№ 4 (2012)

The efficacy of phytogenic drug prolit septo in the complex treatment of patients with urolithiasis complicated by infectious-inflammatory process was evaluated. The effects of prolit septo were assessed by a comparative evaluation of the results of microbiological analysis of urine in 14 patients of main group and 12 patients of control group. Patients in both groups were matched by sex, age, and results of raiological, clinical, biochemical and microbiological methods of examination. For the treatment of 11 patients of the main group, prolit septo was applied in combination with standard anti-bacterial treatment, 3 patients received monotherapy with prolit septo within 3-6 weeks. The drug was administered at a dose of 1200 mg (2 capsules) 3 times a day. Twelve patients of the control group received only standard treatment. The duration of treatment in both groups was 1-2 weeks. It was found that combined therapy with prolit septo is more effective than standard antibacterial treatment. Against the background of combined therapy the disappearance of bacteriuria was noted in 54.5% of patients of main group compared with 8.3% of patients of control group.

62 case histories of patients with bladder injuries who were admitted in the Department of Urology and Emergency Surgery of the Republican Scientific Center of Emergency Medicine (RRCEM) from 2001 to 2010 were retrospectively analyzed. 15 (24.2%) patients with hematuria or urethremorrhagia were admitted in the emergency room within an hour after the injury onset. Three (4.8%) patients were hospitalized in the period 1-3 h since injury onset, 12 (19.3%) patients since 3-6 hours, 5 (8.1%) - since 6 to 12 h, 16 (25 8%) patients - since 12 to 24 hours, and 11 (17.7%) patients - after 24 hours. Concomitant injury of the bladder with fractures of the pelvic occurred in 21 (33.8%) cases. At the time of admission in the emergency room, I-II degree traumatic shock was diagnosed in 37 (60%) of patients, III-IV degree traumatic shock - in 11 (17,7%). All 62 patients had a complete rupture of the bladder, 37 (59.6%) of patients had intraperitoneal rupture, 23 (37.1%) - extraperitoneal rupture, and only 2 (3.3%) - mixed rupture. Strict adherence to the RRCEM algorithm of diagnosis and treatment of patients with bladder injuries have substantially improved the efficiency of complex of medical and diagnostic measures and improved the outcomes of this group of patients - mortality was 12.9%.

The article presents the results of evaluation of effect of M-cholinoblocer tolterodine on the symptoms of lower urinary tract diseases (LUTD) and quality of life of patients with recurrent chronic cystitis. The study included 47 patients with chronic recurrent cystitis at acute stage with non-obstructive type of urination and LUTS. Group 1 included 23 women aged 45 to 56 years, who received tolterodine on the background of antibacterial therapy, taking into account the sensitivity of the isolated strain. Control group included 24 patients who received standard antibacterial therapy, also taking into account the sensitivity of the pathogen, and spasmolytics. The groups were almost homogeneous and did not differ on the basic characteristics. Analysis of the results of the study showed that tolterodine as a symptomatic therapy can reduce the time of rehabilitation. Therapy with tolterodine has shown clinical efficacy for 85.7% of women, has improved the quality of life by 24.8% compared with the control group, and provided relief of urgent and irritative symptoms in the short time.

Patterns of metabolic imbalance of biogenic amines in the tissue of the prostate, leading to violations of hemodynamics and trophism, were revealed in experimental study on laboratory animals. At the same time the stress was acute inducer of functional testosterone deficiency, which persisted throughout the observation period. Based on experimental data obtained, pathogenetic role of stress-induced metabolic imbalance of biogenic amines and steroidogenesis as possible early pathophysiological mechanisms of prostate diseases in humans is proved.

An open, short-term, prospective, randomized study was conducted. 114 men with chronicurethroprostatitisagainst chlamydial-mycoplasmal infection, mean age 41,2 ± 0,4 years, were observed. Follow investigations were performed: PCR, microscopic examination of urethral secretions and semen, transabdominal and transrectal ultrasound examination of prostate, evaluation of indicators of local and systemic immunity. In patients with chronic urethroprostatitis, abnormal urethral secretions were dominated; according to data of ultrasound examination, changes in the prostate were registered in all patients, as well as disturbances in cellular and humoral immunity. Depending on the method of treatment, patients were divided into two groups: Group 1 received an immunomodulator Lavomax and basic treatment: azithromycin at a dose 1.0 g once a week for 3 weeks, Celebrex, physiotherapy (low-intensity laser radiation), prostate massage; and Group 2 received only basic therapy. The control group consisted of 30 healthy men. The most pronounced normalization of cellular immunity (decreased number of leukocytes, reduction of lysosomal activity, increased activity and intensity of phagocytosis, and functional reserve of neutrophils in the ejaculate), as well as normalization of lymphocyte subpopulation composition, immunoregulatory index in the peripheral blood, and levels of IgA, IgG, IL-8, INF-γ, resolution of clinical symptoms were observed among patients in Group 1. Moreover, the rate of elimination of infectious agents was significantly higher in Group 1. Thus, the use of immunomodulator Lavomax is pathogenetically substantiated treatment for chronic urethroprostatite against chlamydial and mycoplasmal infection, which allows to include Lavomax in a comprehensive treatment of this disease.

Results of treatment of 32 patients after nephrectomy with thrombectomy for renal cell carci-noma complicated by tumor thrombosis of the inferior vena cava were analyzed. The study in-cluded patients only with II - IV clot levels: 26 patients with T3b - the length of the thrombus 5.1 ±1.75 cm, 6 patients with T3c - the length of a thrombus - 14.8± 0.98 cm. One patient (3.1%) died due to pulmonary artery thromboembolia in immediate postoperative period. 1-2 degrees Clavier Complications were observed in 11 patients, 3-4 degree - in two (6.2%) patients. 90.4% of patients had metastases in distant organs and (or) in the regional lymph nodes, which nega-tively affected the survival rates of patients - 5-year survival rate was 36%. The presence of lymphogenous metastases, MSKCC criteria were factors affecting survival rate. Survival rates of patients with T3b and T3C levels were not statistically different. The results of postoperative systemic targeted therapy were significantly statistically better than the results of immunotherapy.

The article presents the results of the examination and treatment of 125 patients with benign prostatic hyperplasia who underwent surgery in the urological clinic of RMAPE. Retropubic adenomectomy according to the method proposed by the Clinic of Urology and Surgical Andrology of RMAPE was performed in 83 patients, and 42 patients underwent transvesical adenomectomy. In accordance with a number of parameters (timing of surgery, frequency of intra- and postoperative complications, extent of blood loss, duration of bladder drainage, length of hospital stay), a modified method of retropubic prostatectomy demonstrated significantly better results than transvesical adenomectomy.