[THE MODERN PROSPECT FOR CITRATE MIXTURES IN THE TREATMENT OF UROLITHIASIS].

The authors present a review of literature on the use of litholytic citrate medications for conservative management of urolithiasis. Urate urolithiasis is the most common clinical condition encountered by urologists. Citrate agents, in particular Blemaren, not only may be employed in a conservative therapy of uric acid stones, but can also be successfully used in the treatment of the calcium urolithiasis, i.e. mixed composition stones, which is supported by current international urology guidelines.

[On extended biopsy of the prostatic gland].

The aim of our trial was to investigate correlation between the size of the prostate and probability of cancer detection with transperineal biopsy. Transperineal 12-sample biopsy of the prostate was made in 203 men aged 48-58 years (mean age 68.0 +/- 8.6 years) suspected of having prostatic cancer (PC). Total detection of cancer was 33.5%. PC patients had higher levels of PSA, more frequent alterations at rectal palpation and transrectal ultrasound investigation, while mean size of the prostate was the same in cancer and cancer-free patients. Differences in PC detection rate in patients with different sizes of the prostate were statistically insignificant. Use of sextant biopsy could not detect PC in 15 males (22.1%) cases. Thus, there is no correlation between the size of the prostatic gland and diagnostic value of transperineal biopsy obtaining 12 tissue samples. The above data do not support the necessity of extended biopsy in patients with large prostate.

[Local anesthesia with block of the sexual nerve in conduction of transperineal biopsy of the prostate].

We studied 137 males (mean age 68 +/- 8.6 years) with suspected prostatic cancer who had undergone transperineal biopsy of the prostate (12 tissue samples). The biopsy was made under local anesthesia either as paraprostatic block (n=76, group 1) or paraprostatic block in combination with block of the sexual nerve (n=61, group 2). Pain intensity was evaluated with visual analogue scales. Induction of anesthesia was more painful in group 2, three other stages--in group 1. Mean pain at biopsy was significantly (p < 0.001) lower in group 2. Thus, addition of sexual nerve blockade to standard paraprostatic block increases efficacy of anesthesia in conduction of transperitoneal biopsy of the prostate.

[The role of ureteral function in formulation of indications for endoscopic treatment of neuromuscular dysplasia of the ureters in adults].

Function of the affected ureter was studied with multichannel impedance ureterography in 6 adult patients (age 18-35 years) with neuromuscular ureteral dysplasia (NUD). Of them, 5 patients had compensated ureteral contractility. These patients received endoscopic therapy with Ho-laser consisting of circular ablation of congenital stricture of intramural portion of the ureter. Control examinations (maximal follow-up 6 years) demonstrated a significant stable decrease in dilatation of the upper urinary tracts.

[Subtotal transurethral prostatectomy in the treatment of patients with prostatic cancer].

The results are given of subtotal transurethral resection (subtotal TUR) in 21 patients with prostatic cancer (PC) operated in 1998-2004. The patients had contraindications to radical treatment. The aim of the surgical intervention was maximal possible removal of the prostatic tissue to the prostatic capsule that improves results of adjuvant hormonal and radiotherapy. Postoperative follow-up lasted from 6 months to 6 years. The control groups consisted of 20 patients subjected to palliative prostatic TUR and 24 PC patients given only hormonal or radiotherapy. Subtotal transurethral prostatectomy and TUR of the prostate were successfully made in all the patients. The number of postoperative complications and reoperations was less in patients after subtotal transurethral prostatectomy than in those after palliative TUR. The treatment reduced blood PSA levels in all the groups but the progress of this reduction depended on the treatment method. The group after subtotal transurethral prostatectomy achieved maximal PSA lowering after 2 months after surgery. The follow-up registered distant metastases in 19.04% patients of the study group and 20 and 29.4% in the control groups. One-year survival was 80.95, 80, 83.3%, respectively; 3-year survival was 80, 45.5 and 77.8%, respectively. Thus, combined treatment of prostatic cancer (subtotal transurethral prostatectomy and maximal androgenic blockade) rapidly corrects urination without deterioration of survival parameters compared to hormonal therapy alone.

[Biodegradable ureteral stents in treating patients with infravesical obstruction]. / Biorastvorimye uretral'nye stenty v lechenii bol'nykh s infravezikal'noi obstruktsiei.

