The average age of men and women with chromophobe RCC was 46,5±6,8 years; there were no age difference in patients with symptomatic and incidental RCC. Among the benign tumors of the kidneys, angiomyolipoma was most commonly diagnosed — in 13 (53,8 %) cases. Thus, incidental tumors have a better prognosis than symptomatic tumors.

This article describes a decision making support system for urologists on the prediction and management of preventive interventions for urolithiasis using fuzzy logic decision-making device. Dictionary of informative signs and alphabet of classes are formed. The formulas for calculating the membership functions according to the known features are developed; these formulas allow to calculate the certainty factors for pertaining of inspected object to the desired class by means of iterative rules of rule of logical inference. Based on comparison of the values obtained with the threshold certainty factors, dephasification of conclusion is produced. In accordance with the obtained decision rules, control algorithm for the prevention measures in urolithiasis is developed. To test the effectiveness of «operation» of the synthesized decision rules, the certainty factors were calculated for 200 patients with urolithiasis, which were divided into two groups according to the results of observation during the year depending on the presence of recurrence. The analysis of the intersection of histograms of distribution of coefficient values showed high diagnostic efficiency (0,94) of synthesized decision rules.

The study was aimed to the evaluation of efficacy and safety of cefixime and amoxicillin/clavulanate in the treatment of asymptomatic bacteriuria in pregnant women. A prospective, multicenter, randomized study that included 112 pregnant women with asymptomatic bacteriuria was performed. 58 women were randomized in group 1 (cefixime [suprax solutab®] 400 mg 1 time a day, 7 days), 54 women were included in group 2 (amoxicillin/clavulanate [amoksiklav®] 625 mg 3 times a day, 7 days). The average age of the patients in group 1 was 25,2±6,6; in group 2 - 26,6±5,8 years. Physical examination, evaluation of complaints, collection of data on adverse reactions, and bacteriological analysis of urine were performed after enrollment in the study at visit 2 (day 10±1) and 3 (day 35±2). Comparable effectiveness of cefixime and amoxicillin/clavulanate in the treatment of asymptomatic bacteriuria in pregnant women was found. Eradication of the pathogen and sustained bacteriological response were observed in 94,8 and 92,7% of women treated with cefixime, and in 98,2 and 92,5 % of women treated with amoxicillin/clavulanate, respectively (P> 0,05). At the same time, the use of amoxicillin/clavulanate compared with cefixime significantly higher was followed by the development of adverse reactions (13% and 1,7; respectively; P = 0,02). Seven-day courses of cefixime at a dose 400 mg 1 time a day and amoxicillin/clavulanate at a dose of 625 mg 3 times a day are high-effective treatment regimens for asymptomatic bacteriuria in pregnant women in Russia. The use of amoxicillin/ clavulanate is significantly more often accompanied by the development of adverse reactions compared with cefixime.

The study was aimed to the evaluation of the efficacy of prolit in patients with urolithiasis and localization of stone in the ureter. 225 patients with various localization of solitary ureteral calculi ranged from 0,4 to 0,7 cm were under observation. Depending on the treatment, the patients were divided into two groups. The study group (n = 175) has received prolit for 30-40 days, control group (n = 50) has received standard therapy. As a result of treatment, spontaneous discharge of ureteral stone was registered in 158 (90.3%) patients of study group and only in 21 (42%) patients of control group. Renal colics during treatment were recorded four times more often among patients of control group. The intensity of pain in patients receiving prolit was less pronounced.

The study was aimed to the evaluation the effect of NO- synthase inducer impaza on endothelial function and erectile function in patients undergoing coronary artery bypass grafting (CABG). The study involved 127 men with stable coronary artery disease (CAD), aged 55,8±5,3 years, which were planned on CABG. The survey included assessment of IIEF score and blood lipid levels, registration of nocturnal penile tumescences, postcompression tests on the shoulder and cavernous arteries. Endothelial function was assessed as the plasma levels of nitric oxide (NO) and endothelin-1 (ET-1). The comparison group of patients (n=67) were treated with standard rehabilitation program, and the study group (n=67) additionally has received impaza 1 tablet a day for 24 weeks. It is shown that in patients with erectile dysfunction (ED) undergoing CABG, the use of impaza for 24 weeks facilitates optimal dynamic expression of the ED. But a year after the operation, there were marked deterioration in erectile function, indicating a short-term effect of action of impaza that may require its longer use. In addition, 6 months after CABG, patients receiving impaza had better indicators of functional activity of the endothelium in shoulder and cavernous arteries compared with patients who received conventional rehabilitation; one year after surgery, however, there were no significant differences in these parameters. Restorative treatment using impaza in CAD patients after myocardial revascularization operations has positive influence on the NO, ET-1 levels, which is reflected in the functional state of the endothelium and characterized by an increase in vasodilator properties and decrease in vasoconstrictor properties.

