№ 5 (2010)

A wide spectrum of aerobic-anaerobic associations were found at bacteriological examination of 138 samples of the middle urine portion from 46 healthy women aged 17-25 years (22 sexually inactive and 24 active). Facultative-anaerobic (corinebacteria and coagulase-negative staphylococci) and non-clostridial anaerobic bacteria (peptococci and propionibacteria) predominated in both groups. The majority of facultative anaerobic bacteria had marked adhesive and antilysosyme activity indicating a pathogenic potential. Experimental and clinical trials are necessary to study the role of non-clostridial-anaerobic bacteria in development of acute and chronic infections of the kidney and urinary tract.

We studied a harmful action of laser, ultrasound and ballistic energies on intact wall of human ureter in 15 ureters of men and women with renal carcinoma aged 43-55 years (mean age 48+-8 years) before nephrureterectomy in vivo. With growing time of exposure to laser radiation, ureteral mucosa undergoes destructive alterations up to muscular layer. Ureteral wall exposure to ultrasound do not change thickness of the wall considerably, cell elements remain viable. Histological examination of the ureteral wall after exposure to intraureteral ballistic impact suggests that 15 second and longer exposure to this impact may reduce probability of mucosal regeneration because of irreversible changes. The analysis of literature data and original findings shows that now there is no absolutely safe energy for contact ureterolithotripsy.

We compared local immunometabolic effects of two dosage forms of longidase in patients with prostatic adenoma (PA) in combination with chronic prostatitis (CP) in the postoperative period. Transurethral resection (TUR) of the prostate was conducted in 81 patients aged 50-70 years suffering from PA and CP. All the patients after TUR were divided into three groups by postoperative treatment: group 1 (n = 25) received standard pharmacotherapy, group 2 (n = 28) - standard pharmacotherapy and longidase injections, group 3 - standard pharmacotherapy plus longidase suppository. Immunological parameters were studied in biological material (urine) obtained before operation, after it and after treatment course. By changes in immunometabolic status (concentrations of cytokines TNFalpha, IL-1beta, IL-2, IL-4, IL-6, IL-8, IL-10, IL-18, receptor antagonist IL-1 Ra, complement components C3-, C3a-, C4-, C5-, C5a, regulators of the complement system factor H, C1-inhibitor) and sIgA, content of acylhydroperoxides, malonic dialdehyde, stable metabolites of hitric oxide, catalase and superoxiddismutase activity it is shown that PA patients with CP have pretreatment disturbances of local immunity and oxidant status (high levels of proinflammatory cytokines, subnormal IL-10, activated complement system, lipid peroxidation, low sIgA, NO-synthetic activity of capillary endothelial activity). TUR aggravates shifts of local immunometabolic status. Standard postoperative pharmacotherapy does not correct the disturbances adequately. The addition of longidase to standard postoperative treatment was effective in correction of immune and oxidant status. Thus, longidase injections and, especially, suppositories correct disturbances of local immunity and oxidant status in patients with PA and CP in postoperative period.

The procedure of transvesical extraurethral adenomectomy (EUA) and the results of its application were characterized in comparison with transurethral resection (TUR) of the prostate in adenoma. EUA is made via the approach through the extraperitoneal cut of the soft tissues of the anterior abdominal wall, anterior wall of the urinary bladder, semioval or sphenoid incision of the vesicourethral segment. Dissection is conducted of the affected posterior half-round of only proximal prostatic part of the urethra in unaffected anterior and lateral urethral surface. Adenomatous tissues are removed in fragments and radically. Enucleation of the adenomatous nodes is followed by correction of the vesicourethral segment and hemostasis. TUR of the prostate is made without incision of the soft tissues of the anterior abdominal wall, but with removal of the prostatic portion of the urethra, sphincter mechanism of the bladder. After TUR the prostate contains residual adenomatous tissue, inner wound cavity in adenoma bed. The wound of the anterior abdominal wall, anterior wall of the bladder and vesicourethral segment healed by primary intention for 10-14 days, while adenoma bed heals for 6-18 months. EUA does not cause such complication as "adenoma bed", urethral stricture, scar deformation of the bladder neck, urinary incontinence. Radical EUA produces complications 5 times less frequently than TUR of the prostate.

