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Nº 2 (2004)
- Ano: 2004
- Artigos: 23
- URL: https://journals.eco-vector.com/1728-2985/issue/view/6563
Articles
The results of long-term permixon® treatment in patients with symptoms of lower urinary tractsdysfunction due to benign prostatic hyperplasia
Resumo
The trial enrolled 155 patients (mean age 65 years) with documented
benign prostatic hyperplasia and lower urinary tracts symptoms
(LUTS) (IPSS > 6). All the patients received permixon m a dose
160 mg twice a day for 2 years. The data on 130 patients eligible for
assessment were processed statistically by dynamics of IPSS, quality
of life (QOL), index of sexual function (MSF-4), size of the prostate
urodynamic and biological parameteers which were estimated in 6
(V6) 12 (V12), 18 (V18) and 24 months (V24). Clinical examination
with registration of all side effects was made each 3 months. Permixon
was found to noticeably reduce IPSS and QOL and increae maximal
urine flow speed. The size of the prostate diminished insignificantly.
Sexual function remained unchanged for 1 year and improved markedly
within the second year (p = 0.001). Permixon had no effect on
the level of prostate-specific antigen. Plasma hormones (testosterone,
DHT, estradiol, LH, androstendion) did not change. Nine patients
developed 10 side effects but they were unrelated to the treatment
Urologiia. 2004;(2):3-7
3-7
Shortand long-term results of ureterosigmostomy with creation of Mintzpouch II and Hasan reservoir
Resumo
The aim of the study was analysis of short- and long-term results
of treating patients operated with intestinal replacement of the urinary
bladder by Mintz pouch II and Hasan. Thirty-two ureterosigmostomies
with creation of the reservoir from the rectosigmoid angle (17
Mintz pouch II and 15 Abol-Enein operations) were made from
1997-2002. The age of the patients ranged from 16 to 73, the follow-up
was 12-72 months. The operation was indicated in infiltrative cancer
of the urinary bladder, microcystis of various etiology, extrophy
of the urinary bladder. Postoperative urine retention was observed in
all the patients both in the day and night time. Renal function remained
unchanged or improved in 93% patients. Quality of life was
good. All the patients except two with recurrent attacks of pyelonephritis
were socially adapted. Able patients resumed their jobs. Early
after the operation one woman developed incompetence of the sutures
of the reservoir anterior wall which required relaparotomy. Four patients
died of local recurrence and/or distant metastases in different
terms after surgery. Two patients had reflux with frequent attacks of
pyelonephritis as well as a serious impairment of acid-base balance
manifesting as hyperchloremic acidosis, the other two patients had
late unilateral strictures of the intestinoureteral anastomosis which
was reestablished. Thus, updated ureterosigmostomy significantly reduces
the rate of complications and is a good alternative to heterotopic
and ortotopic urine derivation in contraindications for the operations.
Moreover, Hasan's operation allows implantation of delated
ureters. In most cases, ureterosigmostomy with formation of reservoir
from rectosigmoid angle provides good quality of life in adequate selection
of patients.
Urologiia. 2004;(2):7-13
7-13
Resistance of hospital urinaryinfection pathogens by the data of multicenter microbiologicalstudies UTIAP-I and UTIAP-II
Resumo
Aim. To study causative agents and sensitivity of E-coli strains
isolated from adult outpatients with uncomplicated urinary infection
(UI) in different regions of Russia.
Material and methods. A multicenter prospective epidemiological
study included adult patients with uncomplicated infections of the upper
or lower urinary tracts. MPK of antibiotics was established by dilution
in agar according to NCCLS recommendations, 2000-2002.
Results. Among UI causative agents, E.coli was most frequent
(85.9%). K. Pneumoniae, Proteus spp., Staphylococcus spp., P. Aeruginosa,
Enterococcus spp.occurred much less frequently (6, 1.8, 1.6,1.2,
and 1.0%, respectively). E. Coli UI was highly resistent to ampicilline (37.1%),
cotrimoxasol (21%),maximal resistance being in St-Petersburg
(51.9 and 31.5%, respectively). Such oral antibiotics as
norfloxacin and ciprofloxacin, cefuroxim, amoxicillin/clavulanat, nitrofurantoin
were maximally active against E. Coli (4.3, 2.4, 2.6 and
1.2%, respectively).
