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No 4 (2004)
- Year: 2004
- Articles: 20
- URL: https://journals.eco-vector.com/1728-2985/issue/view/6566
Articles
Conservative surgery - a basic principle of childhood urology
Abstract
Dysfunction of the solitary kidney was established in 58 patients
after the contralateral kidney removal in childhood. The tests were
made at senior school age, at adolescence, at adult age. The disorders
in the renal function were more severe in pathological processes in
the solitary kidney, chronic pyelonephritis, nephron dysplasia, etc. In
49 children the kidney was preserved even in functional failure 70-90%.
These patients had less evident renal failure. Basing on this evidence
and other arguments, the authors recommend to limit indications
for nephrectomy in children.
Urologiia. 2004;(4):3-5
3-5
Application of principles of evidence-based medicine in cancer of the urinary bladder
Abstract
Meta-analysis has been made to answer the question whether a proven
advantage exists of chemotherapy of locally advanced and metastatic
cancer of the urinary bladder (UB) with gemcitabine+cisplatin over the
scheme M-VAC. The data for 1990-2002 obtained from the data base
Medline, library of Cocrane Association, proceedings of the symposia
and conferences, publications in domestic periodicals Urologiya, Voprosy
Onkologii covered 3477 items on UB cancer.Nine publications
were selected which seem to use significant information in terms of evidence-based
medicine. The patients were divided into two groups.
Group 1 consisted of patients with local and metastatic UB cancer treated
with the combination gemcitabine+cisplatin (n = 390). Group 2 patients (n = 499)
received chemotherapy with M-VAC. By principles of
evidence-based medicine, group 1 patients had more frequent unfavourable
outcomes (absence of complete and partial regressions) - 50 and
42%, respectively. A decrease in the absolute risk is significant (p < 0.05,
chisquare = 5.8). It is 8% in the confidence interval (CI) 4,12. A decrease
in the relative risk was 19% (CI 13.7-24.3), odds ratio 1.39 in CI
1.3-1.48. Thus, at present there are no reliable data on advantages of local
and metastatic UB cancer treatment with the scheme gemcitabine-cysplatin
over standard treatment M-VAC
Urologiia. 2004;(4):5-12
5-12
Surgical treatment of epithelial tumors of the upperurinary tracts
Abstract
The authors present the results of different operative treatments
of tumors of the upper urinary tracts (UUT). A total of 116 patients
with UUT tumors were examined and treated from 1990 to 2002 (age
19-80 years, mean age 61.3± 1.3 years; males 82, females 34). Tumors
of the renal pelvis and the ureter were detected in 76 (65.5%) and 40
(34.5%) patients, respectively (8.0 and 4.3% of a total number of patients
with tumors of the kidneys and UUT). 107 (92.2%) patients
were operated. Nephroureterectomy and ureterectomy with resection
of the urinary bladder were performed in 73 (68.2%) patients, TUR
of the urinary bladder wall, ureteral ostium with pelvic part of the ureter
and nephroureterectomy (including endovideosurgery) - in 22
(20.6%), nephroureterocystectomy - in 4 (3.7%), resection of the pelvic
ureter with Boari's operation - in 5 (4.7%), nephroscopy, ureteroscopy
with removal of urothelial tumor - in 3 (2.8%) patients. Postoperative
complications (most of them infectious-inflammatory) developed
in 10 (9.3%) patients. Lethality was 0.9%. Tumor recurrences
occurred in 27 (25.2%) patients within 5-year follow-up. 15 (14.0%)
patients were reoperated. 5-year survival reached 67.0%. Conventional
and radical method of treating patients with tumors of the renal
pelvis and ureter is nephroureterectomy with urinary bladder resection
and its modification. In invasion of the tumor in the muscular layer
of the bladder wall surgery should be extended and supplemented with
cystectomy. Conservative surgical interventions are indicated in tumors
of the sole kidney, bilateral process, benign or surface tumor of
the urothelium.
