Ашық рұқсат
Рұқсат берілді
Рұқсат ақылы немесе тек жазылушылар үшін
№ 2 (2009)
- Жылы: 2009
- Мақалалар: 23
- URL: https://journals.eco-vector.com/1728-2985/issue/view/6634
Articles
The urological clinic of I. M. Sechenov Moscow Medical Academy today. Yury Antonovich Pytel - the 80th anniversary of birth
Urologiia. 2009;(2):3-9
3-9
Current trends in the treatment of urological patients with transplanted kidney
Аннотация
The examination and surgical treatment were performed in 34 kidney recipients (22 males and 12 females aged 16-65 years) with different urological diseases admitted to the urological clinic of M.F. Vladimirsky Moscow Region Research Clinical Institute in 1992-2007 3 weeks to 15 years after kidney transplantation. Most of the patients had urolithiasis, prostatic adenoma, some patients had renal cyst, implanted kidney tumor, tumor of the arteriosclerotic kidneys, posterior urethra stricture, posterior urethra valve. The recipients with such urological diseases as chronic pyelonephritis, vesicoureteral reflux, chronic prostatitis, chronic cystitis received conservative treatment outpatiently. Extracorporeal lithotripsy (ELT) was made in 12 patients (each patient, except one, was exposed to 2 sessions, one patient - 3) - a total of 27 sessions. After the first ELT session fragments of the concrements (mean size 2-5 mm in diameter) evacuated spontaneously. Transurethral (retrograde) x-ray-endoscopic operations for removal of the transplanted kidney uroliths were not conducted as the newly created ostium in the upper part of the urinary bladder made it impossible to use a retrograde approach for elimination of the concrements. Kidney recipients with prostatic adenoma (2 and 5 years after transplantation) in 3 cases were subjected to scheduled TUR because of manifest obstructive symptoms. Four patients with AUR undergoing TUR showed intraoperative tissue hemorrhage as the operation was conducted during anticoagulant and anti-platelet therapy used early (3 months to 2 months after the transplantation. In view of this, TUR lasted longer as adequate hemostasis was needed. Urethral nitinol stenting was made in one patient with AUR and prostatic size over 60 cm3, TUR was made 4 months later. Thus, low invasive surgical interventions in kidney recipients with urological diseases have changed routive approaches to treatment of such patients consisting in open surgery which was often cancelled because of contraindications. ELT is a basic method of treatment of the transplants uroliths, in other cases different endourologic interventions are used. Prostatic adenoma is treated, as a rule, surgically (TUR of the prostate).
Urologiia. 2009;(2):9-13
9-13
Immunometabolic activity of fluoroquinolones immobilized into cell carriers in toxic lesion of the kidneys due to staphylococcal infection
Аннотация
The study of immunomodulating, antioxidant and hepatoprotective activity of some fluoroquinolones (norfloxacin, ofloxacin, levofloxacin) immobilized into erythrocyte and leukocyte carriers was made on Wistar rats with body mass about 150-180 g. It is shown that toxic action on the kidneys of mercury dichloride, especially a combined action of mercury dichloride and staphylococcal infection, raised the levels of urea and creatinine, caused immunosuppression, activated hepatotoxic, cytolytic and oxidative processes, decreased antioxidant and energetic potentials of erythrocytes. Unbound fluoroquinolones intensified the above processes. Introduction of fluoroquinolones immobilized into erythrocyte and leukocyte carriers, respectively, decreased and normalized intensity of lipid peroxidation, cholestasis, cytolysis, improved and normalized immune system functions, antioxidant and energetic potentials of erythrocytes.
Urologiia. 2009;(2):13-18
13-18
Leucoplakia vesicae in females: diagnosis and treatment
Аннотация
Sixty patients suffering from leucoplakia vesicae (LV) were examined using cystoscopy with biopsy of the urinary bladder wall, blood enzyme immunoassay for detection of antibodies to agents of sexually transmitted infections (STI), uroflowmetry, culture analysis of cervical canal and mucosa samples for STI. As shown by a pathomorphological examination of the vesical mucosa biopsy specimens, long-term persistence of pathogenic (chlamydia, trichomonades) and opportunistic (mycoplasma, ureaplasma, fungi) flora underlies development of LV. Morphogenesis of LV is characterized by hyperplastic reactions of urothelium and its metaplasy in laminated squamous keratosic epithelium, often with para- and dyskeratosis, developing in the presence of inflammatory reactions in the lamina in the presence of persisting infection. In LV, specific infection agents are often found in the urogenital tract. The spectrum of these agents is identical for samples from the cervical canal and vesical mucosa from leucoplakia foci. Vesical mucosa is most frequently contaminated with Mycoplasma hominis (57.2%), Candida albicans (51.4%), Ureaplasma urealiticum (37.1%) and Trichomonas vaginalis (22.9%). Associations of the infection agents are detected in 70% of LV patients. Persistent dysuria is a basic clinical symptom of leucoplakia. The following therapeutic measures should be taken: transurethral coagulation of the vesical mucosa, intravesical therapy, immunocorrection, antibacterial treatment by standard schemes or according to the isolated flora sensitivity.
