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卷 11, 编号 4 (2021)
- 年: 2021
- 文章: 9
- URL: https://journals.eco-vector.com/uroved/issue/view/4477
- DOI: https://doi.org/10.17816/uroved.114
Original articles
肾癌药理冷缺血条件下体外切除原位再植肾的方法
摘要
研究现实性:提高肾癌患者的治疗效果是肿瘤学的主要问题之一。在其解决方案中,高度重视新外科技术的发展。
本研究的目的是评估肾癌患者在冷缺血条件下进行体外肾切除术并原位再植的结果。
材料与方法。这项研究包括44名肾癌患者,包括31名男性(70.5%),13名女性(29.5%)。所有患者在2012和2021之间进行治疗。患者的平均年龄为55,92±12,6岁。TNM分期:Ca1—3bN0M0-1 G1-3。 75%(33)的患者诊断为pT1a-1b期;pT2a–2b—在11.4%(5)中,一名患者发现多处病变;pT3a–3b—在13.6%(6)中,一名患者的单个肾脏最多有15处病变;两名手术患者患有单发肾癌并有腔内侵犯。肾计量指数R.E.N.A.L.—10.32的平均得分±1.34.
结果。手术时间为402.07±83.21分钟。冷缺血持续时间为149.9±53.1分钟。失血量-751.1±633.6毫升。13例患者进行了肾血管修复术。根据Clavien–Dindo分类,在16名(36.6%)患者中检测 到了II级以上的术后并发症。术后第4天因肠系膜血栓形成而致死的结果只有1例。3例(6.8%)病例出现疾病进展。术前肾小球滤过率水平平均为72.3±16.8毫升/(分钟·1.73平方米),术后早期为58.7±28.3毫升/(分钟·1.73平方米),术后1年为69.4±26.2毫升/(分钟1.73平方米)。随访时间为8至 86个月(平均58.7±19.1/月)。这些患者的五年总生存率为91%,癌症特异性生存率为93%。
结论。该技术适用于多个病灶、位于中心的大肿瘤、难以到达的定位,以及不可能发生体内药理缺血和器官血液供应特殊性的患者。
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Predictive value of inflammatory indices LMR, PLR and NLR in patients with muscle-invasive bladder cancer
摘要
BACKGROUND: Increasing the efficiency of predicting the results of treatment of patients with bladder cancer is one of the important tasks of modern urology.
AIM: Our aim was to identify and evaluate the association between the most significant clinical, morphological and immunological markers and survival of muscle-invasive bladder cancer patients treated with radical cystectomy. We also developed an algorithm for diagnosis and treatment of patients with muscle-invasive bladder cancer.
MATERIALS AND METHODS: This retrospective study included 100 muscle-invasive bladder cancer patients, who underwent radical cystectomy between 1995 and 2013. The study endpoints were overall survival.
RESULTS: Univariable analysis revealed that continuous (Lymphocyte-monocyte ratio), PLR (platelet-lymphocyte ratio) и NLR (neutrophil-lymphocyte ratio) were significantly associated with overall survival. On multivariable regression model analysis, continuous LMR, NLR, and PLR independently predicted both endpoints.
CONCLUSIONS: Our findings indicate that the cheap and simple blood-based biomarkers may be valuable in identifying muscle-invasive bladder cancer patients treated with radical cystectomy, who are at higher risk of all-cause mortality.
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Antioxidant therapy of male infertility in patients with varicocele
摘要
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.
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Results of ultrasound dopplerography of the penis in patients with before and after transurethral enucleation of benign prostatic hyperplasia
摘要
BACKGROUND: The development of modern technologies for the surgical treatment of urological diseases poses new questions for urologists. One of them is to evaluate the effect of transurethral enucleation of benign prostatic hyperplasia on the erectile function of patients.
AIM: The aim of the study was to assess the state of erectile function in patients before and after transurethral enucleation of benign prostatic hyperplasia using Doppler ultrasound of the vessels of the penis.
MATERIALS AND METHODS: The study included 102 patients with benign prostatic hyperplasia aged 50 to 80 years (average 65 years) with complaints of erectile dysfunction and urinary disorders. All patients underwent transurethral enucleation of benign prostatic hyperplasia: 55 patients with the laser method (HoLEP, group 1) and 47 patients – with the bipolar method (TUEB, group 2). The severity of ED was assessed using the IIEF-5 questionnaire (International Index of Erectile Function). To assess the state of blood flow in the penis, ultrasound dopplerography of the vessels of the penis was performed using a vasoactive erection stimulator. The studies were carried out before surgery and 24 weeks after it.
