卷 11, 编号 4 (2021)

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。

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.

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。