卷 10, 编号 1 (2020)

绪论间质性膀胱炎/膀胱疼痛综合征（IC/PBS）的现代治疗方法不能实现长期临床缓解。

研究的目的。目的探讨膀胱颈经尿道切开手术（TUI）治疗对有间质性膀胱炎/膀胱疼痛综合征患者的临床疗效。

材料与方法。对间质性膀胱炎/膀胱疼痛综合征及经证实膀胱颈部狭窄的患者（n = 29）行膀胱颈部的经尿道切开手术。在手术治疗后1个月、3个月、6个月对手术结果进行评估。治疗效果评估采用 GRA（Global Response Assessment）量表、间质性膀胱炎/膀胱疼痛综合征症状量表（尿急症状评分）、排尿日记，通过分析，可以确定膀胱的功能容量，排尿频率和夜尿。疼痛采用视觉模拟评分法（VAS）进行评估。功能效率是通过尿动力学研究确定的，其中包括膀胱测量能力，最大流量，和残余尿量。将治疗结果与39例无膀胱颈狭窄征象的间质性膀胱炎/膀胱疼痛综合征患者进行比较。

结果：在膀胱颈经尿道切开手术后1个月和3个月GRA指标≥2的分别有96.5和72.4%。术后VAS、尿急症状评分、膀胱容量、最大排尿率、残余尿量、排尿频率、夜尿率等指标均有明显改善。

结论。这项前瞻性临床研究是首次研究膀胱颈狭窄女性间质性膀胱炎/膀胱疼痛综合征的病程。在膀胱颈部经尿道切开手术后1个月，96.5%的患者间质性膀胱炎/膀胱疼痛综合征症状减轻，无尿路感染及局部并发症发生。与此同时，72.4%的患者术
后3个月和68.9%的患者术后6个月都保持了这种效果。

Objective. To study the adaptive capacity of a single remaining kidney in the early postoperative period of nephrectomy in an experiment.

Materials and methods. The experiment involved 35 laboratory white rats, which were divided into three experimental groups. Group 1 (n = 5) intact animals, group 2 (n = 15) animals underwent nephrectomy on the left; group 3 (n = 15) animals underwent nephrectomy and additionally were created 90 minute hypoxic hypoxia. Histological material was collected on the 5^th, 21^st and 60^th days after surgery.

Results. Characteristic morphological changes in the only remaining kidney were an increase in the size of the glomeruli and a decrease in their number. Nephron fibrosis was detected, accompanied by increased production of antigens by the tubular epithelium, which is likely a response to a cascade increase in oxidative stress and increased release of cytokines that stimulate the production of intrarenal collagen.

Conclusion. Nephrectomy and hypoxia are provocateurs for the development of systemic distress syndrome, the result of which is the formation of a “vicious pathogenetic circle”, which reduces the functionality of the renal tissue. This can be considered as one of the early preclinical mechanisms for the initiation of single kidney disease in the future.

研究的目的。评估精索静脉曲张患者经精索静脉结扎后左肾静脉血流的特点及急性肾损伤的生物学标志物的动态变化。

材料与方法。对64名18-23岁的第一种血流动力学型精索静脉曲张患者进行观察。3例患者出现明显的左肾静脉压迫，其余61例患者接受了伊万尼塞维奇手术。术前及术后第2、10、30、90天行左肾静脉彩色多普勒超声检查，测量静脉血流量。在此期间，所有患者都接受实验室检查，包括研究血液和尿液中胱抑素C和白介素-18的含量。

结果。在结扎内精静脉后的第一天，血液和尿液中急性肾损伤的生物标志物浓度增加。术后所有患者均出现左肾静脉直径增大1.5-2毫米，肾门血流线速度降低5-6厘米/秒。术后第10天，肾门左肾静脉直径增加3-4毫米，线性血流速度减慢2-2.5厘米/秒。术后3个月内左肾静脉血流速度及内径恢复正常，并且，在大多数情况下，它恢复到最初的指标，而22.9%的患者在随访第90天未恢复。

结论。精索静脉曲张内精静脉结扎时，左肾静脉血流异常，急性肾损伤生物标志物浓度升高，表现为静脉高压和肾缺氧。在大多数患者中，这些指标在术后随访90天恢复正常。

The aim of the study is to investigate the effectiveness of conservative therapy with the inclusion of cryoprecipitate in its composition and its effect on the angiogenesis of renal blood vessels in patients with purulent pyelonephritis.

