Vol 7, No 4 (2017)

Articles
The features of expression and prognostic significance of the peptide molecules connected with the key properties of renal cell carcinoma
Pasechnik D.G., Kogan M.I., Akhokhov Z.M.
Abstract

Relevance. The modern approach to prognostication of the course of renal carcinoma requires identification of the biological markers, which determine the key properties of the tumor in particular cases.

The purpose of this study is to clarify the nature of expression of the molecules connected with the phenotype of the cancer stem cell (CD133, N-cadherin), TGF-α growth factor for tubular epithelium, and carboanhydrase IX (CA-IX) – one of the key molecules connected with VHL by the molecular way of carcinogenesis in cases of renal cancer.

Materials and methods. We studied 61 observations of renal cell carcinoma (RCC). The immunohystochemical examination was based on a panel of antibodies, which included antibodies to TGF-α (Аbcam), N-cadgerin (M3613 clone; Dako), CD133 (Prominin-1, Biorbyt), carboanhydrase IX (CAIX; NCL-L-CAIX, Leica Biosystems). The degree of the markers' expression was evaluated by a semiquantitative method depending on the content of the positive-reaction cells in the tumor. The differences between the compared groups were identified through the use of the Mann-Whitney U test and the chi-squared test.

Results. Expression of TGF-α was found in 36 observations (59%) of RCC. TGF-α was most frequently present in the papillary (100%) and the clear-cell (55.9%) versions, and only rarely in chromophobic carcinoma (23.1%). A connection was found between the expression level of this marker and the neoplastic differentiation degree (p < 0.05). Expression of N-cadgerin was met in 38 observations (62.3%), CD133 occurred in 37 observations of renal carcinoma (60.6%). N-cadgerin and CD133 were found in the clear-cell and the papillary versions of RCC. There was a connection between the expression of N-cadgerin in the tumor and its invasive potential (p < 0.05). A higher occurrence rate of CD133 expression was recorded in the patients with metastatic forms of RCC, and also in cases of sarcomatoid transformation of the tumor (p < 0.05). Expression of carboanhydrase IX (CA-IX) occurred in 35 observations (57.4%). It was found in the clear-cell version of RCC. In cases of symptomatic RCC, expression of CA-IX was more frequently met (p < 0.05). There was a consistent association between the expression of CA-IX and the tumor size, stage and invasive potential.

Urology reports (St. - Petersburg). 2017;7(4):5-16
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Morphologic features of benign prostatic hyperplasia depending on the size of intravesical prostatic protrusion
Krivoborodov G.G., Raksha A.P., Efremov N.S., Bolotov A.D., Sotnikova T.N.
Abstract

Relevance. Benign prostatic hyperplasia (BPH) is characterized by the presence of stromal and glandular hyperplasia in the periurethral and transitional zones. To describe the nature of intravesical growth of prostate tissue, an index of intravesical prostatic protrusion (IPP) was proposed. Clinically, men with an IPP measuring 10 mm or more are less likely to respond to α1-blocker therapy and 5α-reductase inhibitors. Thus, the description of the morphological features of the prostate depending on IPP grade is an actual issue.

Purpose: to identify features of the morphological structure of the IPP in men with BPH. Materials and methods. Surgical treatment of the clinical form of BPH was performed to 30 men. Patients were divided into 2 groups: 1st group had IPP less than 10 mm (n = 12) and the 2nd group had IPP 10 mm or more (n = 18). In this study we evaluated the age, prostate volume and the value of IPP. The material for morphological investigation was obtained with transurethral resection of the prostate from the IPP zone. For light-optical examination, the preparations were stained with hematoxylin-eosin for routine evaluation of the structure of the prostate gland and for Van Gieson to estimate the proportion of the muscular and fibrous components of the stroma. The quantification of structural indicators was carried out by means of the television image analyzer MEKOS-TS2 in an automatic mode.

Results: The groups were similar in age and prostate volume. In the group with IPP value of 10 mm or more, the proportion of the stromal component in the IPP zone was 77.5 ± 11.0%, the proportion of the glandular component was 22.5 ± 11.0%, respectively. In the group of men with IPP less than 10 mm, the proportion of the stromal component in the IPP zone was 96.0 ± 1.5%, the proportion of the glandular component was 4.0 ± 1.5%, respectively (p < 0.05). It was also found that with an increase in IPP there is a tendency to decrease the proportion of the muscular component of the stroma.

Conclusion: In men with BPH, with an increase in the value of intravesical prostatic protrusion in this zone, a relative increase in the proportion of the glandular component and a decrease in the proportion of the stromal component is proved, as well as a tendency to reduce the proportion of the muscular component of the stroma.

Urology reports (St. - Petersburg). 2017;7(4):17-23
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Long-term results of surgical treatment of solitary kidney cysts
Korneyev I.A., Kiselev A.O., Ishutin E.J., Radomskij J.A., Al-Shukri S.H.
Abstract

Introduction. Simple kidney cyst is a common disease that may need surgical treatment for pain, hypertension and kidney obstruction. Long term results of kidney cyst treatment need further investigation.

The aim of the study was to assess patient complaints and kidney ultrasound sonography data in patients in a long term after percutaneous cyst aspiration (PCA) with sclerotherapy and laparoscopic decortications of the cyst wall (LDC).

