No 4 (2014)

48 patients aged 35 to 69 (51,0 + 0,6) years with extended or multiple ureteric strictures of specific (n = 36) and non-specific (n = 12) origin underwent ureteroplasty using intestinal grafts (enterourethroplasty). Before plastic surgery, percutneous pyelonephrostomy followed by assessment of glomerular filtration rate (GFR) was performed in 35 patients. It is shown that in case of baseline GFR less than 10 ml/min, reserve capacity of the kidney in hydrouretheronephrosis of tubercular etiology are exhausted. When creatinine clearance is greater than this value, restoration of function deblocked kidney occurs. The first case is indication for the nephrectomy, or nephroureterectomy, second case - for the reconstructive intervention on the ureter. Ileum was used in 45 patients, appendix - in 3 patients. In 26 (54.2%) patients, only replacement of ureter was performed; in 22 (45.8%) patients - replacement of the ureter and bladder. Enteroplasty of one of ureter was performed in 43 patients, two ureters - in 5 patients. It is established that these operations enable to release patients from lifelong external drainage of kidney in most cases, thereby significantly improving the quality of life (QOL). In the late postoperative period, quality of life significantly improves: particularly important - the mental health component, vitality and role functioning of patients; sustained reduction in pain intensity is observed (P <0.05). The optimum method of reconstruction of the ureter is ileoureteroplasty, if impossible -appendicourethroplasty.

The article compares the results of treatment of patients with urinary bladder leukoplakia who underwent transurethral resection (TUR) - 76 patients; and interstitial laser therapy (ILT) using a YAG-Nd laser (yttrium-aluminum-garnet with neodymium) Medilas Fibertom 5100 («DornierMedTech», Germany) - 32 patients. The advantage of ILT is demonstrated: chronic pelvic pain syndrome after ILT was three times less longer than after TUR (15.6 and 50%, respectively); fibrosis developed in impact area was observed 3.5 times less frequently (18.8 and 67.1%, respectively). A year after intervention, only 19.7% of patients after TUR was satisfied with the outcome of treatment, while those after ILT were 84.4%.

Uncomplicated urinary tract infections (UUTI) occur in women of reproductive age with anatomically and functionally normal bladder and urinary tract. In 25-40% of women, relapse of UUTI occurs 6-8 months after the first episode. Despite the relatively wide range of antimicrobial agents, various schemes of antimicrobial prophylaxis of recurrence of cystitis, phytotherapy, estrogen therapy, and vaccinotherapy, cystitis yet often recurs. The study was aimed to the evaluation of the components of innate immunity in the epithelial cells of the mucous membrane of the urethra in women with chronic bacterial cystitis and in healthy women at the level of gene expression of Toll-like receptors TLR2 and TLR4 and the antimicrobial peptide produced by the bladder mucosa, β-defensin-1 (HBD1). In 80% of women with chronic recurrent bacterial cystitis, significant increase in the TLR2 and TLR4 gene expression levels compared with a group of healthy donors was found, and HBD1 gene expression in urethral mucosa was reduced in all examined patients. Our study allows to understand the cause of the frequent recurrence of bacterial cystitis and identify ways for search of new drugs and drug-free modalities.

The article presents the results of the survey of opinions of pediatricians (n = 80, 97.5% of the total number of specialists) in Stavropol city about the role of pediatric primary care in organization of pediatric uroandrological service. Analysis of the results indicates a lack of awareness of pediatricians in matters of pediatric urology, andrology, which is confirmed by 42.5% of respondents who said they did not receive information on the problem during the training courses. The lack of awareness of 22.5% pediatricians about the institutions that specialize in providing pediatric uroandrological care is conspicuous, and 3.8% of specialists treat these diseases themselves, that indicates non-compliance with the existing routing schemes in identifying children with uroandrological diseases. In addition, 11.3% of physicians during primary patronage only in some cases carry out inspections for pediatric uroandrological pathology, and even 6.3% of the specialists do not do it at all, that indicates the low level of suspicion among primary care pediatricians, that can result in negative impact on the reproductive health status of the child population of Stavropol city.