Materials and methods. The study included 30 patients aged from 20 to 45 years (6 men, 24 women) with acute purulent pyelonephritis. All patients were assessed for markers of angiogenesis in blood plasma: vascular endothelial growth factor (VEGF-A), angiopoietin 1 (Ang1) and angiopoietin 2 (Ang2). The patients were divided into two groups. Patients of group 1 (n = 15) received conservative therapy with the inclusion of cryoprecipitate, patients of group 2 (n = 15) received surgical treatment. The control group consisted of 10 healthy donors aged 20–35 years, whose blood angiogenesis markers were determined to obtain reference values.

Results. In the course of preliminary studies, the blood content of angiogenesis markers was determined in 10 healthy donors. The level of VEGF-A in patients of both groups and the level of Ang1 in patients of group 1 at admission to the hospital significantly exceeded the corresponding values in the control group. In group 2 patients, the level of VEGF-A and Ang1 remained elevated during treatment, which indirectly indicated an ongoing inflammatory process. The level of Ang2 in patients of both groups did not change significantly. Conservative treatment of group 1 patients showed high efficiency, which was confirmed by positive dynamics of clinical and laboratory indicators, as well as data from instrumental examination.

Conclusions. The results obtained indicate the effectiveness of conservative therapy with the administration of cryoprecipitate in patients with purulent pyelonephritis, and the effectiveness of such treatment is comparable to the effectiveness of surgical treatment . The use of cryoprecipitate has an endothelioprotective and anti-inflammatory effect on blood vessels, stabilizes the processes of angiogenesis, which contributes to limiting the inflammatory process and its regression.

The results of androgen replacement therapy with the appointment of a transdermal gel with testosterone in patients with androgen deficiency were presented. 90 men with testosterone deficiency (<12 nmol/L) and impaired erectile function were observed. The average age of patients was 58 ± 5.2 years. Patients were divided into 3 groups. Patients of the 1^st (control) group underwent basic behavioral therapy, the 2^nd group received basic therapy with testosterone gel for a dose of 50 mg, the 3^rd group received basic therapy with testosterone gel at a dose of 100 mg. The duration of treatment was 6 months. The use of testosterone in the form of a transdermal gel led to a significant increase in the content of total testosterone in both patients of the 2^nd (50 mg) and 3^rd groups (100 mg). A dose-dependent effect was noted, in patients of the 3^rd group the level of testosterone was significantly higher than in patients 2^nd group. An increase in testosterone was accompanied by a decrease in FSH and LH levels.

本文综述了近年来选择性应用5型磷酸二酯酶抑制剂治疗下尿路症状的药理学和病原基础的研究进展。详细探讨了这些药物对各种尿路功能障碍的治疗作用机制，其中以改善血液循环、降低盆腔器官缺血为主导。

尿道旁囊肿是良性的囊性形成，其临床症状取决于其大小。本病例描述一位36岁女性的一个巨大的尿道旁囊肿的临床图像、手术治疗的阶段和组织学检查结果。对诊断和治疗妇女尿道旁形成的现代方法进行了回顾。

Modern data on terminology, classification, pathogenesis, diagnostics and treatment of urosepsis were presented in clinical lecture. Particular attention is paid to laboratory and clinical criteria for assessing the severity and prognosis of the disease, as well as methods for preventing urosepsis.

The article is dedicated to the 150^th anniversary of the birth of Professor Georges Marion, an outstanding French surgeon and urologist. The main stages of his clinical and scientific activities are presented. G. Marion is the author of more than 300 scientific papers, including the fundamental guide to urology. He made a great contribution to the development of the surgical field in urology. G. Marion first performed many operations, subsequently named after him, and the hypertrophy of the bladder neck described by him was called Marion’s disease.