No 3 (2015)

This paper presents a morphological study of kidneys of 30 patients, who died as a result of multiple injuries. In 96.7% of decedents, in the absence of external signs of kidney integrity violation, there were plasmorrhagia, hemorrhage, destruction of glomeruli and tubules, epithelium desquamation, emergence of hyaline casts in the tubules. After 3 days lymphoid leukocyte infiltration in the parenchyma of the kidney was found, and after 30 days collagen fibers around the glomeruli and tubules were detected, which is representative of renal fibrosis.

The purpose was to determine the concentration of the neurotrophin nerve growth factor in urine to assess its possible role as a marker in the diagnosis of various forms of overactive bladder. The study included patients with urinary frequency and urgency: 21 patients with idiopathic detrusor overactivity, 18 - with overactive bladder without detrusor overactivity and 11 healthy volunteers (control group). The level of nerve growth factor in the urine was determined in all participants of the study by the enzyme immunoassay (ELISA). In the control group the average ratio of nerve growth factor level to the level of urine creatinine was 0,2 ± 0,06, in patients with overactive bladder without detrusor overactivity - 0,33 ± 0,06 (p> 0.05). In patients with idiopathic detrusor overactivity the rate was significantly higher and amounted to 6,04 ± 0,9 (p <0.05). Therefore, measurement of the concentration of nerve growth factor in the urine may be used for differential diagnosis of the presence or absence of detrusor overactivity in patients with overactive bladder.

The fourth, terminal, stage of bladder tuberculosis (BT) manifests itself in irreversible changes and requires surgical treatment. Objective: To identify the reasons for delayed diagnosis of this urogenital tuberculosis complication. Medical history of 26 urogenital tuberculosis patients with a complicated form of stage 4 BT, referred to the Novosibirsk TB Research Institute for reconstructive surgery were analysed. In 22 patients, bladder volume ranged from 55 to 100 ml, 4 patients previously underwent cystostomy due to extremely small bladder volume. Average duration of BT hidden in the guise of «urogenital infection» was 6.2 years. Patients were treated with norfloxacin (a total of 104 courses), ciprofloxacin (86 courses), amikacin (43 courses), nitroxoline (27 courses), third generation cephalosporins (32 courses), lomefloxacin (17 courses), levofloxacin (11 courses), Amoxicillin clavulanate (4 courses), ampicillin (2 courses). It was demonstrated that all cases of BT stage 4 were iatrogenic. Irreversible debilitating complications occurred due to suboptimal therapy, primarily due to administration of amikacin and fluoroquinolones for urogenital infections, which was tuberculosis in disguise. Absence of M. tuberculosis growth does not exclude tuberculosis; pathological specimens must be further examined at least by PCR. Interventional material must be mandatory examined histologically and stained by Ziehl-Neelsen method to identify M. tuberculosis. Effective and not masking tuberculosis, optimal therapy for urogenital infections includes fosfomycin, furazidin (nitrofurantoin), gentamicin, III generation cephalosporins (in outpatient settings dispersible form of efixime should be preferable).

Evisceration of the pelvic organs (EPO) is a fairly uncommon surgical treatment that removes all organs from a patient's pelvic cavity. We use gracilis musculocutaneous flap to repair pelvic floor after EPO. Over the period from November 2013 to December 2014 we carried out EPO with reconstructive repair of the pelvic floor with gracilis musculocutaneous flap in 10 patients with locally advanced pelvic tumors. We describe the surgical procedure and surgical outcomes in these patients. Mean age of the patients was 55 years. Mean duration of EPO with the pelvic floor repair was 285 min., mean blood loss - 595 mL and the average length of hospital stay - 19 days. Gracilis musculocutaneous flap has a sufficient arterial supply and mobility for pelvic floor reconstruction. Necrosis of flap’s distal edge occurred in one of the 10 clinical cases, while the remaining flaps were fully preserved. Complete healing of wounds with no signs of weakening of the pelvic floor muscles was observed in all cases. Pelvic floor reconstruction is an essential procedure in order to reduce complications associated with the evisceration of the pelvic organs. The Gracilis musculocutaneous flap is the logical alternative to repair pelvic floor defect. It does not contribute to complications like functional deficiency of the lower limbs, complications of stoma formation or weakening of the muscles of the anterior abdominal wall.