Urologiia. 2004;(4):12-15
12-15
Neoadjuvant hormone therapy with kasodex in a dose 150 mg prior toradical prostatectomy in patients with prostatic cancer
Urologiia. 2004;(4):15-19
15-19
Regional metastases of penile cancer: optimal treatment policy
Abstract
Emergence of regional penile cancer (PC) metastases reduces late
survival of PC patients from 94.4 to 83.9%. PC stage can hardly be
diagnosed by clinical data significantly. Bilateral inguinal lymphadenectomy
is indicated for all PC patients with enlarged and clinically
negative regional lymph nodes in poorly differentiated primary
tumor (G3) and stages T2-3. Follow-up can be recommended for patients
with stage Tis-Tl, low and moderate anaplasia (Gl-2) of the
primary tumor. Metastases to the iliac lymph nodes are an indication
to pelvic lymphadenectomy. Preventive removal of the iliac lymph
nodes in intact inguinal ones is not justified. Unremovable fixed regional
lymph nodes should be exposed to radiotherapy.
Urologiia. 2004;(4):19-23
19-23
A direct uretero-enteroanastomosis: a return to the past?
Abstract
The authors analyse their experience with ureter implantations into
a small intestinal retaining reservoir - both direct and antireflux.
From 1994 to 2004 orthotopic replacement of the urinary bladder
(UB) with an ileal segment was performed in 62 patients (59 males,
3 females) for UB cancer (n = 55), microcystis (posttraumatic, radiation-induced,
tuberculous)(n = 7). Orthotopic replacement of the
UB was made according to VIP (vesica ileale Padovano) technique
with creation of antireflux uretero-enteroanastomoses by Le Due
(group 1, 43 patients, 82 anastomoses) and Hautmann technique in
modification of Lippert-Theodorescu (group 2, 14 patients, 28 direct
uretero-enteroanastomoses). A direct uretero-enteroanastomosis was
performed by Nesbit and Bricker technique. Five patients were withdrawn
from the final analysis: 3 of them died early after the surgery
because of complications, 2 patients died due to progression within
3 and 4 months after the operation. A total length of the ileac segment
used for UB repair in both groups was 60 cm. Upper urinary tracts
(UUT) and kidneys after the operation were assessed by the results
of ultrasonic investigation of the caliceropelvic system, kidneys, UB,
residual urine, serum creatinine, excretory urography, spiral CT (on
demand), etc., after recovery of miction (3-4 weeks after operation),
3 and 6 (-(-cystography) after the operation, 12 months after the operation
and annually. Comparison of the results of direct and antireflux
anastomoses suggests a conclusion that a high rate of strictures
due to antireflux anastomoses provoking UUT and renal dysfunction
makes their benefit doubtful. Antireflux bypass ureteral surgery with
neocystis of low pressure seems unjustified. In creation of capable
uroreservoir of low pressure a direct implantation of the ureter into
it is simple to do and less risky in respect to development of anastomotic
stricture and damage to the renal function
Urologiia. 2004;(4):23-27
23-27
New fluoroquinolones in urology
Urologiia. 2004;(4):27-32
27-32
Dopplerographic assessment oftherapeutic efficacy of incoherent quantum irradiation in combinedtherapy of acute pyelonephritis
Abstract
The authors present a comparative estimation of therapeutic efficiency
of conventional antibacterial therapy, coherent and incoherent
impulse quantum irradiation at a constant magnetic field in combined
therapy of 130 patients with acute pyelonephritis. Incoherent
impulsive quantum irradiation at a constant magnetic field showed
high clinical efficacy manifesting in early normalization of microcirculation
of the affected kidney
Urologiia. 2004;(4):32-34
32-34
Male genitaltuberculosis in West Siberia
Abstract
Clinical picture and structure of male genital tuberculosis were
analyzed basing on case histories of Novosibirsk regional tuberculous
hospital (outpatient department): 42 patients with tuberculous epidydymitis
and 58 patients with prostatic tuberculosis. Efficiency of com-
bined etiopathogenetic treatment was estimated in 91 patients admitted
to the Urogenital clinic of Novosibirsk Research Institute of Tuberculosis.
