Vol 11, No 4 (2021)

BACKGROUND: Increasing the effectiveness of the treatment of patients with kidney cancer is one of the main problems of oncourology. In its solution, great importance is attached to the development of new surgical technologies.

AIM: The aim of the study – to evaluate the results of extracorporeal kidney resection in conditions of pharmaco-cold ischemia with orthotopic renal replantation in kidney cancer patients. Our study is aimed at assessing the results of extracorporeal resection of the kidney under pharmaco-cold ischemia with orthotopic replantation of renal vessels in patients with kidney cancer.

MATERIALS AND METHODS: 44 patients [of them, 70.5% (n = 31) – men and 29.5% (n = 13) – women] with kidney cancer were recruited in a study. All patients were treated between 2012 and 2021. The mean age of patients was 55.92 ± 12.6 years. The stage was determined using the TNM system: pT1a-3bN0M0-1 G1-3. 75% (n = 33) of patients had stage pT1a–1b; 11.4% (n = 5) – pT2a–2b, one patient was present with multiple lesions; 13.6% (n = 6) – pT3a–3b, one patient had up to 15 lesions in a single kidney. Two previously operated patients had cancer of a single kidney with intraluminal invasion. The mean R.E.N.A.L nephrometric score was 10.32 ± 1.34.

RESULTS: The duration of the surgery was 402.07 ± 83.21 minutes. The duration of cold ischemia was 149.9 ± 53.1 minutes. Blood loss – 751.1 ± 633.6 ml. Renal vascular replacement was performed in 13 patients. Postoperative complications >II degree according to Clavien – Dindo were detected in 36.6% (16) of patients. There was only one lethal outcome due to mesenteric thrombosis at day 4. Disease progressed in 6.8% (n = 3) of cases. The GFR level before surgery was on average 72.3 ± 16.8 ml / (min · 1.73 m²⁾, in the early postoperative period – 58.7 ± 28.3 ml / (min · 1.73 m²⁾, 1 year after surgery – 69.4 ± 26.2 ml / (min · 1.73 m²⁾. One year after surgery it was 69.4 ± 26.2 μmol/l. The follow-up period ranged from 8 to 86 months (on average 58.7 ± 19.1 months).

CONCLUSIONS: This technique is effective in patients with multiple foci, centrally located and large tumors, for hard-to-reach localizations, as well as in patients with the impossibility of intracorporeal pharmaco-cold ischemia, peculiarities of organ blood supply.

BACKGROUND: The study of the relationship between the presence of varicocele and male infertility is the subject of numerous studies, while many aspects of impaired spermatogenesis remain unclear. It has been established that after surgical treatment of varicocele, fertility is not restored in a significant number of patients. In this regard, the search for new and pathogenetically substantiated methods of treating such patients seems to be very relevant.

AIM: To evaluate the effectiveness of antioxidant therapy in spermatogenesis disorders in men with varicocele, prescribed both in combination with surgery and as monotherapy.

MATERIALS AND METHODS: Three groups of infertile men with varicocele were observed, who were treated with Speroton (a complex containing folic acid, L-carnitine, zinc, selenium, vitamin E) 1 sachet once a day, the duration of the course was three months. Patients of the first group (n = 43) were prescribed the drug after the Ivanissevich operation, the patients of the second group (n = 37) received antioxidant therapy during three months before the Ivanissevich operation and continued for three months after it. Patients of the third group (n = 21) did not undergo surgery, but received only antioxidant therapy for six months. The results of the combined treatment and conservative therapy with Speroton were compared with the results of treatment of 65 infertile patients who underwent only Ivanissevich’s operation.

RESULTS: In patients with varicocele with initially pathological parameters of ejaculate, who were prescribed drugs with antioxidant properties in the postoperative period as an adjuvant treatment for 3 months, in 76.7% of cases there was a change in spermogram indicators towards improvement. The most significant changes were observed six months after the operation and subsequent adjuvant therapy. The indicators characterizing sperm motility underwent more noticeable changes. In patients who received only antioxidant therapy for six months, in all cases, there was a statistically significant (p < 0.001) improvement in sperm motility, which persisted for six months and exceeded these changes in groups of patients with adjuvant therapy and neo- and adjuvant therapy.

CONCLUSIONS: The results obtained allow us to conclude that there is no need for surgical treatment for varicocele in order to treat male infertility, since the operation itself can negatively affect the state of spermatogenesis, and conservative antioxidant therapy leads to better results in infertility treatment than the performed operation or any combination of it with antioxidant therapy.

BACKGROUND: Improving the results of treatment of patients with chronic prostatitis is one of the important problems of modern urology.