The aim of the study was to analyze the role of the kallikrein-kinin and renin-angiotensin systems in the molecular mechanisms of prostate cancer (PCa) and use the findings for identification of new markers of the disease. Analysis of proteolytic disturbances in the prostatic secretions in benign prostatic hyperplasia (BPH) and prostate cancer based on the identification of key indicators of the kallikrein-kinin and renin-angiotensin system in the prostate secretion showed that kallikrein activity in prostate cancer is higher and the activity of angiotensin converting enzymes (ACE), by contrast, is lower than in BPH, apparently reflecting the reduction of angiotensin II and increase of the bradykinin content. A characteristic feature of prostate cancer is a dramatic increase in the inhibitory capacity of prostate secretion. It was found that in BPH patients, expression of B1 receptors in the prostate tissue is completely absent. The specific response with anti-B1 antibodies in the glandular epithelium was observed in malignant foci acini and prostatic intraepithelial neoplasia. In contrast, expression of the B2 receptors occurs in the stroma of both BPH and prostate cancer independent of stage and Gleason score. Indicators of kallikrein and ACE activity in prostate secretion and expression of the B1 receptors in prostate tissue may be utilized for prostate cancer diagnosis.

Results of laparoscopic pyeloplasty (LP) with different the methods of the upper urinary tract (UUT) stenting were compared. A total of 76 patients with hydronephrosis were enrolled in the study. Antegrade and retrograde ureteral stenting was used in 42 (55.2%) and 34 (44.8%) patients, respectively. In the first group after resection of the narrowed pyeloureteral segment (PUS) and formation of posterior wall of pyeloureteral anastomosis, antegrade stent was placed into the bladder, which followed by suturing of anterior wall of pyeloureteral anastomosis. While performing transurethral ureteral stenting, cystoscopy with retrograde ureteropyelography was carried out in lithotomy position, and the stent was put into the renal pelvis. Next, the patient was put into the lateral position, and LP was performed by transperitoneal access. There were no cases of conversion. The duration of the LP with antegrade stenting was significantly shorter than LP with retrograde stenting - 135 versus 170 minutes (p <0.05). Differences in the blood loss (55 ± 20 and 60 ± 15 ml) and the length of hospital stay (5 ± 2 and 6 ± 1 day) were not statistically significant. In the group of retrograde stenting there were two cases of stent migration, which required repositioning of the stents. In one patient with antegrade stent placement, the distal end of the stent curled in ureterovesical junction. The stent position was corrected during the ureteroscopy. There was one case of antegrade stenting failure requiring ureteroscopy with retrograde ureteral stenting. Laparoscopic pyeloplasty is an efficient method of surgical management of patients with PUS narrowing. The duration of antegrade stenting was significantly shorter than retrograde stenting. LP with antegrade ureteral stenting as compared to LP with retrograde stenting enables significantly reduced surgery duration.

This study presents results of 113 infertile couples treated with supplements speroton and pregnoton containing folic acid, L-carnitine, vitamin E, zinc, and other vitamins and minerals. Infertility in couples was due to both the pathology of spermatogenesis, and female genital diseases. It has been demonstrated that intake of Speroton restores impaired motility in the ejaculate of patients with several forms of pathospermia, and Pregnoton ensure its preservation in vaginal secretions.

The article presents results of electrophysiological study of the function of the ureter in the frequency range of 0,6-35 Hz, conducted in 100 children aged 5 to 13 years with chronic pyelonephritis. Data of 35 healthy people were used as a control. It was shown that the features of ureter contractions were significantly different in the two groups. Marked decrease of amplitudes of signal harmonics was found at a frequency of 1.4 Hz in patients with pyelonephritis compared to controls. Myostimulation in pyelonephritis group has led to an approximation of harmonic amplitudes to the values of the control group.

The authors present a review of literature on the use of litholytic citrate medications for conservative management of urolithiasis. Urate urolithiasis is the most common clinical condition encountered by urologists. Citrate agents, in particular Blemaren, not only may be employed in a conservative therapy of uric acid stones, but can also be successfully used in the treatment of the calcium urolithiasis, i.e. mixed composition stones, which is supported by current international urology guidelines.

Daily practice of a physician of any specialty is incomplete without an analysis of the data derived from the use of various imaging techniques. Over the past decade, there have been significant changes in the understanding of the clinical anatomy of the patient, which is largely the result of the introduction of modern computer technology in medicine.