Conclusion. High resistance of E.coli, which is the chief causative
agent of uncomplicated UI, to ampicillin, cotrimoxasol was detected.
Fluoroquinolones, amoxicillin/clavulanat, nitrofurantoin, cefuroxim
have high microbiological activity. On the basis of the pharmacokinetic,
safety and other evidence it is concluded that drugs of choice
for therapy of uncomplicated UI in Russia are oral fluoroquinolones
Urologiia. 2004;(2):13-17
13-17
Misdiagnosis in purulent pyelonephritis
Resumo
Most frequent errors in diagnosis of purulent pyelonephritis have
been analysed. It is shown that only a total of data obtained on the
disease history, clinical symptoms, results of laboratory tests, ultrasound
or x-ray symptoms of purulent pyelonephritis enable making
an accurate diagnosis and choice of adequate treatment policy.
Urologiia. 2004;(2):17-20
17-20
Combined therapy of interstitial cystitis with the device AELTIS-SYNCHRO-02-"YARILO"
Resumo
Multiple modality therapy of interstitial cystitis (1С) - the disease
characterized by nicturia, pelvic pains, imperative pollakiuria - is considered.
As 1С nature is not well known, its treatment remains empiric.
Among the underlying causes, most probable are autoimmune,
allergic, infectious, neurological, vascular. Therefore, the treatment
should be multi-modality. Most usable now is combined chemotherapy.
Perspective is also 1С treatment with medicines in combination
with physiotherapy (electromagnetolaser AELTIS-SYNCHRO-02-YAR1LO").
Endovesical electrophoresis can be also applied
Urologiia. 2004;(2):20-23
20-23
OPYT PRIMENENIYa SPAZMEKSA V KOMPLEKSNOM LEChENII INTERSTITsIAL'NOGOTsISTITA U ZhENShchIN
Resumo
Efficiency of interstitial cystitis (1С) treatment of female outpatients
is shown. Combined treatment of 1С was supplemented with
the drug spasmex which has a peripheral anticholinergic and direct
antispastic actions. It quickly relieves irritative symptoms, improves
quality of life, shortens temporary disability and lowers the cost of
the teatment.
Urologiia. 2004;(2):23-26
23-26
Penis-saving treatment of penile cancer
Resumo
Conservative penis-salvage treatment provides a complete local
effect in 55% cases, preservation of the penis in 51.4% patients without
a fall in long-term specific and recurrence-free survival compared
to penectomy and can be recommended as an alternative to penis amputation
in patients with stages Tis-T2. Removal of a penile tumor
raises efficacy of salvage treatment and insignificantly increases survival.
Application of surgical treatment only is associated with a high
rate of local recurrences. Chemoradiotherapy in penile cancer is significantly
more effective vs each method alone. Radiation in a total
focal dose more than 60Gy improves local control over the tumor.
Most effective are schemes of chemotherapy based on bleomycin.
Polychemotherapy has no advantages over monochemotherapy with
bleomycine.
Urologiia. 2004;(2):26-31
26-31
An expandedtechnique of transrectal prostatic biopsy
Resumo
To compare diagnostic value of transrectal prostatic biopsy in obtaining
samples of tissue from different sites in patients with various
levels of prostate-specific antigen (PSA) and prostate size, we made
primary transrectal biopsy of the prostate in 486 patients. The patients
were divided into 7 groups by the number of punctures at biopsy (from
6 to 18). Among the patients with PSA under 20 ng/ml in the number
of tissue biopsy samples 18, a rise in prostatic cancer detection rate
(PCDR) was 16.6%. In PSA above 20 ng/ml, a statistically significant
maximal rise in PCDR occurred in the increase of biopsy number
from 6 to 12 (by 9.3%). The number of local cancer forms in patients
with PSA < 20 ng/ml among all the detected cases rose from 70%
(biopsy from 6 sites) to 92.3% (biopsy from 18 sites). Among the patients with
PSA < 20 ng/ml and the size of the prostate > 50 sm3, a
significant rise of PCDR increased from 20 to 33.3% in an increase
of the puncture number from 6 to 12. In the group of patients with
the same PSA level and prostate > 50 cm3 PCDR improves in biopsy
from 14, 16 and 18 sites (from 12.1 to 27.7%, 28.5 to 33.3%, respectively).