Patients and methods. In this retrospective study clinical data of 891 patients (277 (31,1%) men and 614 (68,9%) women, mean age 61,8 years) with simple kidney cysts operated by PCA and LDC (754 (84,6%) and 137 (15,4%) patients respectively) due to back pain, hypertension, big cyst size and obstruction of urine flow from the kidney was analyzed. Control survey and ultrasound sonography scans were performed in 80 (18,1%) patients, including 40 (50%) patients after PCA and 40 (50%) patients after LDC.

Results. At control sonography kidney cysts were found in 32(80%) and 27(68%) patients after PCA and LDC respectively, but median cyst size decreased. Compared to PCA, LCD more often resulted in complete disappearance of cysts and also caused more prominent cyst size reduction (p = 0,027), however the lengths of stay (LOS) was longer after LDC (p = 0,005). After surgery the back pain and hypertension persisted in many patients, while the flow of urine from the kidney normalized in all patients.

Conclusions. LDC compared to PCA was more effective in complete cyst removal and caused more significant decrease of cyst size. The LOS was longer after LDC, both LDC and PCA were effective in regaining urinary flow from the kidney. Back pain and hypertension should be considered relative indications for surgical treatment of kidney cysts.

Urology reports (St. - Petersburg). 2017;7(4):24-29
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Surgical treatment of right-sized visceroptosis
Bokovoj S.P.
Abstract

This article is devoted to the surgical treatment of right-sided visceroptosis. The original methods of nephropexy, colopexy and hepatopexy are described in details. The indications and peculiarities of the preparation for these operations are given as well as the peculiarities of postoperative management of such patients. Long-term results of surgical treatment of right-sided visceroptosis in 103 patients are presented in the article. A good result was found in 93 (90.3%) patients and satisfactory result in 10 (9.7%) patients.

Urology reports (St. - Petersburg). 2017;7(4):30-38
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The state of prostate hemodynamics in patients with myophascial pain syndrome
Krupin V.N., Krupin A.V., Belova A.N., Nashivochnikova N.A.
Abstract

The aim of this study was to evaluate the state of blood flow in prostate in 59 men with chronic pelvic pain due to myofascial syndrome in the absence of clinical manifestations of chronic prostatitis and its dynamics against the background of the treatment. The results of the study revealed a reliable relationship between the severity of blood flow disorders in the prostate and the intensity of pain symptoms caused by myofascial syndrome. It was concluded that the hemodynamic disorders of the prostate caused by myofascial syndrome are important in the possible formation of clinical symptoms of chronic pelvic pain in men.

Urology reports (St. - Petersburg). 2017;7(4):39-43
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Experimental justification of laser therapy efficiency of men's infertility
Moskvin S.V., Borovets S.J., Toropov V.A.
Abstract

Male infertility is a multifactorial syndrome, which includes a wide range of disorders. It is a symptom of many different pathological conditions affecting both the reproductive and other body systems: endocrine, nervous, blood-vascular, and immune systems. Low level laser therapy is a method of modern physiotherapy, in which the impact is carried out by low-intensity laser irradiation (LILI). It is widely used in all areas of modern medicine, due to its high efficiency, simplicity of use, the absence of contraindications and side effects. The results of russian and foreign experimental studies on the article subject were analyzed. A definite conclusion is drawn that low level laser therapy should be used as much as possible in the complex treatment of men with infertility, since the effectiveness of the method is not just high, but often has no alternatives. At the same time, the available low level laser therapy techniques should be widely used: locally, rectally, laser acupuncture, ILBI (intravenous laser blood irradiation), on the projection of various organs, paravertebrally, etc. All parameters of laser action should be set (wavelength; mode of operation; frequency for pulsed lasers; power; power density, determined by the method of exposure; exposure, localization), which are specified by the relevant regulatory documents and clinical recommendations.

Urology reports (St. - Petersburg). 2017;7(4):44-53
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Peculiarities of clinical course of urolithiasis in patients of elderly and senile age
Agenosov M.P., Kagan O.F., Kheyfets V.K.
Abstract

This article presents an analysis of literature data of the study of exogenous and endogenous etiologic risk factors for the progression of urolithiasis in elderly and senile patients, the clinical course, modern treatment methods and tactics for managing patients of this age group. It was noted that patients of the older age group require special attention both in the choice of treatment tactics and in further observation due to a decrease in the functional reserves of the renal parenchyma and the presence of concomitant diseases. In the diagnosis and treatment of urolithiasis in elderly patients are preferred to use non-invasive methods.

Urology reports (St. - Petersburg). 2017;7(4):53-59
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Diagnosis and therapy of urinary infections. What should always remember (clinical lecture). Part 2
Borisov V.V.
Abstract

The clinical lecture presents the modern concepts of complicated infections of the kidneys and urinary tract. The principles of dividing infections into complicated and uncomplicated ones are considered in the lecture. Data are presented on the classification, epidemiology, etiology and pathogenesis of pyelonephritis, the features of the inflammatory process in the kidney depending on such pathogens as E. coli, pathogenic cocci, Pseudomonas infection. The modern possibilities of revealing reversible and irreversible inflammatory changes in the kidney, the pathogenesis of complications of acute purulent pyelonephritis are considered in details. Considerable attention is given to differential diagnosis of the nonspecific inflammatory process in the kidney and nephrotuberculosis. The role of urologists and general practitioners in assisting patients in outpatient and inpatient stages of diagnosis, treatment and rehabilitation has been clarified.

Urology reports (St. - Petersburg). 2017;7(4):60-66
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