Biodegradable endoprostheses SR-PLGA and SR-PLLA were used in combined treatment of 39 patients with urethral stricture (n = 24), neurogenic urinary bladder (n = 9), benign prostatic hyperplasia (n = 4), prostatic cancer (n = 2). In definition of indications for stent implantation the leading role was assigned to preoperative diagnosis of the state of the urinary bladder, urethra and sphincters using urodynamic tests and dynamic Doppler and three-dimensional echourethrography. Introduction of biodegradable urethral stents provides adequate spontaneous urination and allows avoiding external drainage. This prevents nosocomial infection and lowers the number of inflammatory complications. Palliative usage of stents in inoperable and neurological patients is effective in their medical and social rehabilitation. Analysis of errors and complications in 8 patients demonstrates that implantation of biodegradable stents is not absolute safe and requires some caution.

[Features of BCG-therapy in treating patients with superficial bladder cancer]. / Osopennosti BTsZh-terapii pri lechenii bol'nykh poverkhnostnym rakom mochevogo puzyria.

AIM: To specify features of BCG-therapy which may predict effectiveness of the treatment and optimize the treatment regimen. MATERIAL AND METHODS: Intravesical immunotherapy with imuron (a 6-week course) was conducted in 62 patients with superficial cancer of the urinary bladder who had undergone surgical treatment and were prognostically poor. 51 patients of group 1 received maintenance therapy as 3 weekly instillations each 3 months for the first year followed by once in 6 months. 11 patients of group 2 received single monthly instillations. All the patients registered their complaints, measured body temperature with fixation of maximal value. The diagnosis of the recurrence was made with control cystoscopy carried out each 3 months in the first postoperative year and later once in 6 months. RESULTS: Recurrent tumors were observed in 25 (49%) and 7 (63.6%) patients of groups 1 and 2, respectively. Side effects (high body temperature, dysuria and macrohematuria) were reported in group 1 during basic treatment. Side effects occurred also in maintenance. They were more pronounced than in group 2. CONCLUSION: Intravesical BCG-therapy causes cystitis considered a normal reaction to treatment. Fever indicates an inflammatory reaction which is rather a positive sign of immune reaction and may serve a prognostic factor.

[Use of biodegradable stents in treating complex urethral strictures]. / Ispol'zovanie biorastvorimykh stentov v lechenii slozhnykh striktur uretry.

Seven men with complex urethral strictures after examination using three-dimentional and echocontrast sonourethrography were subjected to transurethral laser vaporation of the scar tissue in the region of the narrowing, implantation of the biodegradable urethral SR PLGA stents at contra cystourethroscopy. Internal drainage of the urinary bladder with the use of SR-PLGA stents provides protection against exogenous infection and complications of epicystostomic or urethral cathetarization. High informative value, low invasiveness and relative safety of sonourethrography allows one to revise the role of ultrasound investigation in the algorithm of diagnosis and choice of treatment for patients with strictures and obliterations of the urethra.

[Temporary ureteral stents in patients with neuorgenic dysfunction of the urinary bladder]. / Vremennye uretral'nye stenty u bol'nykh s neirogennoi disfunktsiei mochevogo puzyria.

Biodegradable spiral stents were used in the treatment of detrusor external sphincter dyssynergia (4 patients) and detrusor areflexia with external sphincter spasticity (3 patients). All these patients had spinal injuries. After the stent placement all the patients could urinate almost without residual urine. In patients with detrusor-external sphincter dyssynergia mean voiding pressure was 79 cm water before treatment and 37 cm 10 weeks after the stent introduction. Biodegradable spiral stents are a promising treatment for patients with neurogenic bladder.

[Acute urinary retention caused by urethral polyp]. / Polip uretry, vyzvavshii ostruiu zaderzhku mocheispuskaniia.

A polyp of the prostatic part of the urethra is a rare pathological finding. A 20-year-old male visited our clinic with acute urinary retention. Ultrasound investigation, x-ray and endoscopic examinations revealed a polyp of the prostatic urethra. The polyp was resected by Ho-YAG laser. The resection resolved the urinary retention. The histopathological diagnosis was fibroepithelial polyp.

[Ho-YAG laser endoscopic treatment of ureteral strictures]. / Endoskopicheskoe lechenie striktur mochetochnika gol'mievym lazerom.