AIM: To compare the effect of ozone therapy and hypercapnic therapy on the hemodynamics of the prostate and immune status in patients with chronic abacterial prostatitis.

MATERIALS AND METHODS: The study included 58 patients with chronic abacterial prostatitis, who were divided into three groups. Patients of the 1st group (n = 18) received standard therapy. Patients of the 2nd group additionally underwent a course of transrectal ozone therapy for 10 days. Patients of the 3rd group, in addition to the basic therapy, performed training on a breathing simulator to obtain the effect of hypercapnic hypoxia; the course of treatment consisted of 10 daily trainings. The effectiveness of therapy was assessed using the NIH-CPSI questionnaire. To assess the immune status of patients, we studied the content of IgA, IgG and IgM in the blood, the activity of the pro-inflammatory cytokines IL-1β, TNF-α, IL-6 in the blood serum and IL-8 in the urine. The state of blood flow in the prostate gland was assessed using laser Doppler flowmetry, as well as TRUS performed in the color Doppler imaging mode. The control group included 22 healthy men.

RESULTS: In patients with chronic abacterial prostatitis hemodynamic and microcirculatory changes in the prostate gland were revealed, which were accompanied by characteristic clinical manifestations, urinary disorders, as well as impaired immune status in the form of an increase in the content of interleukins and tumor necrosis factor. The use of basic therapy (1^st group) helps to reduce the clinical manifestations of chronic abacterial prostatitis, but its effect on the immune status, hemodynamics and microcirculation of the prostate gland is insufficiently expressed. Complex therapy, supplemented by training on a breathing simulator using the effect of hypercapnic hypoxia, has a positive effect on the course of the disease (3^rd group). This type of therapy is able to improve the microcirculation of the prostate gland, increasing the index of microcirculation efficiency and average blood flow, reducing the shunting rates, but its effect on immunity is lower than in patients whose treatment included transrectal ozone therapy (2^nd group). This type of treatment leads to a decrease in the activity of the pro-inflammatory cytokines IL-1β, TNF-α, IL-6 in the blood serum, and IL-8 in the urine, but at the same time does not have a sufficient effect on prostate hemodynamics and microcirculation.

CONCLUSIONS: In patients with CAP with pronounced disorders of the immune status, complex treatment is indicated, supplemented by transrectal ozone therapy, and in the presence of pronounced hemodynamic disorders of the prostate gland, complex therapy is indicated, supplemented by the use of the effect of hypercapnic hypoxia.

BACKGROUND: Increasing the effectiveness of treatment of patients with symptoms of the lower urinary tract is one of the main problems of modern urology, which is associated both with their high prevalence and with a significant deterioration in the quality of life of patients.

AIM: The article presents the results of the usage of the entomological drug Adenoprosin® in the combined treatment of patients with lower urinary tract symptoms due to benign prostatic enlargement.

MATERIALS AND METHODS: 80 patients were treated (mean age 63.6 ± 6.4 years). At the initial phase of the study, all patients received Tamsulosin 0.4 mg once a day for 4 weeks. At the second phase, the patients were divided into two groups. Group 1 patients were prescribed a combination therapy with Adenoprosin (1 rectal suppository (150 mg) at night, for a course of 30 suppositories) and Tamsulosin (0.4 mg per day). Patients of the 2^nd group continued monotherapy with Tamsulosin (0.4 mg per day). The duration of the second phase of treatment was 4 weeks.

RESULTS: The results of the study showed a more pronounced positive dynamics of clinical indicators in patients of the 1^st group, who received combination therapy with Adenoprosin and Tamsulosin, compared to patients of the 2^nd group. There was a more pronounced decrease in the IPSS score, an improvement in the quality of life, an increase in the urine flow rate and a decrease in the volume of residual urine. The volume of the prostate gland did not change significantly. When examined 2 weeks after the end of treatment, the positive dynamics of clinical indicators in patients of the 1^st group persisted. The tolerability of the treatment was satisfactory in patients of both groups.

CONCLUSIONS: The results of the study indicate the advisability of including Adenoprosin in the combination therapy of patients with lower urinary tract symptoms due to benign enlargement of the prostate gland.

The review article is devoted to the usage of extracorporeal magnetic stimulation in the treatment of urological diseases. Based on the analysis of scientific publications in the PubMed, Medscape, Google Scholar databases, modern data on the mechanism of the therapeutic effect of this method, the method of performing the procedure, the results of clinical studies of its effectiveness in the treatment of urinary incontinence, bladder hypoactivity, chronic pelvic pain syndrome, erectile dysfunction and premature ejaculation are presented.