The study was aimed to the evaluation of the safety and feasibility of partial nephrectomy for clinically localized renal cell carcinoma in patients with a normally functioning contralateral kidney. A comparative analysis of the results of radical nephrectomy (n = 226) and partial nephrectomy (n = 227) in patients with cT1 -2N0M0 renal cancer with normally functioning contralateral kidney was performed. Groups of patients subjected to different extent of operations were matched by sex, age, side of lesion, baseline characteristics of the tumor, and renal function (P> 0.05 for all); pT1a category and degree G1of anaplasia were more often diagnosed in the partial nephrectomy group (P < 0.0001). None of the 453 patients has received additional treatment. Median follow-up period was 50 (12-224) months. It was found that partial nephrectomy is associated with a significant increase in the duration of surgery (P = 0.031), blood loss volume (P <0.000), and the risk of complications (OR = 2.8 (95% CI: 1.64.7); P < 0.0001) compared with radical nephrectomy. Complications of partial nephrectomy do not increase the risk of decline in renal function and death. Partial nephrectomy is comparable to radical nephrectomy in terms of recurrence free survival (HR = 5.9 ( 95 % CI: 0.9-38.3)), specific survival (HR = 0.1 ( 95% CI : 0-12555.9 )) cardiospecific survival (HR = 1.1 ( 95 % CI: 0.3-4.6)), and overall survival (HR = 0.8 ( 95 % CI: 0.2-2.5)), including stratification of patients by demographic characteristics, characteristics of the tumor and postoperative renal function (P> 0.05 for all). Nephrectomy increases the risk of acute renal dysfunction by 1.8 times and reduces the risk of developing stage ≥ 3 chronic kidney disease in the late postoperative period by 1.4 times compared with radical nephrectomy. The effects of extent of operations on the quality of life were not revealed. Thus, the use of partial nephrectomy allows to improve the longterm functional results of surgical treatment for clinically localized renal cell carcinoma, and is associated with an increased incidence of complications that do not lead, however, to a decrease in survival compared with radical nephrectomy. The choice of method of surgical treatment of such patients should be individualized.

For the evaluation of the effectiveness of combined herbal drug ”prolit super septo” in the prevention of exacerbations of chronic bacterial prostatitis, an open prospective comparative ”case-control” study, which included 54 patients with a diagnosis of chronic bacterial prostatitis was performed. 27 patients received standard etiopathogenic therapy; other 27 patients in addition to standard therapy received prolit super septo 2 capsules twice a day for two months. 6 months after treatment, it was found that exacerbations occurred in 4 (14.8%) patients in the comparison group, and in 2 (7.4%) patients in the main group who received prolit super septo; in other patients sustained remission was achieved. In patients in the comparison group, the pain intensity of 3.2 points has persisted, and 2.8 points - in patients in the study group. A moderate increase of white blood count in the prostate secretion was more than 1.5 times often detected in the control group by than in the group of patients taking a prolit. Clinically significant bacterial growth was not observed in any patient. Quality of life of patients in the study group increased by 4.6 points, and in the comparison group - by 4.2 points

