No 6 (2013)

The clinical and laboratory findings in 78 patients with various forms of urolithiasis depending on the presence of primary hyperparathyroidism (PHPT) were analyzed. PHPT was diagnosed in 17 patients. Group «without PHPT» and group «with PHPT» differed significantly in terms of parathyroid hormone (PTH) level, serum calcium, phosphorus, chloride, alkaline phosphatase, calciuria and kaliuria. In patients with staghorn calculi, PHPT was diagnosed in 12,5%, and staghorn calculi in the presence of PHPT were identified in 17,7% of cases. Hypercalciuria in the group «with PHPT» was detected in 82,4% of patients (all 3 patients with staghorn calculi), and in the group «without PHPT» — in 18% of patients (2 of 21 patients with staghorn calculi). Hyperoxaluria was observed in 42.3% of patients «without PHPT» and in 35,3% of patients «with PHPT», in 36,8% of patients with simple stones and in 57,2% — with staghorn calculi. In 39% of patients «without PHPT», secondary hyperparathyroidism (SHPT) was diagnosed. SHPT prevalence was 28% in patients with staghorn calculi, and 45% in patients with simple stones. In 87,5% of patients with hypomagnesemia, staghorn calculi were observed. Significant relationship between magnesium and triglycerides (r s=-0,296; P=0,041), and magnesium and high-density lipoproteins (r s=0,339; P=0,032) in all patients with urolithiasis were revealed. Thus, the study found no association between staghorn nephrolithiasis and PHPT. Elevated PTH levels usually indicate SHPT rather than PHPT. In hypocalcemia, there was more strong association between PTH and calcium, in normocalcaemia — between PTH and magnesium.

Prevention of recurrence of urinary tract infections by Uro-Vaxom is recommended by domestic and international guidelines; up to date, however, there is no reasonable standard regimen for the use of drug, and long-term results of immunoprophylaxis were not evaluated. The study included 48 patients who received a first course of Uro-Vaxom 5 years ago (2007-2008), including 19 men with chronic bacterial prostatitis/urethroprostatitis and 29 women with recurrent cystitis. Over 5 years, 125 recurrences of urogenital infection were observed; Uro-Vaxom along with antibiotics or uroseptics in combination with phytopreparations was used in 88 (70,4%) cases, and in the remaining 37 (29,6%) cases monotherapy with Uro-Vaxom was used for the relief of inflammatory processes. During the follow-up period, 254 1-month courses of treatment with Uro-Vaxom were conducted; 125 (49,2%) courses were assigned for the treatment of recurrent urogenital infection, and 129 (50,8 %) - for the prevention without exacerbation of underlying disease. The main indications for use were intercurrent infection, mainly respiratory - 86 (66,7%) cases, stress - 14 (10,8%); in 29 (22,5%) cases, the patients have received Uro-Vaxom focusing on their feelings without a doctor's prescription.

The article presents the results of the examination and treatment of 30 patients with overactive bladder receiving M-anticholinergic drug tolterodine at a dose of 2 mg twice a day for 1 month. Evaluating the effectiveness of the drug was performed on the basis of the data on voiding diary, urodynamic changes, and results of ultrasound examination. The analysis showed that treatment with tolterodine within 15 days has a positive trend: normalization of urination was observed in 96,6% of patients, 76,6% of patients have reported decrease of the frequency of urgency urination, and episodes of imperative urinary incontinence decreased in 83,3% of patients. The therapy promoted the increase the duration and volume of urination, reduction of maximum uroflow rate, indicating that the effectiveness of treatment. On the 30th day of treatment, the vast majority (80%) of the patients reported improvement of their wellbeing.

The article presents the results of the use of alternative method of treatment - endovascular occlusion of the prostatic plexus - in patients with isolated venogenic erectile dysfunction. The IIEF-5 and AMS questionnaires were used for the evaluation of results of the operation. Improvement of quality of erection in the first 3 months after surgery was achieved in the majority of patients. The use of this innovative technology provides secure, minimally invasive and pathogenetically justified treatment of ED caused by abnormal venous drainage from the cavernous bodies.

The article presents the results of treatment of 51 men with recurrent genital HPV infection in the form of genital warts. Patients were divided into two groups depending on the treatment. Group 1 of patients has received the combination treatment — electrocoagulation + pharmacotherapy (panavir intravenously and topically in the form of a gel), Group 2 of patients — only electrocoagulation. According to the results of foIIow-up within 6 months, disease recurrence rate was significantly higher in Group 2 — 39,5 % versus 9,6 % in the Group 1. Postoperative complications were also more frequently recorded in the Group 2. These findings suggest that the combined treatment of reccurent forms of genital warts is preferred than just using destructive methods of treatment.

