№ 2 (2004)

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.

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.

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.

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.

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.

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.

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

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.

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.