Standard biopsy is insufficient for adequate PCDR, it is necessary
to obtain samples of tissue from a large number of sites with
puncture of peripheral zone of the prostate. Transrectal biopsy of the
prostate according to the extended method improves PCDR, primarily,
in local cancer.
Urologiia. 2004;(2):31-33
31-33
Extracorporealshock-wave therapy in the treatment of Peyronie's disease
Resumo
The authors analyse the results of treatment of 28 patients with
Peyronie's disease using extracorporeal shock-wave lithotripsy (ESWL)
performed on Dornier U15 lithotriptor. A total of 2-6 sessions
were made, maximal number - 12. The efficacy was controlled by
clinical indices and ultrasonic investigation (Doppler mapping of the
blood flow). ESWL proved to be efficient in the treatment of Peyronie's
disease (PD), primarily, in patients with early disease before appearance
of severe fibroplastic alterations. Less plaque vascularization
by energetic Doppler mapping due to ESWL is an important diagnostic
criterion of PD treatment efficacy. Conservative treatment is
not indicated in marked deformities and plaque calcification, erectile
dysfunction. Moreover, any injection into the tunica albuginea, especially
complicated by hematomas may be a damaging factor which
triggers fibrous inflammation. Such patients should be treated surgi-
cally. If the patient is interested in immediate results or is not interested
in continuation of sexual life, the treatment is prognostically uneffective.
Thus, ESWL is an effective, safe method of PD treatment
but requires further study and accumulation of clinical experience.
Urologiia. 2004;(2):33-36
33-36
Impase in therapy of erectile dysfunction
Resumo
Efficacy of impase in therapy of sexual dysfunctions of vascular
genesis was studied in 38 male patients aged 35-68 years. The drug
was taken for 2 months. The control was conducted with ultrasonic
dopplerography. Impase showed high efficacy in therapy of vascular
sexual dysfunctions especially in the group of patients aged 35-50
years with initial values of maximal systolic speed at least 15 cm/s.
Urologiia. 2004;(2):36-38
36-38
Prolit in the treatment and prophylaxis of nephrolithiasis
Resumo
In the course of prolit treatment there was a spontaneous evacuation
of small concrements from renal calyces and ureters in 11
(27.5%) patients, dilution of the concrements and reduction in size
of the latter were observed in prolit combination with blemaren (2
patients-5% and 7 patients -17.5%, respectively). Overall response
was 50% while that to cyston - 16.7%. Diuretic, anti-inflammatory
and plastic actions of prolit manifested in 100% patients with disappearance
of salts from urinary sediment, abatement of microhematu-
ria and mild leukocyturia. Thus, prolit is a highly effective food additive
in the treatment of nephrolithiasis and opens new perspectives
in the treatment of urolithiasis.
Urologiia. 2004;(2):38-40
38-40
Modification of the test "pressure-flow" for evaluation ofdetruzor contractility in the absence of urination
Resumo
The aim of the study was design and validation of the test for examination
of detrusor contractility in the absence of urination. The
method consists in registration of detrusor pressure in maximal speed
of urinary flow in the course of artificial urination using Foley's catheter.
Urethral resistance was modeled by raising drainage up to 40 cm
above the level of the symphysis which was adjusted and found optimal
in 48 of 179 examinees. The method allowed to select patients
with infravesical obstruction (IVO) and normal detrusor contractility
(n = 36) as well as patients with hypocontractility without IVO (n =12).