RESULTS: The results of ultrasound dopplerography of the vessels of the penis before surgery revealed the arteriogenic type of ED in 18 (17.6%) patients, the venous type – in 45 (44.2%) patients, the mixed arteriovenogenic type – in 22 (21.6%) patients. In 17 (16.7%) patients ED was regarded as psychogenic. 24 weeks after the operation in patients of both the 1st and 2nd groups, according to the data of the IIEF-5 questionnaire, positive dynamics of the severity of erectile function was noted, regardless of the type of ED. For patients with vasculogenic types of ED, similar trends were noted regardless of the type of surgery. Thus, in patients with arteriogenic and arteriovenogenic ED a significant increase in the maximum systolic blood flow velocity (Vmax) in the cavernous arteries was recorded, while the values of the resistance index (RI) did not change significantly. At the same time, the Vmax values in these patients were initially low before the operation, and after the operation did not reach the reference values. In patients with venogenic ED, there was no significant improvement in penile blood flow, as evidenced by the absence of significant differences in Vmax and RI values. At the same time, the RI in these patients before the operation was reduced, and the Vmax values were in the range of normal values.
CONCLUSIONS: The erectile function of patients after transurethral enucleation of benign prostatic hyperplasia improves regardless of the type of operation and the type of erectile dysfunction. Ultrasound dopplerography of the vessels of the penis is a minimally invasive and highly informative diagnostic method that makes it possible to detect circulatory disorders in the penis and assess its state in dynamics during treatment.
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Complex conservative therapy of chronic abacterial prostatitis
摘要
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 (1st 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 (3rd 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 (2nd 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.
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Physico-biochemical parameters of urine and blood and biominerology of urinary bladder stones in patients with bladder outlet obstruction
摘要
BACKGROUND: Bladder outlet obstruction is one of the main factors leading to the formation of stones in the urinary bladder. Understanding of the physico-biochemical processes in urine and blood, as well as the biomineralogy of urinary bladder stones, will make it possible to determine the pathogenetically justified treatment of such patients.
AIM: The aim of the study was to identify and study the relationship between the physico-biochemical parameters of urine and blood and the biomineralogical composition of urinary bladder stones in patients with bladder outlet obstruction.
MATERIALS AND METHODS: A comprehensive examination of 76 patients at the age of 37 to 89 years with urinary bladder stones occurred against the background of bladder outlet obstruction was carried out. A comprehensive diagnosis, including an assessment of the physico-biochemical parameters of urine and blood, bacteriological urine tests, radiological diagnostics, as well as biomineralogical studies of concretions, was carried out.
RESULTS: The data obtained show that not all physicochemical parameters of blood and urine of the subjects are comparable with the data of patients with nephrolithiasis. In the vast majority of the studied kidney calculi were not detected, in addition, blood biochemical parameters, including the level of stone-forming substances were within the reference values. In urine tests an increase in some lithogenic substances is detected. Urinary stones in patients with bladder outlet obstruction had a mixed composition, more often phosphates and uric acid salts were detected (75 and 54% of cases, respectively). Considering the nature of metabolism and the increase in uric acid excretion with age, as well as the presence of residual urine in case of bladder outlet obstruction, it can be assumed that uric acid is the primary matrix in cystolithiasis. The data obtained indicate a connection between the infectious process in the bladder and the composition of urinary stones. Against this background, there is a more intensive process of cystolithogenesis.
CONCLUSIONS: The algorithm for the diagnosis of urinary bladder stones secondary to bladder outlet obstruction should include not only the collection of anamnesis and the performance of routine blood and urine tests, but also specific physical and biochemical studies, as well as assess the biomineralogy of urinary stones, which will make it possible to choose an adequate tactics for the pathogenetic treatment of patients and effective metaphylaxis of stone formation.
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Efficacy evaluation of entomological drug Adenoprosin® usage in combined treatment of patients with lower urinary tract symptoms due to benign prostate enlargement
摘要
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 2nd 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 1st group, who received combination therapy with Adenoprosin and Tamsulosin, compared to patients of the 2nd 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 1st 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.
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Reviews
体外磁刺激在泌尿外科的应用
摘要
本文综述了体外磁刺激在泌尿系统疾病治疗中的应用。基于对PubMed、Medscape、Google Scholar数据库中的科学出版物的分析,关于该方法治疗效果机制的现代数据,介绍了执行该程序的方法,临床研究结果表明其在治疗中的有效性尿失禁、膀胱活动不足、慢性盆腔疼痛综合征、勃起功能障碍和早泄。
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非光动力治疗非侵入性膀胱癌的方法
摘要
本文就光动力学在非肌层浸润性膀胱癌诊断中的应用作一综述。本文介绍了这种治疗方法的机理和发病基础、实施方法、所用光敏剂的优缺点以及临床研究结果。已经表明,术中光动力疗法显着降低了经尿道前列腺切除术后膀胱癌复发的发生率,包括carcinoma in situ和尿路上皮肿瘤多灶性生长的患者。
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