These patients received polychemotherapy alone (control
group) or in combination with laser therapy (study group). Combination
of polychemotherapy with laser radiation proved more effective
than polychemotherapy alone
Urologiia. 2004;(4):34-37
34-37
Prostatic calculi: diagnostic and therapeutic aspects
Abstract
Strength properties of prostatic calculi (PC) were studied by microhardness HV.
Fifteen calculi under study were divided into 3
groups by the size: 2-3 mm (group 1), 4-6 mm (group 2), > 6 mm
(group 3). The surface of the thin sections of the calculi appeared as
concentric, spherical layers of different size indicating formation of
the calculus from the center. In the latter one could see a pigmented
nucleus of organic nature. Some calculi had two nuclei under one
cover - attached calculi. Correlations between the structure, morphology
of prostatic calculi and their strength properties were established.
These correlations allowed one to characterize destruction features of
the calculi in different destructing impacts. We have designed and introduced
into practice a complex of local physiotherapy in prostatolithiasis.
This physiotherapy was conducted in combination with medicines
for chronic prostatitis and included exposure of the prostate to
ultrasound in impulse regime (4 mc, 0.4-1.0 W/cm2). The ultrasound
was delivered through the rectum (insertion of the setting IUT 2.264-7-2.09u
to the site of the concrements location) and alternated with
laser therapy (insertion of the radiator P-2 into the rectum and radiator
LOl to the perineal area (5 W, 80 Hz, 64-128 s) and introduction
of sulfide mud heated with the device PPK-01 Pra, electrostimulation
for better passage of the prostatic section. The above therapy destructed
the concrements which eliminated from the prostatic ducts as a
result of which prostatic function recovered. The complex produced
a good effect: 65% patients stated enhancement of the erectile function
after 3 days of the treatment. After 5-6 procedures pain syndrome
relieved in 40% patients, after 11-15 procedures - in 87%. Ultrasonic
investigation showed that posttreatment size of the prostate diminished
from 0.8 to 0.2 cm. The absence of the calcinates's shadows
were recorded in 87% patients, the symptoms of chronic prostatitis
disappeared. The results of the combined physiotherapy demonstrate
efficacy of the above method in true prostatoliths.
Urologiia. 2004;(4):37-41
37-41
Famcyclovir in the treatment of family herpes
Urologiia. 2004;(4):41-44
41-44
Botulinictoxin in patients with neurogenic dysfunction of the lower urinarytracts
Abstract
Botulinic toxin (ВТ) is a new method of lowering intraurethral
pressure in symptoms of obstructive voiding in patients with neurogenic
dysfunction of the lower urinary tracts (LUT). Transperineal
introduction of 100 units of ВТ type A (botox, Allergan) was used
under electromyographic control into the external urethral sphincter
of 9 patients (6 males and 3 females) with LUT neurogenic dysfunction
aged 17 to 68 years (mean age 37.2 years). Two patients had subnormal
detrusor contractility due to myelodysplasia and diabetic
polyneuropathy, two other patients -non-incontinent striated urethral
sphincter after hemorrhagic stroke and spinal contusion, five patients
suffered from detrusor-sphincteral dyssynergia (DSD) resultant from
Schmorl's hernia, multiple sclerosis, Charcot-Marie disease and
ischemic stroke of the spinal cord. Three patients had cystostomic
drainage. The rest of the patients complained of dysuria, three patients
performed self-cathetarization, mean volume of the residual
urine was 170 ml (180-240 ml). In 10 days residual urine was not
found in 2 patients with subnormal detrusor contractility and in 4 patients
with DSD. Abdominal pressure fell from 75 to 39 cm, on the
average. In DSD patients maximal detrusor pressure fell from 59 to
29 cm, on the average. Mean maximal urinary flow rate rose from
4.3 to 9.6 ml/s. In 20 days, on the average, suprapubic fistula healed
in all the patients. In a month, therapeutic effect persisted in all the
patients. Complications, side effects were not registered. ВТ treatment
to induce adequate urine evacuation in neurological patients is
a promising approach in neurourology. Further studies should find
answers to questions about regimen of ВТ introduction, loss of sensitivity,
new indications in urology.
