№ 4 (2004)

Meta-analysis has been made to answer the question whether a proven advantage exists of chemotherapy of locally advanced and metastatic cancer of the urinary bladder (UB) with gemcitabine+cisplatin over the scheme M-VAC. The data for 1990-2002 obtained from the data base Medline, library of Cocrane Association, proceedings of the symposia and conferences, publications in domestic periodicals Urologiya, Voprosy Onkologii covered 3477 items on UB cancer.Nine publications were selected which seem to use significant information in terms of evidence-based medicine. The patients were divided into two groups. Group 1 consisted of patients with local and metastatic UB cancer treated with the combination gemcitabine+cisplatin (n = 390). Group 2 patients (n = 499) received chemotherapy with M-VAC. By principles of evidence-based medicine, group 1 patients had more frequent unfavourable outcomes (absence of complete and partial regressions) - 50 and 42%, respectively. A decrease in the absolute risk is significant (p < 0.05, chisquare = 5.8). It is 8% in the confidence interval (CI) 4,12. A decrease in the relative risk was 19% (CI 13.7-24.3), odds ratio 1.39 in CI 1.3-1.48. Thus, at present there are no reliable data on advantages of local and metastatic UB cancer treatment with the scheme gemcitabine-cysplatin over standard treatment M-VAC

The authors analyse their experience with ureter implantations into a small intestinal retaining reservoir - both direct and antireflux. From 1994 to 2004 orthotopic replacement of the urinary bladder (UB) with an ileal segment was performed in 62 patients (59 males, 3 females) for UB cancer (n = 55), microcystis (posttraumatic, radiation-induced, tuberculous)(n = 7). Orthotopic replacement of the UB was made according to VIP (vesica ileale Padovano) technique with creation of antireflux uretero-enteroanastomoses by Le Due (group 1, 43 patients, 82 anastomoses) and Hautmann technique in modification of Lippert-Theodorescu (group 2, 14 patients, 28 direct uretero-enteroanastomoses). A direct uretero-enteroanastomosis was performed by Nesbit and Bricker technique. Five patients were withdrawn from the final analysis: 3 of them died early after the surgery because of complications, 2 patients died due to progression within 3 and 4 months after the operation. A total length of the ileac segment used for UB repair in both groups was 60 cm. Upper urinary tracts (UUT) and kidneys after the operation were assessed by the results of ultrasonic investigation of the caliceropelvic system, kidneys, UB, residual urine, serum creatinine, excretory urography, spiral CT (on demand), etc., after recovery of miction (3-4 weeks after operation), 3 and 6 (-(-cystography) after the operation, 12 months after the operation and annually. Comparison of the results of direct and antireflux anastomoses suggests a conclusion that a high rate of strictures due to antireflux anastomoses provoking UUT and renal dysfunction makes their benefit doubtful. Antireflux bypass ureteral surgery with neocystis of low pressure seems unjustified. In creation of capable uroreservoir of low pressure a direct implantation of the ureter into it is simple to do and less risky in respect to development of anastomotic stricture and damage to the renal function

The authors present a comparative estimation of therapeutic efficiency of conventional antibacterial therapy, coherent and incoherent impulse quantum irradiation at a constant magnetic field in combined therapy of 130 patients with acute pyelonephritis. Incoherent impulsive quantum irradiation at a constant magnetic field showed high clinical efficacy manifesting in early normalization of microcirculation of the affected kidney