Urologiia. 2009;(2):18-22
18-22
Prophylaxis of recurrences of urinary tract infection
Аннотация
Canephron® N, a medicine of plant origin, was tested in outpatient aftertreatment for prophylaxis of recurrent infection of the upper urinary tract, in intravesical therapy for prophylaxis of lower urinary tract infections in sexually transmitted diseases. Canephron® N provides an additional anti-inflammatory and symptomatic effect which lasts after active antibacterial therapy, and effective antibacterial protection in invasive manipulations, intravesical instillations, in particular. The drug showed good tolerance.
Urologiia. 2009;(2):22-25
22-25
X-ray endoscopic diagnosis and treatment of iatrogenic injuries of the upper urinary tract
Аннотация
X-ray endoscopic diagnosis and treatment of iatrogenic pelvoureteral injuries (PUI) were made in 200 patients (age 18-70 years, mean age 41.7 years, 68(34%) males, 132(66%) females). Preoperative examination was standard for obstructive diseases of the upper urinary tract (UUT). The end stage of the diagnosis included diapevtic transurethral ureteropyeloscopy or percutaneous nephroureteroscopy. In 57 (28.5%) patients x-ray and endoscopic diagnoses did not coincide. A total of 250 x-ray endoscopic operations were conducted. Direct dissection of the UUT stricture (obliteration) was made with a "cold" knife in 38.8% cases, with an uncinate electrode - in 14.8%, with a Ho laser applicator - in 46.4% cases. Patients with ureterovaginal (uterine) fistulas after relief of the obstruction have undergone ablation and coagulation of the fistula. UUT draining and splinting of the dissection zone were performed with "inner" stents 608 Fr in diameter and 24-28 cm long as well as with endopyelotomic stents 6-7 Fr with extention to 12-14 Fr. Draining of the kidney after percutaneous operation was made with pigtail drains 7-12 Fr and a long (35-50 cm) intubation drain tube 12-16 Fr in diameter. The drainage continued 4-12 weeks. Control examination took part in 6-12 months. Good and satisfactory results were achieved in 186 (88.2%) cases. Endourological reoperation was made in 33 patients, three times operative intervention was conducted in 6 patients. Basing on our findings, we have developed prognostic criteria of efficacy of PUI roentgenoendoscopic treatment which was effective in short strictures (obliterations) of the UUT in relatively intact renal function, absence of manifest UUT hypotension, when performed 3 weeks to 3 months after iatrogenic injury.
Urologiia. 2009;(2):25-32
25-32
Contact electroimpulse lithotripsy
Аннотация
Efficacy and safety of endoscopic contact electroimpulse lithotripsy (EILT) were studied in 146 patients with urolithiasis (mean age 48±16 years). Of them, 10 (7%) had ureteropelvic (UP) concrements, 124 (85%) had ureteroliths and 12 (8%) had bladder stones. The impulses were generated by the electroimpulse lithotripter Urolit-105M (Lithotech Medical, Israel; MedLine, Russia). EILT produced a complete destruction of UP concrements, ureteroliths and bladder stones in 96% cases. Complications occurred in 8.2% cases. The risk of intraoperative EILT complications was higher in destruction of stones more than 8 mm in the largest parameter of size, long-standing ureteral concrements complicated by ureteritis. EILT of UP concrements must be conducted by means of single impulses (impulse energy 0.45 J), of ureteroliths - by single or paired impulses (impulse energy 0.45-0.6 J), of bladder stones - by paired or serial impulses (impulse energy 0.6-0.7 J).
