编号 4 (2013)

The study presents an analysis of the experience of treatment of urinary incontinence in women using free synthetic suburethral sling. Between 2001 and 2008, 1081 patients underwent surgery. Of these, 841 (77,8%) suffered from stress urinary incontinence, 202 (18,62%) suffered from the mixed form of urinary incontinence with a predominance of the stress component, and 38 (3,52%) had recurrent urinary incontinence. Group 1 included patients with stress urinary incontinence who underwent surgery using suburethral synthetic sling with retropubic access (TVT operation); Group 2 included patients, who underwent surgery using suburethral sling implanted with transobturator access (TVT-O operation). Group 3 consisted of patients with mixed urinary incontinence, who underwent TVT-O operation. Retropubic suburethral TVT sling was implanted in 273 (25,25%) patients, transobturator TVT-O sling - in 740 (68,45%) patients, and other synthetic suburethral slings - in 68 (6,3%) patients. The average follow-up period was 50.1, 31.1 and 32,6 months in each group, respectively. Cough test was used for the objective evaluation of the effectiveness, and visual analogue scale - for the subjective evaluation of effectiveness. In the TVT group, the negative cough test in the postoperative period remained at 85,58% of the patients, and in in TVT-O group - in 84,36% of patients. Analysis of the frequency of intraoperative complications showed that the probability of occurrence of complications was not associated with age, body mass index and obstetric history of patients. It was noted that the perforation of the bladder and pelvic hematoma were more likely to occur when using the retropubic access. Transobturator access is associated with a higher risk of injury of the lateral vaginal fornix, although bladder injury is not ruled out. Objective and subjective indicators of efficacy of treatment of mixed form ofurinary incontinence were 86.15 and 87.69%, respectively. The study suggests that the operations using suburethral TVT and TVT-O slings are safe and effective methods of treatment of stress urinary incontinence in women.

The evaluation of urine and bladder bioptic samples (bacteriological examination and polymerase chain reaction) of 28 women with chronic cystitis was performed. In 85,7% of cases, mixed infections with predominance of nonclostridial anaerobes in the urine was detected. Herpes simplex virus type 1 was detected in 7,1% of cases. In the same manner as in urine, predominance of nonclostridial anaerobes in bladder bioptic samples (85,7%) was observed. Identical bacteria in urine and bladder bioptic samples were revealed in 64,3% of patients. Herpes viruses and papillomaviruses were frequently registered (p <0,05) in the bioptic samples.

According to the data of preventive medical examinations since the end of 2009 to April 2012, data on the urological incidence in 654 athletes surveyed during this period were collected and analyzed. Among the diseases identified in athletes, the main place is occupied by varicocele (5,35%), urethritis (5,04%), urolithiasis without clinical manifestation of acute inflammation (1,37%).

The article presents the results of an open, noncomparative, observational study of the efficacy and safety of continued use of the Serenoa repens (prostamol uno®) plant extract at a dose of 320 mg 1 time a day for 10 years in 38 patients with early manifestations of BPH and the risk of its progression. The results of study showed the absence of progression, both on subjective criteria (IPSS, and QoL scores), and objective criteria (prostate volume, the rate of urination, residual urine volume). Furthermore, patients had no undesirable effects directly related to the use of this drug.

The study was aimed to the evaluation of vascular endothelium status in patients with stress-induced arterial hypertension, coupled with erectile dysfunction (ED). 51 patients underwent examination. Laurent - Segal Male Copulative Function Questionnaire (MCF), and International Index of Erectile Function (IIEF) were used for the detection of ED and assessment of its severity. Microcirculation in penile vessels was evaluated by laser Doppler flowmetry. Markers of endothelial function - endothelin 1 and asymmetric dimethylarginine-were measured. For the correction of violations identified, the drug udenafil (zydena) was used at a dose of 50 mg daily for 1 month. Against the background of therapy with udenafil, restoration of function of endothelial cells was detected. This suggested the functional nature of the violations in the genital sphere, and was regarded as a manifestation of stress-induced ED. Elimination of endothelial dysfunction led to significant reduction in ED symptoms.

Using laser Doppler flowmetry, basal blood flow in patients with chronic prostatitis was evaluated. 90 men with chronic prostatitis and 30 healthy men of reproductive age underwent examination. For the assessment of endothelial vasomotor function, ionophoretic tests with 5% acetylcholine and 5% sodium nitroprusside were performed. Results of the study suggested a violations of the skin vasomotor activity in patients studied, which indicated a decrease in reserve capacity of the microvasculature both in bacterial and abacterial genesis of chronic prostatitis.

The results of 11 extracorporeal partial nephrectomies for neoplasm with subsequent autologous transplantation of kidney are presented. In 4 patients, resection was performed ex vivo in the presence of a large centrally located tumor in a solitary kidney. Another two patients had bilateral tumor process. In 2 patients, a large, centrally located tumor in solitary kidney was the indication for extracorporeal resection. 3 patients had elective indications for the operation. Early postoperative complications occurred in 5 patients. 3 patients had oligoanuria. One patient developed postoperative bleeding; one patient developed obliteration of the upper third of ureter. Recurrence of renal cell cancer has not been identified; the functional state of the kidney vessels and vessels of upper urinary tract was regarded as satisfactory. Good results of these operations indicate the feasibility of expanding the indications for extracorporeal organ-sparing surgery.

Oncological outcomes of laparoscopic partial nephrectomy are no worse than those after open sparing operation for kidney cancer. However, laparoscopic procedures are accompanied by a longer warm ischemia. In order to reduce the ischemic injury, local ischemia by isolation and temporary clamping of the individual branches of the renal artery was used. From January 2009 to June 2012, 60 laparoscopic partial nephrectomies were performed in the clinic, including 34 resections with temporary clipping of renal artery and 26 resections with temporary clipping of secondary and tertiary segmental and subsegmental branches. Functions of affected kidney were evaluated before and after surgery in both groups of patients. At 3 months after surgery, significantly lower decline of the function of affected kidney was observed in patients who underwent resection with the use of local ischemia compared with patients who received the intervention accompanied by a temporary clamping the renal artery. Partial nephrectomy using local ischemia can significantly expand the indications for laparoscopic and retroperitoneoscopic sparing operation for renal cell cancer.

The article presents the results of the evaluation of the influence of varicocele on the reproductive system of adolescents from the perspective of involvement of periprostatic venous plexus and prostatovesicular complex in the pathological process. The study involved 90 adolescents 16-18 years old with left varicocele and disturbances in ejaculate parameters, of which 60 had pelvic congestion. Patients and control group received a comprehensive treatment, including preoperative trophic and flebotonic therapy, laparoscopic surgical clipping of the internal spermatic vein and post-operative rehabilitation. Patients of the study group along with this treatment received prostatotropic drug Vitaprost. According to the results of study, it was found that in patients with varicocele, attention should pay to the status of the venous outflow from the pelvic organs, which leads to the pelvic congestion and causes degenerative changes in the prostate in half of cases, which in turn negatively affects the spermogram parameters and increases the risk of subfertility. The use of prostatotropic drugs in the treatment of patients suffering from varicoceles with pelvic congestion is appropriate and pathogenetically justified, as it promotes a more rapid restoration of the structure and function of the prostate.