No 1 (2014)

A comparative analysis of biochemical parameters of blood serum and daily urine in patients with urolithiasis developed after spinal cord injury (study group - 35 patients) and patients without development of the disease (comparison group - 20 patients) was performed. It was found that patients after spinal cord injury have developed productive azotemia, which led to the disruption of renal excretory function (accumulation of urea and creatinine in blood, and lowering their clearance). Against this background, there is violation of excretion of uric acid, magnesium, decreased sensitivity of the renal tubules to aldosterone (in patients with nephrolithiasis K/Na ratio in urine was lower). As a result, patients have decreased reabsorption of sodium and water retention, increased urine osmolality; against the background of electrolyte imbalance in urine, this leads to the formation of stones. In patients with spinal cord injuries, main trigger mechanism of formation of urinary stones was excessive posttraumatic azotemia. The high concentration of the products of protein-nitrogen catabolism in the serum of patients in the acute and early periods of spinal cord injury may be unfavorable criterion determining the significant risk of developing of kidney stones.

The article presents the results of the pilot questionnaire survey of doctors of various specialties, living in some cities in the Southern Federal District, in the diagnosis and treatment of various urination disorders. The survey involved 101 urologists, 33 obstetricians, 37 internists, 35 surgeons, 9 neurologists and 1 infectiologist. Inadequate training of doctors of various specialties regarding the diagnosis and treatment of various disorders of urination of inflammatory and non-inflammatory nature should be noted. Misunderstanding of differential diagnosis of various forms of urinary incontinence and tactics of management of each of them come under notice. Most urologists (95.46%), obstetricians (92.3%), physicians (100%), neurologists (66.6%), and surgeons (88.58%) did not have a thorough knowledge about the symptoms of overactive bladder (OB). Only 63.37 % of the entire group of respondents, and 81% of urologists using conservative therapies, has prescribed M-anticholinergics for the treatment of OB. In the treatment of urgent forms of urinary incontinence, only 64.5% of urologists use M-anticholinergics. Excessive use of M-anticholinergics for the treatment of stress urinary incontinence still persists - 38 % of urologists. а- blockers are the main group of drugs (96.6%) used in medical treatment of LUTS in benign prostatic hyperplasia. However, there is reduced (14.8%) understanding of the need to designate combination therapy with M-cholinergic antagonists when indicated. The issues of therapy of patients with lower urinary tract infections, namely the choice of antibiotics without considering antibiotic sensitivity and antibiotic resistance and knowledge of Russian and national guidelines and recommendations of the European Association of Urology are of particular concern. Curiously enough, there is underestimation of this issue by urologists (23%) compared to obstetricians (45%) and physicians (40.7%). These findings can determine the need for education programs for professionals in different areas of medicine, because patients with urination disorders occur in practice of doctors of various related specialties.

The effectiveness of perineal biopsy for the detection of prostate cancer (PC) using an array for brachytherapy/cryotherapy was evaluated. It is shown that perineal saturation biopsy provides high detection rate of prostate cancer in patients with suspected cancer after negative transrectal biopsies, does not increase the detection of clinically insignificant cancer and incidence of complications, but requires a lot of time and cost.

Using scanning electron microscopy, various portions of the ureter in reflux and obstructive ureterohydronephrosis in children were evaluated. In the first case, architectonics of the distal portions is preserved, while in the second case connective tissue is proliferated. Differences in the structure of proximal and distal portions in both forms of ureterohydronephrosis consist in inflammatory changes and violation of the integrity of the epithelial lining, edema and infiltration of the underlying layers, especially the inner muscle layer of the distal portion. The wall of the ureter in proximal part is much thinner, especially the muscular and mucous layers.

В первой части обзора представлены результаты наиболее интересных и крупных исследований, посвященных проблеме лечения бактериального простатита и опубликованных после 2010 г. Во второй части изложены ключевые положения современных клинических рекомендаций Европейской ассоциации урологов по антибиотикотерапии простатитов, опубликованных: в 2011 г. и базирующихся на исследованиях, проведенных до 2010 г. включительно.