Urologiia. 2009;(2):32-37
32-37
Prognostic implications of preoperative diagnosis of clinically local and locally advanced prostatic cancer
Аннотация
The data of preoperative diagnosis and morphological examination were compared for 144 patients with prostatic carcinoma T1-4N0-XM0 subjected to radical prostatectomy in 1997-2007. In assessment of prostatic capsule invasion, sensitivity of the rectal examination was 21.7%, specificity - 89.8%, diagnostic efficacy - 68.1%, PPV - 50.0%, NPV - 70.9%, AUC under ROC curve - 0.558 ± 0.053 (p = 0.348); sensitivity of transrectal ultrasonic investigation - 21.7%, specificity - 89.8%, diagnostic efficacy - 68.8%, PPV - 52.6%, NPV - 71.2%, AUC under ROC curve - 0.563 ± 0.053 (p = 0.211). Factors of a poor prognosis of prostatic capsule invasion were PSA > 10 ng/ml (p = 0.028) and Gleason score > 7 (p = 0.052). Combined use of these two parameters raises quality of preoperative assessment of category T [sensitivity - 80.0%, specificity - 55.1%, diagnostic efficacy - 56.3%, PPV - 80.4%, NPV - 44.9%, AUC under ROC curve - 0.624 ± 0.049 (p = 0.017)]. Sensitivity of clinical assessment of N category was 11.1% in 100% specificity, 94.4% diagnostic efficacy, 100% PPV, 94.4% NPV, 0.556 ± 0.107 (p = 0.577) AUC under ROC curve. A single significant prognostic factor of pN+ category was PSA > 10 ng/ml (p = 0.014). Sensitivity of histological examination of biopsy material in relation to true Gleasons parameter (<7 or >7) was 59.4%, specificity 89.3%, diagnostic efficacy 82.6%, PPV 61.3%, NPV 88.5%, AUC under ROC curve 0.743 ± 0.056 (p < 0.0001). Thus, combined use of a baseline PSA concentration with a borderline value > 10 ng/ml and biopsy Gleason score > 7 raises quality of preoperative evaluation of extraprostatic tumor extension and condition of regional lymph nodes.
Urologiia. 2009;(2):37-42
37-42
Opticalcoherence tomography in diagnosis of urinary bladder cancer
Аннотация
Optical coherence tomography (OCT) was tested in diagnosis of bladder cancer (BC) in 100 BC suspects. This method showed higher sensitivity (by 16%) in diagnosis of BC compared to standard cystoscopy as it more presicely identified squamous intraepithelial and noninvasive tumors. The analysis of OCT images was made with a noval computer program of filtration and color overlay. This improved quality of the image allowed verification or rejection of BC, its localization on urinary bladder wall.
Urologiia. 2009;(2):42-44
42-44
Epidemiology of urinary bladder cancer in the Samara region
Аннотация
The 1998-2007 incidence of urinary bladder cancer in the Samara region was analysed. Intensive and standard incidence rates were estimated indirectly. Stabilization of bladder cancer morbidity in a total population of the Samara region and in men living in this region was stated (11.9%ооо in 1998 and 12.5%ооо in 2007, t = 1.0; 21.34%ооо in 1998 and 21.28%ооо in 2007, t = 0.4, respectively). In women the morbidity demonstrated a rise (from 3.9%ооо in 1998 to 5.3%ооо in 2007, t = 2.1). This rise was significant in women over 70 years (17.9 and 24.3%ooo, t = 2.1).
Urologiia. 2009;(2):44-46
44-46
Modern aspects of pathophysiology and prevention of erectile dysfunction and cavernous fibrosis after radical prostatectomy
Аннотация
Partial denervation of cavernous tissue (CT) during nerve sparing radical prostatectomy (RPE) can cause development of neuropraxy and cavernous fibrosis (CF) resulting in erectile dysfunction (ED) after operation. We investigated the impact of intracavernous nitric oxide donor therapy on cavernous tissue after denervation in rats. Twenty six adult male Wistar rats were divided into three groups. Bilateral cavernous nerves (CN) crashing was made in ten rats (group 1). Ten underwent bilateral CN crashing with intra- and postoperative (2 times a week) intracavernous injection with new nitric oxide donor dinitrosyl iron complex (DNIC) in a dose 0.5 mmol/l (group 2). The latter six underwent sham operation (a control group). We evaluated CT changes by electrone microscopy (cells in the field of vision - CFV) and immunohistochemistry 3 and 6 months after the operation. CT denervation in group 1 led to a significant decline in mitotic activity of smooth muscle cells (1.79 ± 0.04 and 1.14 ± 0.03 CFV), in stimulation of endothelium and fibroblasts proliferation activity (3.14 ± 0.07 and 5.17 ± 0.11 CFV, 6.19 ± 0.97 and 8.21 ± 1.13 CFV, respectively) 3 and 6 month after operation. In the control group mitotic, endothelium and fibroblasts proliferation was 2.01 ± 0.06; 1.07 ± 0.01 and 4.18 ± 0.22 CFV, respectively. The greatest changes were in smooth muscle cells (SMC). We found synthetic activity of collagenase in SMC 3 (5.18 ± 0.64 CFV) and especially six (6.18 ± 1.19 CFV) months after CN crashing. Some of SMC had round or star-shaped forms which are common for fibroblasts. There were abnormalities of contact braking of the cellular layer and appearance of chaps between the endothelium. As a result, some cells were climbing and creeping onto neighbor cells causing changes in configuration of endothelial monolayer. Nitric oxide replacement therapy using DNIC prevented morphological changes of all types of cells in CT. We registered stabilization of endothelial (1.97 ± 0.07 and 1.74 ± 0.05 CFV) and fibroblast (3.97 ± 0.11 and 4.01 ± 0.17 CFV) proliferation and improvement of SMC mitotic activity (2.56 ± 0.09 and 2.34 ± 0.12 CFV) three and six months after operation. Synthetic activity of collagenase in SMC was 0.47 ± 0.01 DFV and was absent 3 and 6 months after CN crashing, respectively. These results show that restoration of a nitric oxide level in the penis can prevent development of cavernous fibrosis after CN injury and that DNIC has a significant potential for penile rehabilitation and treatment of ED after RPE.