Ho-YAG-laser radiation with wave length 2.09 microns is a perspective line in high-energy laser treatment of urinary diseases. The authors have performed 24 operations in 23 patients with ureteral strictures. The antegrade approach was used in 11 patients while the retrograde one in 12 cases. Primary or secondary strictures occurred in 8 and 15 patients, respectively. Dissection and ablation of the scar tissues were conducted in 15 patients with secondary strictures. Cut of the stricture only was made in 8 patients with primary strictures. Ho-YAG-laser endoscopic treatment of secondary and primary ureteral strictures reached 93.3%(14 patients) and 75%(6 patients), respectively. Overall efficacy was 88.2%(20 patients). Ho-YAG-laser endopyeloplasty promoted quicker recovery of urodynamic and functional parameters of the upper urinary tract.

[Holmium laser treatment of benign prostatic hyperplasia]. / Gol'mievyi lazer v lechenii bol'nykh dobrokachestvennoi giperplaziei predstatel'noi zhelezy.

Transurethral laser adenomectomy was performed in 37 patients with benign prostatic hyperplasia (BPH) aged 49-73 years (mean age 68 years) under epidural anesthesia. The intervention lasted 35-90 minutes (mean--55 minutes). Ho-YAG-laser was used (Versa Pulse, Coherent; 80 W, impulse regime, 2.09 microm, 50-100 Hz). 32 patients had intercurrent diseases (essential hypertension, diabetes mellitus, etc.). If the procedure technique was not violated, the postoperative period ran uneventfully. Coagulative effect of Ho-laser minimizes blood loss. Foley catheter was inserted. 12-24-h continuous irrigation of the urinary bladder was carried out. The drainage of the bladder with urethral catheter took 1-3 days. All the patients were discharged from hospital on postoperative day 5-7. Their condition was satisfactory. The patients were followed up for 8 months. Positive changes in urodynamics were recorded: I-PSS dropped from 21.4 to 11.2, maximal urine flow rate increased from 7.3 to 20.2 ml/s. Residual urine volume diminished to 0-30 ml compared to 190 ml before the operation. Secondary bleeding was absent. Minimal traumaticity and minimal blood loss allow to recommend laser adenomectomy both for BPH with and without intercurrent diseases.

[Diagnosis of the "valve effect" of the middle lobe of prostate in benign prostatic hyperplasia and choice of the treatment method]. / Diagnostika "klapannogo éffekta" dobrokachestvennoi giperplazii prostaty za schet srednei doli i vybor metoda ee lecheniia.

As there are still no accurate criteria of assessing middle-lobe prostatic benign hyperplasia contribution through the "valve effect" to development of infravesical obstruction, the authors propose to introduce "miction" transrectal ultrasonic study. This study provides evidence allowing to divide patients with middle-lobe prostatic benign hyperplasia into three groups by the degree of the "valve effect". This enables differential approach to choice of the scope of the operative intervention.

[Pharmaco-profilometry using alpha-1a adrenergic blockers in the diagnosis of dynamic infravesical obstruction in the vesicourethral zone segment]. / Farmakoprofilometriia s alfa 1a-adrenoblokatorami v diagnostike dinamicheskoi infravezikal'noi obstruktsii v zone puzyrno-uretral'nogo segmenta.

Alpha-blockers decrease sympathetic influence and thus lower pressure in bladder neck region. Pharmacoprofilometry with tamsulosin was used in diagnostic dynamic outlet obstruction in 43 patients with benign prostatic hyperplasia (BPH) and in 17 patients with urethral stricture. 12 BPH patients with positive results of the test received tamsulosin in a single daily dose 0.4 mg. After 3 months the subjective symptom score significantly improved in all the patients. Stenosis of the urethra and bladder neck was found in 17 patients who had micturation disturbance in different periods after prostatectomy. In 9 patients urethral pressure in the region of the bladder neck decreased after 3 days of tamsulosin treatment given a single daily dose 0.4 mg. Urethrotomy without bladder neck resection was performed in these patients. Three months later average Q max increased from 6 ml/s to 18 ml/s and residual urine decreased from 112 ml to 30 ml. Selective alpha-blocker profilometry allows to distinguish between organic and functional neck stenosis and choose the necessary treatment.