The test "pressure-flow" in artificial urination evaluates detrusor
contractility in patients unable to urinate. The test distinquishes patients
with normal detrusor contractility and those with different degree
of its impairment. This is important in assessment and prognosis
of deficient urination.
Urologiia. 2004;(2):40-44
40-44
Retroperitoneoscopic operations in cystic lesions of the kidneys
Resumo
In 1997-2002 retroperitoneoscopic dissection of renal cyst walls
(RDRC) was made in 21 patients. Computed tomography, excretory
urography, retrograde ureteropyelography were conducted in 14, 3
and 2 patients, respectively. Ultrasonic investigation was made in all
the patients before and after operation. Dissection of the cystic walls
was successful in 20 of 21 patients, material for cytological and histological
examinations was also obtained. Advantages of endoscopic
operations are now obvious, so RDRS is perspective in cystic lesions
of the kidneys and its usage will increase
Urologiia. 2004;(2):44-47
44-47
Endoscopic nephropexy
Resumo
In line with new prospects, introduction of laparoscopic technique
in nephropexy gave rise to some problems. One of them - postoperative
rotation of the kidney (RK). Upper-pole endovideosurgical
nephropexy (EVSN) with prolen net performed in the diagnostic
center "Zdoroviye" in 90 patients has demonstrated that late after surgery 9 (10%)
patients had pains provoked by RK and abnormal renal
circulation confirmed by dopplerography. In 1998 specialists of the
diagnostic center "Zdoroviye" developed a novel method of EVSN
providing elimination of the ptosis and RK. A total of 88 patients have
been operated since. 67 patients with nephroptosis and RK have undergone
nephropexy with a splitted flap of the prolen net, 21 patients
without RK - standard nephropexy. Long-term postoperative follow-up
showed that only 3 of 88 patients failed to retain normal velocity
of the major renal blood flow, though they improved this velocity
noticeably. Thus, a differentiated approach to EVSN based on
dopplerographic examination of the major renal blood flow brings
about improved treatment results in nephroptosis
Urologiia. 2004;(2):47-50
47-50
Use of gas-free lateral retroperitoneoscopy from an open mini-approach for adrenalectomy
Resumo
The aim of the study was assessment of efficacy of gas-free lateral
retroperitoneoscopy from the open miniapproach for adrenalectomy.
Arguments are given for location of the mini-cut in the anterior segment
of the 10th intercostal space and analysis was made of operative
space parameters in retroperitoneoscopy from open mini-approach.
The wound aperture 5.0 cm in size and 15.0 cm in depth is good as
it provides the diameter of the monofocal zone 16.0 cm and bifocal
zone 4.0 cm. If the size of the wound increases to 7.0 cm, the above
parameters rise to 20.0 and 7.9 cm, respectively. Such visualized space
is sufficient for adrenalectomy. Variants of the intervention are proposed
depending on the side and kind of the lesion. A total of 21 patients
with various adrenal pathology were operated. The operation
lasted for 114.7+1.5 min. Overall blood loss reached 22.0±3.2 ml,
transfusion _ 137.811.0 ml. The intestinal function normalized on
day 1-2. In the postoperative period mean number of narcotic analgetics
injections made up 4.9±1.5. Body temperature returned to normal
on day 5.3± 1.6 after the intervention. The length of the scar was
4.210.6 cm. None lethal cases were registered. Conversion to the
classic open procedure had to be made in four cases. Gas-free lateral
retroperitoneoscopic adrenalectomy from open mini-approach is
minimally invasive operation. In well selected cases this is a safe and
effective alternative to conventional and endovideoscopic gas surgery
Urologiia. 2004;(2):50-54
50-54
Pathogenetic mechanisms of infectious-inflammatory and thrombohemorrhagic complications oftransurethral prostatic resection
Resumo
The role of hemostatic disorders and alterations in urine proteolytic
activity in pathogenesis of infectious-inflammatory and thrombohemorrhagic
complications of prostatic transurethral resection
(PTR) was studied. Hemostasis and urine proteolytic activity were investigated
with biochemical and coagulological tests in 54 patients
with benign prostatic hyperplasia (BPH) before and after PTR. Significant
hypercoagulation in early postoperative period found in the
examinees promoted formation of inflammation-related contaminated
dense protein products which serve a sourse of permanent reinfection.