Urologiia. 2009;(2):46-51
46-51
Oxidative stress of spermatozoa in pathogenesis of male infertility
Аннотация
Oxidative stress is a common pathology seen in approximately half of all infertile men. Peroxides causing infertility are generated by sperm and seminal leukocytes. Oxidative stress occurs when production of potentially destructive reactive oxygen species exceeds natural antioxidant defenses resulting in cellular damage. The causes of the oxidative stress include environmental factors (phthalates et al.), chronic inflammation of the prostate, varicocele, autoimmune response to seminal antigens.
Urologiia. 2009;(2):51-56
51-56
Prevalence of androgenic deficiency in male population of Dagestan
Аннотация
Incidence of androgenic deficiency in Dagestan males was studied using AMS questionnaire. Assessment of the results was made by standard criteria. The obtained statistics on 780 responders over 30 years of age demonstrate that symptoms of androgenic deficiency exist in 51.15% males in Dagestan. They are primarily caused by sexual problems.
Urologiia. 2009;(2):56-60
56-60
Efficacy and safety of tulosine in patients with prostatic adenoma
Аннотация
The study of tulosine (tamsulosine) efficacy and safety was made in 92 patients with lower urinary tract symptoms (LUTS) due to prostatic adenoma (PA). Tulosine treatment relieved both obstructive and irritative symptoms, IPSS parameters improved by 8.0 ± 0.3 points, QoL - by 1.4 ± 0.1 points, Qmax - by 2.6 ± 0.3 ml/s. Ultrasound investigation found no significant changes in the adenoma size. Residual urine volume reduced from 42.4 to 19.7 ml (by 53.7%). Blood pressure lowered insignificantly. Side effects were mild. Thus, tulosine is a safe and effective drug for treatment of prostatic adenoma.
Urologiia. 2009;(2):60-65
60-65
A reproductive function in metallurgists
Аннотация
The analysis of the results of a complex investigation of a reproductive function including examination of semen and blood hormones in 100 metallurgists and 80 workers not engaged in metallurgy of ferrous metals (a control group) has shown that 44% metallurgists and 18.5% controls have pathology (p < 0.001). Metallurgists had more often agglutination, asthenozoospermia, increased semen viscosity, oligospermia, teratospermia, asthenoteratospermia, male sterility than the control group (p < 0.001). Metallurgists have a moderate and high relative risk of reproduction function pathology (RR = 1.6-2.9). Urological pathology in metallurgists can be reduced after prophylactic programs. This proves the necessity of including urological examination and ultrasonic scanning in programs of regular check-up of metallurgists.
Urologiia. 2009;(2):65-68
65-68
Tadenan treatment of prostatic adenoma
Аннотация
Tadenan, a drug of plant origin, was given to 27 patients with documented prostatic adenoma for 3-12 months. Home uroflowmonitoring for 1, 3, 6 and 12 months registered positive changes in urinary flow rate and urination volume. Side effects were absent. IPSS and QoL parameters were also assessed.
Urologiia. 2009;(2):68-73
68-73
Choice of a drainage method in plastic reconstructive operations for congenital hydronephrosis in boys
Аннотация
We analysed surgical outcomes in 41 boys aged 2.5 months to 17 years with congenital hydrohephrosis who were treated with external drainage (nephrostoma, intubation drainage, Gibbons drainage) and by means of stenting. We discovered that stent drainage produces urethral traumas, orchitis, orchoepididymitis. Our study made us to recommend external drainage methods for boys with congenital hydronephrosis undergoing reconstructive plastic surgery to prevent injuries and inflammation in the urogenital system.
Urologiia. 2009;(2):73-77
73-77
Pregnancy and physiological delivery in a woman with intestinal orthotopic urinary bladder
Urologiia. 2009;(2):77-78
77-78
Prostatic adenoma and overactive urinary bladder: assessment of symptoms and choice of therapy
Urologiia. 2009;(2):78-84
78-84
Clinical guidelines on the treatment of non-inflammatory urination disorders in females
Urologiia. 2009;(2):84-88
84-88
Obesity and prostatic cancer
Urologiia. 2009;(2):88-92
88-92
Hyperbaric oxygenation in patients with prostatic adenoma
Urologiia. 2009;(2):92-95
92-95
Professor Yu. A. Pytel' (k 80-letiyu so dnya rozhdeniya)
Urologiia. 2009;(2):95-
95-