Development of retrograde ejaculation is observed in the majority of patients who underwent standard transurethral resection of the prostate (TURP). One of the main causes of this state has always been a damage of the bladder neck during surgery. At the same time, preserving the intact the area around the seminal crest during TURP allows to protect the natural ejaculatory mechanisms. From May to December 2010, 42 patients with infravesicular obstruction caused by benign prostatic hyperplasia (study group) underwent adopted original method of ejaculatory-protective TURP (EP TURP). The control group consisted of 40 patients who underwent standard TURP. Exclusion criteria included: history of surgery on the pelvic organs, the presence of urethral stricture, diabetes mellitus, neurological disease, and erectile dysfunction. Patients in both groups were matched by age, prostate volume, I-PSS and QoL indices, peak flow rate and residual urine volume. The performance of intraoperative and immediate postoperative period, as well as long-term results 12, 24 and 36 months after surgery were evaluated. The mean duration of surgery in the study group was 44.5 ± 19.5 min, in control group - 32.9 ± 16.1 min. In the study group, 32.8 ± 8.4 g of tissue was removed, in the control group - 58.2 ± 6.3 g. In both groups, the positive results achieved by surgery have remained stable for 3 years. Serious intra- and postoperative complications in any of the groups were not recorded. Ejaculatory-protective surgery has allowed to fully preserve the natural ejaculation in 48.7% of patients, and partially - in 25.6% versus 14.3 and 8.6% of patients who underwent the standard method of surgery. The ejaculatory-protective TURP is an effective and safe method of surgical treatment of patients with benign prostatic hyperplasia, wishing to maintain antegrade ejaculation.

Cryptorchidism is the most common abnormality of the male genitalia. Improvement of the technology of the second stage of Fowler-Stephens procedure, the most commonly surgery used in this disease, has allowed to reduce the incidence of postoperative testicular atrophy from 20 to 15 %. However, there are technological resources, which may result in improved results of the intervention. From 2006 to 2013, 167 boys with cryptorchidism (209 nonpalpable testes) underwent surgery in our clinic. Unilateral cryptorchidism was diagnosed in 125 (74.9 %) patients, bilateral cryptorchidism - in 42 (25.1 %). Average age was 53.7 ± 34.7 months. All patients underwent Fowler-Stephens procedure. During the first stage of the operation, abdominally located testes were revealed in 97 (46.4 %) cases, among them long loop of vas deferens was detected in 29 (29.9%); for 36 (37.1%) gonads, the presence of long loop of vas deferens was impossible to reliably exclude; obliterated processus vaginalis was detected in 3 (3.1%) cases. Patients were divided into two groups according to the type of second stage of intervention. The Group 1 included 27 boys (34 testes) who underwent surgery by the standard method; the Group 2 - 51 boys (63 gonads) who underwent surgery by modified technique. In order to evaluate the results of surgery, position and volume of cryptorchidic testes were defined intraoperatively and 6 months after. Testicular atrophy was revealed in 5 (15.2%) and 2 (3.3%) patients at the group 1 and Group 2, respectively (P <0.05). Author’s experience shows the feasibility of a scrotal mobilization of vaginal process of the peritoneum, if any, during the second stage of the Fowler-Stephens procedure, regardless of presence of loop of vas deferens. The use of proposed approach simplifies the mobilization of testes and reduces the incidence of subsequent testicular atrophy.

Nephrectomy is the standard method of management of patients with so-called “small tumors.” Sparing surgery on kidney, except neoplastic lesions, are used in the treatment of urolithiasis, urinary tract anomalies, kidney tuberculous, cysts, xanthogranulomatous pyelonephritis, renovascular hypertension and echinococcosis. Any penetrating lesion of parenchyma can cause significant bleeding. In this regard, nephrectomy is such a “wound”, but under controlled conditions. Therefore, hemorrhagic complications after sparing surgery are a major cause of death. This review presents information on existing methods of hemostasis used during partial nephrectomy in the experiment and in the clinical setting.

The article presents the modern literature data indicating the importance of evaluation of the role of hyperuricemia as a cause of endothelial dysfunction and oxidative stress in the pathogenesis of cardiovascular diseases (CVD) and erectile dysfunction (ED). It is hypothesized that hyperuricemia can really affect the outcomes of vascular lesions, and the use of diets and medicines aimed at reducing the uric acid levels, therefore, may be a new method of prevention of cardiovascular diseases, erectile dysfunction, and renal glomerular lesions. Further research in this area will soon have to give answers to these questions.