The article presents the results of a clinical trial of efficacy of ALMGP-01 device in 34 patients with chronic prostatitis. The device provides local microwave hyperthermia of the prostate which appeared highly effective in combined treatment of chronic prostatitis.

A total of 40 patients with non-gonococcal urethritis (NGU) were divided into two groups. Twenty patients of group 1 received standard antibacterial treatment while 20 patients of group 2 received the same treatment plus an immunotropic drug based on tiloron (lavomax) in a course dose 1.25 g. Patients of group 2 had no recurrences while in group 1 recurrences were seen in 25% patients. Addition of lavomax resulted in clinical and etiological cure and activation of local (secretory IgA) and systemic (interferons alpha and gamma in blood serum) factors in anti-infection defense in NGU patients.

Effects of the sympathetic nervous system (SNS) on detrusor function in the collection phase were studied in 57 men over 50 years of age. Heart rate (HR) was a clinical marker of SNS activity, effective volume of the bladder marked detrusor activity in 34 patients of group 1. The value HR/volume were registered in all voidings for 1-3 days. It was found that enhancement of SNS activity was accompanied by a decline of the reservoir function of the bladder. In HR < 80 and > 100 b/min the differences were significant and reached 56%. Group 2 patients (n = 23) with prostatic adenoma have undergone uroflowm etric monitoring before and after treatment with doxasozine (640 uroflowgrams). The reservoir function of the bladder increased from 111.0 to 151.4 ml (by 36.3%) in response to block of alpha1-adrenoreceptors. Thus, SNS plays an essential role in management of detrusor function in the collection phase. Its hyperactivity leads to this phase decifiency. It may be a humoral process mediated by vasoconstriction and disorder of vesical blood flow. The proportion HR/volume shows "sympathetic background" in patients before administration of alpha1-adrenoblockers.

Избавление от камня в настоящее время является основным этапом лечения пациента, страдающего мочекаменной болезнью. Однако удаление камня лишь может создать условия для улучшения уродинамики, коррекции воспалительного процесса в мочевыводящих путях. Тем более что избавление от камня не может оказать воздействия на метаболические процессы, происходящие в организме каждого больного. Метафилактика подразумевает под собой комплекс мероприятий общеоздоровительного характера, проведения медикаментозного, различных методов оперативного и противорецидивного лечения, направленных на избавление пациента от камня и предупреждение рецидива заболевания после его самостоятельного отхождения или удаления оперативным путем. В настоящее время отмечен выраженный рост интереса к применению фитотерапии, тем более что эффективность современных экстрактов лекарственных растений ни в чем не уступает по эффективности химическим веществам. Одним из таких препаратов является растительный лекарственный препарат канефрон® Н, обладающий диуретическим, противовоспалительным спазмолитическим, антимикробным, сосудорасширяющим, нефропротекторным, антиоксидантным действием. Канефрон® Н ведет к изменению pH мочи, усиливает выведение солей мочевой кислоты, препятствуя выпадению в мочевыводящих путях кристаллов и росту имеющихся и формированию новых конкрементов. Проведена оценка эффективности препарата канефрон® Н в период ранней послеоперационной метафилактики МКБ у 79 больных, подвергшихся дистанционной литотрипсии. Отмечено значительное усиление эффективности литоизгоняющей терапии у пациентов основной группы изо всех отделов мочевыводящих путей, отмечено исчезновение лейкоцитурии на 7-е сутки у 93,1% пациентов основной группы и у 46,6% контрольной, pH мочи стабилизировался в диапазоне 6,2-6,8, суточный диурез увеличился до 2-2,5 л. Канефрон® Н показал эффективность в процессе ингибирования процесса патологической кристаллизации мочи, при этом препарат не является специфичным для определенного вида уролитиаза вследствие его патогенетического механизма действия. In vitro отмечается весьма эффективное действие канефрон® Н на фосфаты (весовая убыль массы камня на 63%) и оксалаты. Растворимость оксалатного камня возрастает с увеличением в его составе ведделлита (кальций-оксалат дигидрат) и соответственно снижается с увеличением в его составе вевеллита (кальций-оксалат могогидрат) и от величины камня. Таким образом, лекарственные растения могут оказывать непосредственное влияние на процесс камнеобразования, стабилизацию ионной силы мочи и ингибиторов камнеобразования. Для них характерно отсутствие побочных эффектов и возможность периодического применения.