Urologiia. 2004;(4):44-48
44-48
Tamsulosin in the treatment of detrusor-sphincter dyssynergia of the urinarybladder in patients with multiple sclerosis
Abstract
Urination disorders occur in 80% patients with multiple sclerosis
(MS). Most common of them is detrusor-sphincter dyssynergia
(DSD). Alphal-adrenoblockers can relax the neck of the urinary
bladder (UB) and urethral sphincters, thus eliminating dynamic obstruction,
reducing resistance to urine flow and facilitating voiding.
Our study assessed feasibility of using a selective alpha lA/D-adrenoblocker
tamsulosin in MS-associated DSD. The choice of this alphaadrenoblocker
was based on its high safety profile in relation to cardiovascular
system. The trial enrolled 28 patients (20 females and 8
males) with verified diagnosis of DSD. They were given tamsulosin
(omnik) in a dose 0.4 mg/day (1 capsule) for 2 months. To the end
of the trial quality of life raised in 96% patients. Occurrence of pollakiuria,
number of imperative micturate urges diminished, the IPSS
score decreased by 54%, QL index improved by 58%. There was also
a decrease in the volume of the residual urine, amplitude of involuntary
detrusor contractions, an increase in maximal volumic speed of
urine flow, cystometric volume of the UB, mean urine volume in urination.
Side effects were not registered. Thus, tamsulosin has a positive
effect in voiding disorders in the presence of DSD associated
with MS. This considerably improves quality of life of MS patients.
Urologiia. 2004;(4):48-51
48-51
Viagra effects on polysystemic energy metabolism in stress (an experimental study)
Abstract
Experiments on 40 white rats were made to study effects of cardura
(doxasozine) and viagra on polysystemic energy metabolism in
stress. All the animals were examined for cytochemical activity ofsuccinate
dehydrogenase, lactate dehydrogenase in blood lymphocytes,
antioxidant activity of blood plasm, levels of hydroperoxides, malonic
dialdehyde. 3-hour immobilization raises functional activity of mitochondria
manifesting with intensification of energy metabolism.
Adrenoreceptors blockade by Cardura prevents changes in the ceUular
metabolism. The same antistress effect is observed in viagra action.
This newly discovered mechanism may prevent complications of
adrenergic reactions accompanying sexual intercourse..
Urologiia. 2004;(4):51-55
51-55
Surgical treatment of vesico-ureteral reflux incomplete doubling of the ureters
Abstract
Eleven patients aged 1 to 12 years were examined after operation
of creation of intravesical ureter fissus (IVUF) from urinary bladder
mucosa. The IVUF acts as a valve preventing vesico-ureteral reflux
(VUR) in complete doubling of the ureters. One of the patients has
undergone one-stage antireflux operation on double ureters on the
right and triple ureters on the left. The operations were performed in
VUR of the third-fourth degrees. Examination of the patients included
excretory urography, ultrasonic investigation of the kidneys and
urinary bladder, cystography, cystoscopy. Stenosis of the artificial
ureteral ostium was not observed. The kidney functioned in all the
patients. Urine retention, VUR were absent. This technique does not
destruct natural ureterovesical anastomosis, helps reestablish an adequate
valvular mechanism irrespective of ureteral dilatation
Urologiia. 2004;(4):55-58
55-58
Comparison of rotoresection and transurethral resection in the treatment of benign prostatichyperplasia
Abstract
Comparison of duration, blood loss and efficacy of TUR and rotoresection
in the treatment of benign prostatic hyperplasia has demonstrated
that rotoresection allows almost bloodless and effective
transurethral removal of prostatic hyperplastic tissue and, therefore,
is a promising alternative to routine TUR of the prostate.
Urologiia. 2004;(4):58-61
58-61
Cure of a patient with prostatic leiomyosarcoma withradiotherapy
Urologiia. 2004;(4):61-63
61-63
Affection of urogenital organs in Wegener's syndrome
Urologiia. 2004;(4):63-65
63-65
Flap urethroplasty
Urologiia. 2004;(4):65-71
65-71
Anatoly Georgievich Pugachev (the 75th anniversary of birth)
Urologiia. 2004;(4):71-72
71-72