№ 4 (2005)

The trial of efficacy of physical factors in combined treatment of BPH stage I patients with concomitant abacterial chronic prostatitis (category IIIA) enrolled 42 patients who were divided into two groups. Group 1 received combined treatment including complex physical factors (CAP-ELM-01). The efficacy of the treatment was judged by dynamics of clinical and device indices and severity of leading CP syndromes. It is shown that physical factors contributed to noticeable improvement in the parameters of prostatic secretion, uroflowmetry, size of the prostate, hemodynamics, clinical manifestations of chronic prostatitis.

We studied the role of integrins, primarily, the role of allele distribution of GP3a gene in development of prostatic cancer (PC) and assessment of its prognostic significance. From November 2003 to May 2004 we examined 32 patients with PC: 11 patients with local PC T1-2N0M0; 14 patients with locally advanced cancer T3N0M0 and 7 patients with invasive and/or metastatic cancer T3-4N1M0-1 or T3-4N0-1M1. The blood from all the patients we studied with PCR for alleles of GP3a gene, PSA. Seventeen patients were found to have alleles PLAIAI, 14(44%) - alleles PLA1A2, 1(3%) - alleles PLA2A2. Alleles PLA1A2 occurred significantly more often than in the population (p < 0.005). The group analysis has found that 8 patients with local PC had alleles PLAIAI, 3 patients - alleles PLA1A2 (27%). We discovered alleles PLA2A2, PLAIAI and PLA1A2 in 1(7%), 5(36%) and 8(57%) patients with locally advanced PC, respectively. Among patients with metastatic and/or invasive prostatic cancer, there were 4 (57%) and 3 (43%) cases of alleles PLAIAI and PLA1A2, respectively. Our study demonstrated influence of carriage of PLA2 allele on occurrence of PC risk (5-fold higher) and its invasive forms (10-fold higher and more). Probability to develop local invasion among patients with prostatic cancer - carriers allele PLA1A2 is 6 times higher than among carriers of alleles PLAIAI. A PC course in carriers of alleles PLA1A2 may be characterized by faster development of local invasion and metastasizing vs carriers of alleles PLAIAI. These findings can be used in design of nomograms for prognostication of invasion of clinically small tumors in verification of significance on greater number of the patients.

The analysis is presented of combined treatment of locally advanced prostatic cancer (LAPC), stage T3NXM0, in 158 LAPC patients treated in 1998-2002. The patients were divided into four groups: group 1 (n = 72) received hormones in parallel with radiation, group 2 (n = 52) received only hormones, group 3 (n = 27) received radiotherapy after failure of long-term (1 year and more) hormone therapy, group 4 (n = 7) was given teleradiotherapy only. 3-year recurrencefree survival in patients with LAPC showed advantage of the combined treatment (82 + 0.1%) vs hormone (56 ±0.1%) or radiation (69.3 + ± 0.1%) therapy alone. It provides a high local control over the primary tumor and an increase of survival, prolongs distant metastases free period, improves the patients' quality of life and their adaptation.

To evaluate efficacy of kanefron Hs (KH) in combined therapy of chronic cystitis and urolithiasis (after extracorporeal shock-wave lithotripsy-ESWL), we examined 48 women suffering from chronic cystitis. The patients were divided into two groups by the presence of pyuria: 20 patients of group 1 had pyuria, 28 patients of group 2 had no pyuria. Each group was subdivided into two groups in relation to KH. Subgroup la received phosphomycin as monotherapy, subgroup lb - phosphomycin with KH (2 pellets 3 times a day for 30 days). Subgroup 2a was initially treated with anti-inflammatory drugs, local medication physiotherapy, circulation improving drugs for 10 days. Then the patients were followed up for a months without any treatment. Subgroup 2b received the same initial course but it was followed for 30 days with KH. 79 patients with urolithiasis (uroliths and ureteroliths) have undergone ESWL. 45 entered KH group (2 pellets 3 times a day), 34 - the control group (spasmolytic and anti-inflammatory therapy). KH in combined treatment of chronic cystitis raises efficacy of the initial therapy (antibacterial or combined, made in the absence of pyuria), promotes achievement of longer disease remission, elimination of concrement fragments from the urinary tract. Long-term administration of KH induce no side effects. Thus, KH can be recommended in chronic cystitis and urolithiasis in patients exposed to ESWL as an effective and safe drug.

Alphal-adrenoblocker tamsulosin reduces muscle spasm in the ureteric wall, decreases peristalsis below and raises pressure above the stone thus facilitating stone passage. Patients on tamsulosin had spontaneous stone passage in 73.8% cases while only 22.4% patients on routine therapy became stone free. Tamsulosin also shortens hospital stay. Use of tamsulosin 0.4 mg daily in patients with distal ureteric stones is pathogenetically validated, is highly clinically and cost effective.

The treatment of 120 patients with acute purulent pyelonephritis (APP) brought about the following results. 86% patients given standard therapy showed deterioration of their condition, D1C syndrome and inflammatory process were not cured, pyoinflammatory process in the kidney continued. On the contrary, 84.1% patients on combined conservative treatment improved: D1C syndrome and active inflammation relieved, fibronectin content, IgA, IgM and IgG levels rose. Ultrasonic examination and dopplerography indicated that combined conservative therapy including cryoprecipitate arrested development of a purulent focus in the kidney, reestablished intraorganic circulation. Mean stay in hospital was 13.9 days.

Cystoscopy, hydrobougieurage and biopsy of the urinary bladder were made in 80 female patients with interstitial cystitis (1С) aged 2368 years. Endoscopic changes were estimated by an original scale. The analysis of the endoscopic findings revealed a correlation between duration of the process, cystoscopic picture and histopathological evidence. Clinical and cystoscopic pictures provide significant information on morphological changes in the wall of the urinary bladder depending on the disease stage. Histological study of urinary bladder biopsies in 1С is used rather forexcluding other diseases of the urinary bladder with similar clinical symptoms (primarily cancer and tuberculosis).

We examined 86 patients: 24 with functional and 62 with organic erectile dysfunction (EDF). In functional EDF, sildenafil citrate (SC) in a dose 25-50 mg or intracavernous injection of 2% solution of papaverin always resulted in satisfactory erection. In EDF, SC, papaverin injection and LOD test results were compared. Morphological examinations of cavernous tissue and tunical albuginea of the penis. Correlations were found between clinical findings, results of SC and intracavernous papaverin solution administration, LOD-test, morphological evidence. This provides objective data for classification of EDF into three stages (I, II and III). Stages I and II were defined as compensated, stage III - as a decompensated stage of organic erectile dysfunction. SC has some advantages over other tests, therefore it is recommended as a monomethod for diagnosis of functional forms, indirect staging of organic EDF.

To elaborate prenatal differential-diagnostic criteria of functional and obstructive uropathies, we examined 3287 pregnant women. Obstructive fetal urinary malformations (FUM) were detected in 42 (1.3%) cases. Prenatal ultrasonic assessment of fetal pelvis size depending on filling of the urinary bladder allowed identification of two groups: bladder-independent and bladder-dependent. Basing on our findings, we established prognostically significant differential-diagnostic criteria of a FUM variant. Thus, dependence of the size of caliculopelvic complex and the ureter on filling of the urinary bladder is a basic echographic criterion in functional obstruction. The absence of such dependence is the criterion of organic obstruction.