The patients had low proteolytic activity of the urine caused
by renal dysfunction as a result of abnormal urodynamics in this disease.
Thus, hemostatic disorders and subnormal proteolytic activity
of the urine are essential factors in pathogenesis of infectious-inflammatory
and thrombohemorrhagic complications of PTR. The conceptual s
cheme of postoperative complications pathogenesis in BPH
patients subjected to PTR is proposed.
Urologiia. 2004;(2):54-59
54-59
Surgical correction of primary nonrefluxing megaureter in childrenand its long-term results
Resumo
Correction of primary non-reflux megaureter (153 ureters) was
made in 136 patients aged 3 months to 14 years. Bilateral disease was
in 17 patients. Non-reflux non-obstructive megaureter was in 113 cases,
obstructive in 40 cases including association with ureterocele in
23 cases. Resection of distal ureter with its neoimplantation into the
urinary bladder according to the antireflux technique was made in 146
patients, endovesical electroperforation and resection of ureterocele
were made in 5 and 2 patients, respectively. Good results were obtained
in 88.3% (135 ureters), satisfactory in 2.6% (4 ureters), unsatisfactory
in 9.1% (14 ureters). After effective correction of megaureter, the
treatment should be focused on adequate therapy of
pyelonephritis pressent in 90% examinees, on improvement of urodynamics
and stabilization of sclerotic process in renal parenchyma.
The patients need long-term follow-up and more effective treatment.
Urologiia. 2004;(2):59-65
59-65
Role of urodynamics correction incombined therapy of children with urinary infection
Resumo
The authors propose differentiated complexes of therapy of children
with urinary infection. These complexes include medicines (Mcholinolytics,
antihypoxic drugs and drugs improving microcirculation)
and low-invasive therapy. Clinical experience is reported for 4
boys and 40 girls with microbial-inflammatory urinary diseases.
Standard urodynamic tests were made in all the patients before and
after the course of therapy. Three variants of driptan effects on the
urinary bladder were identified: M-cholinolytic, spasmolytic and
mixed (larger volume and lower intravesical hypertension). Some of
the patients experienced standard endoscopic reflux correction with
the use of synthetic hydrophilic gel. Control urodynamic examinations
3 months after the treatment showed that functional disorders
were reduced. Treatment efficacy was assessed with home flowmetry.
Thus, combined therapy of microbial-inflammatory diseases with parallel
correction of lower urinary tracts urodynamics by M-cholinolytics
improves treatment results. Courses of antibacterial and uroceptic
therapy should be followed by non-invasive monitoring to reveal urodynamic
disorders, define dysfunction type and perform an additional
treatment with mediators in combination with physiotherapeutic procedures.
Urologiia. 2004;(2):65-70
65-70
A case ofurethral transposition and vaginoplasty in the presence of urogenital sinus in women
Resumo
A case of female false hermaphroditism is reported in a 30-year-old
woman with urogenital sinus. This woman has undergone vaginoplasty
and urethral transposition. The latter is not usually made in
women with urogenital sinus. This leads to the position of the external
urethral ostium in the depth of the newly formed vagina and, finally,
to ectopia of the external urethral ostium or hypospadia. The result
is that such woman suffers all life from urethritis, cystitis and vulvovaginitis.
Urologiia. 2004;(2):70-71
70-71
A rare form of testicular teratoma
Urologiia. 2004;(2):71-72
71-72
Renal resistance to ischemic damage and cell mechanisms of adaptation
Urologiia. 2004;(2):72-78
72-78
Golubchikov Vladimir Alexandrovich (the 70th anniversary of birth)
Urologiia. 2004;(2):78-79
78-79
Memorable dates in the history of urology and allied fields in 2004
Urologiia. 2004;(2):79-81
79-81