№ 1 (2005)

The aim of the study was to estimate distribution of the nucleoli and argentophilic nucleolar organizers in surface and locally advanced transitional cell tumors of the urinary bladder (TCTUB), to analyse correlation between this distribution, tumor recurrence and survival of the patients. The data on primary examination and 5-year followup of 61 patients (47 male and 14 female, mean age 64 x 1 year) with surface and locally advanced TCTUB were studied retrospectively. AH the patients were radically operated on, 5-year progression-free survival made up 62%, recurrences of the urinary bladder tumors were detected in 61% patients. In addition to the standard morphological examination, tumor tissue was stained with silver nitrate according to the Howell and Black technique and the number of the nucleoli and argentophilic granules in them was counted in magnification lOOO.The findings were compared with the invasion depth, grade of cancer differentiation, tumor recurrence and 5-year survival. The count of argentophilic granules increased with reduction of differentiation grade and an increase of cancer invasion depth. Distribution of the nucleoli and granules significantly differed in the subgroups of patients with recurrent and recurrence-free course of the disease, depending on 5-year survival without progression. Probable duration of the recurrence-free period was estimated best by coefficient of variation of argentophilic granules distribution (p = 0.001). Parameters of distribution of the nucleoli and granules allowed specification of the risk of tumor progression for 5 years for all the patients (p = 0,035) and patients with surface tumors (p = 0.007) irrespective of categories T and G. Thus, the number of nucleoli and argentophilic nucleolar organizers increases with lowering of differentiation and deepening of tumor invasion. The analysis of nucleoli and argentophilic granules distribution provides additional information on recurrence and transient cell carcinomas probability.

The aim of the study was to elucidate influence of alphalA adrenoblocker tamsulosine (omnique) on ischemic heart disease (IHD) symptoms in patients with benign prostatic hyperplasia (BPH). As shown by Holter monitoring, 15 patients of group 1 having IHD, BPH and impaired miction, demonstrated ECG changes before voiding (ST depression, higher rate of supraventricular and ventricular extrasystoles); 28 patients of group 2 had ECG changes unrelated to miction. Subjective and objective effects were registered in a month in all the patients. ECG parameters improved in 11 and 20 patients of group 1 and 2, respectively. Patients without ECG improvement had severe cardial pathology (threevessel affection of the coronary arteries, effort angina of a high functional class, cardiac failure). Thus, miction impairment due to BPH aggravate IHD. Early administration of tamsulosine (omnique) for BPH improves the course of concomitant IHD in 72% patients.

In management of patients with hyperactive urinary bladder (HAUB) it is necessary to take into consideration the fact that long, term intake of M-cholinergic antagonists may result in obstructive micjtion because of low contractile activity of the urinary bladder. Use of M-cholinergic antagonists also problematic in detruzor dysfunction leading to slowing down of the urinary flow. In view of these possible complications, an algorithm of urodynamic diagnosis is proposed based on non-invasive registration of miction disorders using home uroflowmetry. Correction of detruzor contractility with dalfas combines well with cholinoblockers. In some cases administration of nontitrated all phablockers has no alternative especially in long-term treatment with mediators suppressing nonadapted detruzor contractions as it happens in HAUB. The above diagnosticotherapeutic algorithm of female miction disorders management which regards urine flow rates and comprises intake of alfusozine if necessary allows treatment of females with small urinary bladder when cholinergic antagonists are low-effective.

We studied the influence of pressure and rate of irrigative liquid flow on hydrodynamics of the upper urinary tracts in contact pneumatic lithotripsy (Litoclast lithotriptor) in 68 patients with ureteroliths and nephrostomic drainage. To a nephrostome the device was attached on which the linear change of pressure inside the pelvis was measured at the moment of visualization of the stone, its destruction and final ureteroscopy. 45 patients had nephrostome with a pelvis curl. In this group of patients at the moment of stone destruction the pressure inside the pelvis and the speed of irrigative flow were increased. In patients with marked local inflammatiion on the place of stone location the pressure inside the pelvis was the highest. The effect of communicating vessels was seen. The stone was completely destroyed in 34 (75.5%) patients, in 9 (20%) patients the stone was destroyed partially. In 2 cases the stone migrated in the cavitary system of the kidney. A nephrostome-intubator was placed antegradely in 23 patients. The balloon-obturator was placed in the ureter above the stone through the nephrostome. The pressure inside the pelvis during contact lithotripsy was not increased. Full destruction of the stone was achieved in 26 patients (92.8%), migration of the stone in the cavitary system and partial destruction of the stone was observed in 2 (2.2%) patients.

A total of 46 patients with varicocele aged 15-28 years (mean age 17.1 + 1.3 years) were operated endoscopically by means of ligation of the internal seminal vein from an open gas-free mini-approach. The intervention was on the left side (n = 45) and right side (n = 1). Varicocele of the first, second and third degree was diagnosed in 2 (4.3 ± 3.0%), 35 (76.0 ± 6.3%) and 9 (19.6 ± 5.9%) patients, respectively. There were no conversions. Duration of the operation was 28.4 ± 2.7 min. Early after surgery anesthesia with ketorolac trometamine (2.1 ± 1.1 injections, on the average) was made in 37 (80.4 ± 5.9%) patients. Seven (15.2 ± 5.3%) patients refused anesthesia. Control examination was made on day 7. Hydrocele developed in one case (2.2 ± 2.2%). It was managed conservatively. A mean length of the scar was 2.8 ± 0.34 cm. The second postoperative examination was conducted 6.7 ± 1.6 months after the first one. The recurrence arose in one patient (2.1 ± 2.1%). The patient was reoperated from an open mini-approach. A mean level of pain syndrome was 1.8 + 0.5 points. It had no influence on the patients' condition. On postoperative day 3-5 the patients were discharged. Thus, good quality of life in use of the proposed endoscopic operation of ligation of the internal seminal vein from an open gas-free approach makes this surgery an operation of choice in surgical treatment of varicocele.