Strength properties of prostatic calculi (PC) were studied by microhardness HV. Fifteen calculi under study were divided into 3 groups by the size: 2-3 mm (group 1), 4-6 mm (group 2), > 6 mm (group 3). The surface of the thin sections of the calculi appeared as concentric, spherical layers of different size indicating formation of the calculus from the center. In the latter one could see a pigmented nucleus of organic nature. Some calculi had two nuclei under one cover - attached calculi. Correlations between the structure, morphology of prostatic calculi and their strength properties were established. These correlations allowed one to characterize destruction features of the calculi in different destructing impacts. We have designed and introduced into practice a complex of local physiotherapy in prostatolithiasis. This physiotherapy was conducted in combination with medicines for chronic prostatitis and included exposure of the prostate to ultrasound in impulse regime (4 mc, 0.4-1.0 W/cm2). The ultrasound was delivered through the rectum (insertion of the setting IUT 2.264-7-2.09u to the site of the concrements location) and alternated with laser therapy (insertion of the radiator P-2 into the rectum and radiator LOl to the perineal area (5 W, 80 Hz, 64-128 s) and introduction of sulfide mud heated with the device PPK-01 Pra, electrostimulation for better passage of the prostatic section. The above therapy destructed the concrements which eliminated from the prostatic ducts as a result of which prostatic function recovered. The complex produced a good effect: 65% patients stated enhancement of the erectile function after 3 days of the treatment. After 5-6 procedures pain syndrome relieved in 40% patients, after 11-15 procedures - in 87%. Ultrasonic investigation showed that posttreatment size of the prostate diminished from 0.8 to 0.2 cm. The absence of the calcinates's shadows were recorded in 87% patients, the symptoms of chronic prostatitis disappeared. The results of the combined physiotherapy demonstrate efficacy of the above method in true prostatoliths.

Botulinic toxin (ВТ) is a new method of lowering intraurethral pressure in symptoms of obstructive voiding in patients with neurogenic dysfunction of the lower urinary tracts (LUT). Transperineal introduction of 100 units of ВТ type A (botox, Allergan) was used under electromyographic control into the external urethral sphincter of 9 patients (6 males and 3 females) with LUT neurogenic dysfunction aged 17 to 68 years (mean age 37.2 years). Two patients had subnormal detrusor contractility due to myelodysplasia and diabetic polyneuropathy, two other patients -non-incontinent striated urethral sphincter after hemorrhagic stroke and spinal contusion, five patients suffered from detrusor-sphincteral dyssynergia (DSD) resultant from Schmorl's hernia, multiple sclerosis, Charcot-Marie disease and ischemic stroke of the spinal cord. Three patients had cystostomic drainage. The rest of the patients complained of dysuria, three patients performed self-cathetarization, mean volume of the residual urine was 170 ml (180-240 ml). In 10 days residual urine was not found in 2 patients with subnormal detrusor contractility and in 4 patients with DSD. Abdominal pressure fell from 75 to 39 cm, on the average. In DSD patients maximal detrusor pressure fell from 59 to 29 cm, on the average. Mean maximal urinary flow rate rose from 4.3 to 9.6 ml/s. In 20 days, on the average, suprapubic fistula healed in all the patients. In a month, therapeutic effect persisted in all the patients. Complications, side effects were not registered. ВТ treatment to induce adequate urine evacuation in neurological patients is a promising approach in neurourology. Further studies should find answers to questions about regimen of ВТ introduction, loss of sensitivity, new indications in urology.

Experiments on 40 white rats were made to study effects of cardura (doxasozine) and viagra on polysystemic energy metabolism in stress. All the animals were examined for cytochemical activity ofsuccinate dehydrogenase, lactate dehydrogenase in blood lymphocytes, antioxidant activity of blood plasm, levels of hydroperoxides, malonic dialdehyde. 3-hour immobilization raises functional activity of mitochondria manifesting with intensification of energy metabolism. Adrenoreceptors blockade by Cardura prevents changes in the ceUular metabolism. The same antistress effect is observed in viagra action. This newly discovered mechanism may prevent complications of adrenergic reactions accompanying sexual intercourse..

Comparison of duration, blood loss and efficacy of TUR and rotoresection in the treatment of benign prostatic hyperplasia has demonstrated that rotoresection allows almost bloodless and effective transurethral removal of prostatic hyperplastic tissue and, therefore, is a promising alternative to routine TUR of the prostate.