The need for use of antimicrobial drugs in the treatment of patients with chronic bacterial prostatitis is indisputable. Given the variety of pathogenic mechanisms of chronic prostatitis, drug Vitaprost® Plus in the form of rectal suppositories is of particular interest; it combines antibacterial activity with a positive effect on the various links in the pathogenesis of this disease. The evaluation of the efficacy and safety of drugs Vitaprost® Plus and Lomflox was performed. Both groups showed a significant improvement in the NIH-CPSI score in summary and on individual domains; differences between groups were not statistically significant. The number of leukocytes in the prostatic exprimate decreased more markedly in the study group. Microbiological efficacy in the study group was 73.3%, in the control group - 70%. Thus, the use of the drug Vitaprost® Plus increased clinical and microbiological efficacy of treatment, which correlates with the data of previous studies.

The article is devoted to evaluating the results of the use of endoscopic treatment in patients with obstructive complications after brachytherapy for prostate cancer. The study included 51 patients diagnosed with T1-T3 stage prostate cancer, who underwent interstitial radiation therapy with I125. The authors have analyzed the effectiveness of various endoscopic operative interventions - internal urethrotomy, recanalization of the urethra, prostate and urethral prosthetic repair, transurethral resection and incision of the prostate gland — against the background of radiation damage to the urethra and prostate.

The article presents the results of laparoscopic pyeloplasty in 72 patients with primary stricture of pyeloureteral segment (PUS). The study included 34 men, 38 women; mean age was 32±4,6 years. The operation was performed by transperitoneal approach in side position of patients. 4 trocars were used. There were no conversions to open surgery. Urinary leak after surgery was observed in 4 patients; in 3 patients it has discontinued independently, and in one patient it has required a repeat laparoscopy and suturing of anastomotic defect. Due to recurrent narrowing of the PUS, two patients underwent retrograde endopyelotomy, and one patient - open pyeloplasty. The effectiveness of laparoscopic pyeloplasty in these series was 94,4 %. Impediments for performing laparoscopic pyeloplasty included small pelvis size, the presence of inferior polar vessels, and frequent exacerbations of chronic pyelonephritis, which led to the development of adhesive process in the PUS. Thus, laparoscopic pyeloplasty is the treatment of choice in patients with primary constrictions of PUS and is as effective as open plasty of PUS.

During examination of 165 children aged 5 to 15 years (primarily identified during planned monitoring in Petrozavodsk children's institutions) with dysfunctional urination and encopresis without organic lesion of the central nervous system, autonomic dysfunction syndrome (ADS) was revealed. According to the results of urological examination, which was supplemented with the registration of spontaneous voiding rate and counting the radial pulse, overactive bladder syndrome and insufficient relaxation of the pelvic floor muscles during urination and defecation were detected; relationship between the number of heart rate (as a marker of sympathetic nervous system activity) and the effective volume was identified. It was revealed that the children with ADS in the presence of tachycardia show intermittent decrease of effective amounts of urination, and have residual urine. The standard course of treatment using colon hydrotherapy and biofeedback to activate cystic and obturator reflex caused a positive but short-term therapeutic effect; clinically and statistically significant increase in the effective volume of the bladder was not achieved, despite the reduction in residual urine volume. During the course of treatment using methods of biofeedback, bladder volume remained almost unchanged and tachycardia persisted, indicating the continued oppression of the sympathetic activity. The course of treatment using nootropic drug picamilon and α-adrenoblocker doxazosin with peripheral actions allowed to restore the reservoir and evacuation functions of the bladder, to achieve a regular bowel movement without encopresis. It was revealed that the combined dysfunction of pelvic organs occur in children with high activity of the sympathetic division of the ANS, which has a direct impact on the accumulation phase of voiding cycle and relaxation of the pelvic floor muscles.

The lecture is devoted to one of the most important problems of modern urology, which has a long scientific history - the diseases of solitary kidney after nephrectomy. Fundamental theory of solitary kidney was laid in the early XX century, during which it was significantly enriched by fundamental provisions preserving their practical significance in the present time. In the domestic literature of the last decade, however, the problem of diseases of solitary kidney is undeservedly forgotten and slightly developed. At the same time, recent data suggest a certain theoretical and practical conflict in this section of urology: on the one hand, the incidence of diseases of solitary kidney in the last 50 years has increased by at least a 2 times; on the other — an effective conservative treatments of diseases of solitary kidney at different stages of kidney failure have not yet implemented in clinical practice, except hemodialysis and renal transplantation used in the terminal stages of chronic renal failure. Methods of primary and secondary prevention of diseases of solitary kidney are not developed at all. The history and evolution of problems of diseases of solitary kidney is a good example of fact that despite available data and accumulation of new scientific evidence of the close relationship between local and systemic factors in the pathogenesis of these diseases, their new rethinking in the framework of interdisciplinary interactions for the optimization of methods of clinical management of this specific group of patients as well as for the development of new effective methods for early diagnosis, treatment and prevention are required.