17 patients (mean age, 61±1,7 years) with an benign prostate hyperplasia (BPH) and urination disorders were under observation. After examination by ultrasound, urodynamic and laboratory studies, patients received conservative combined therapy, including α1-adrenoblocker silodosin, L-carnitine, B vitamins and picamilon. As a result of the 4,5-month treatment, most of the symptoms were eliminated as evidenced by the decrease in IPSS score from 17 to 3; urodynamic parameters have improved that was recorded by the home uroflowmetry. It was concluded that the use of proposed combined therapy in patients with BPH as the first stage of treatment, followed by the administration of 5α-reductase inhibitors or performing surgical correction in case of formation of bladder outlet obstruction is justified.

In men of middle and older age group, urination disorders and erectile dysfunction are often combined. The role of phosphodiesterase type 5 inhibitors in the treatment of these patients remains uninvestigated. Prospective study included 38 patients with urination disorders and erectile dysfunction. The average age of the patients was 63,6±5,3 years. During first three months of observation, all patients have received alpha-adrenoblocker doxazosin at a dose of 4 mg once daily per os, the next three months - phosphodiesterase type 5 inhibitor udenafil at a dose of 50 mg once daily per os was added to doxazosin. 3 months after treatment, majority of patients reported improvement of urination. The statistically significant changes in BP and heart rate were not recorded, indicating a satisfactory tolerability and safety of doxazosin. Against the background of combined treatment during next 3 months, progressive improvement of erectile function (IIEF score 12,8±3,4 vs 18,4±3,7; p<0,05), and regression of urination disorders, according to IPSS score (13,4±1,2 vs 11,2±1,7; p<0,05) were observed. Uroflowmetric indicators were not significantly changed. Based on experimental and clinical studies, it was suggested that the dysregulation of NO - cGMP system, pathological activation of Rho-kinase pathways, hyperactivity of autonomic innervation, atherosclerosis and impaired blood flow in the pelvic organs are the common pathophysiological mechanisms for LUTS and erectile dysfunction. The clinical efficacy of phosphodiesterase type 5 inhibitors in the treatment of patients with these diseases is explained by its effects on these mechanisms.

Interstitial laser coagulation (ILC) is one of the effective methods of minimally invasive destruction of small renal tumors. For the safe use of ILC in clinical practice, it is necessary to select the optimal mode of action of laser radiation on the tissue of target organ and techniques for the procedure. The effects of ILC on kidney tissue in 6 rabbits weighing less than 3 kg and 5 mongrel dogs weighing up to 20 kg were investigated in vivo. The impact of ILC was made intraoperatively. Organ retrieval in experimental animals for the macro- and microscopic examination was performed immediately after the impact of ILC and at various times thereafter during the month in rabbits and 35 days in dogs. Morphological study in different periods after exposure allowed to establish phasing and volumes of changes in the tissues of the kidney, confirming the safety and efficacy of ND:YAG laser irradiation on kidney tissues. The results indicate the possibility of effective application of ILC of kidney tissues for destruction of small size tumors, without impairment of functions of the organ.

The medical histories of 98 patients with pyoinflammatory diseases of the kidney, who underwent surgery by retroperitoneoscopic access, and 75 patients, who underwent traditional open surgery were analyzed. The degrees of multiple organ dysfunction and endotoxemia were determined in all patients. The groups were comparable in terms of clinical manifestations and severity of intoxication. The advantages of minimally invasive retroperitoneoscopic interventions are demonstrated; they allow to reduce the surgical morbidity, pain after surgery, the frequency and severity of intraoperative complications, length of in-hospital stay, the period of disability, the cost of treatment, and the need for medications

Solifenacin at a dose of 5 mg per day has demonstrated the high efficacy in the treatment of patients with overactive bladder. However, for patients who remained dissatisfied with the outcome of treatment, the dose may be increased to 10 mg per day, which leads to the improvement of patient's condition. However, there is an opinion that treatment should be started with the use of high doses of the drug. Efficiency of solifenacin at a dose of 10 mg was accompanied by favorable safety and tolerability profile. Despite the fact that numerous studies have shown that the clinical efficacy of different anticholinergics is not very different from one another, it is known that patients may prefer some other drugs. Application of solifenacin in these patients leads to significant improvement in quality of life. Thus, flexible approach to the use of solifenacin allows to achieve the best results in the treatment of patients, including those cases where the initial treatment is not effective or is interrupted due to pronounced side effects.