[Treatment of patients with abscess of prostate gland by the method of percutaneous punction].

OBJECTIVES: Demonstrate the treatment of prostatic abscess with a minimally invasive method - abscess puncture with aspiration of purulent fluid and injection of an antibiotic into abscess cavity. MATERIALS AND METHODS: Diagnosis of prostatic abscess of 23 patients using ultrasonography, computed tomography and magnetic resonance imaging of the pelvic region. 19 patients with the abscess within the prostatic capsule were treated with perineal percutaneous puncture method with aspiration of the abscess fluid and injection of antibiotics into cavity. For 4 patients with prostatic abscess and purulent paraprostatitis we performed incision and drainage of purulent cavity with open transperineal access. RESULTS: Single abscess puncture was enough to normalize health status of 15 patients. In 4 cases additional puncture was required in 4-5 days after the first manipulation. All the patients recovered and were discharged from the clinic in 7-8 days. Patients after abscess incision and drainage stayed in hospital for 10-14 days. In 1-3 months after the surgery, imaging methods revealed a high-density lesion in prostate whatever the method was used. DISCUSSION: Treatment response was controlled by imaging methods. 2 days after puncture 4 patients had a lesion with liquid content larger than 50% of the initial purulent lesion size. Repeated puncture was performed in this patients. CONCLUSION: Abscess puncture with aspiration of fluid is an effective method of treatment when prostatic abscess is within the capsule. In cases of purulent paraprostetitis incision and drainage of an abscess cavity is needed.

[Uroflowmetry in examination of the female with stress urinary incontinence].

AIM: Show the ability of uroflowmetry to record episodes of involuntary loss of urine at an altitude cough bursts. MATERIAL AND METHODS: A total of 49 women with a genital prolapse and stress urinary incontinence. The study was conducted during bladder filling 150-300 ml of urine. A patient chair being Uroflowmeter three times at intervals of 3-5 coughs seconds. Episodes of involuntary discharge of urine at an altitude cough shocks on uroflowgramme recorded as separate trapezoidal or triangular peaks. The same procedure was carried out and after surgery. RESULTS: All women graphically documented episodes of involuntary discharge of urine at an altitude cough shocks before operation. Uroflowmetry after surgery confirmed the fact of continence. DISCUSSION: The study is simple, not cumbersome for the patient. The opportunity to document the diagnosis stress urinary incontinence. CONCLUSIONS: The proposed method of uroflowmetry in examining women with stress urinary incontinence allows not only to estimate the total evacuation function of the bladder and urethra, but also graphically record the episodes of involuntary loss of urine during coughing.

[Erosions of the vaginal, bladder and urethral mucosa after transvaginal correction of genital prolapse and stress urinary incontinence using synthetic materials].

The article presents the results of treatment of 13 women with erosion of the vaginal mucosa with an exposure of the part of prosthesis and 4 women with the migration of fragments of the prosthesis into the lumen of the bladder or urethra after surgical correction of genital prolapse and stress urinary incontinence with the use of synthetic materials (Prolift, TVT operations). Interventions included the removal of part or all prosthesis from zone of erosion of the vaginal mucosa and removal of prosthesis migrated into the lumen of the bladder or urethra. Good results of operations were achieved in all cases. 8-12 months after surgery, recurrence of erosion and migration of prosthesis into the lumen of urinary organs were not observed.

[Condition of the urinary tract and the kidneys in females with prolapse and descent of the internal genitalia].

Excretory urography (EU), retrograde cystography (RC), static and dynamic pelvic MRT, renoradiography (RRG) were performed in 82 females with descent and prolapse of the internal genitalia. The above examination identified four degrees of the urinary bladder descent. The latter descent of the third and fourth degree caused ureteral obstruction in 48.1 and 87.1% cases, respectively, renal dysfunction in 81.5 and 100% cases, respectively. Static and dynamic pelvic MRT proved to be the most informative methods of examination of the urinary bladder and urethra in females with prolapse and descent of the internal genitalia.

[Synthetic prosthesis in surgical treatment of females with stress urinary incontinence combined with genital prolapse].

Simultaneous surgical treatment of females with genital prolapse and stress urinary incontinence using Gynecare Prolift, TVT techniques with use of mesh, colpo-urethrosuspension with threads corrected static disorders of the genital organs in 96.7 +/- 3.3% cases, resulted in adequate continence in 93.3 +/- 4.6% operated patients. A 1.5 to 8 month postoperative follow-up registered adequate urination (no residual urine, complete continence) in 93.3 +/- 4.6% patients.

[Simultaneous operations for combined surgical diseases in urological practice].

The study covered 653 patients with a combination of two surgical urological diseases or one urinary disease with one abdominal disease. Simultaneous operations were made in 409 patients, staged surgical treatment was performed in 154 patients who rejected one stage treatment. Simultaneous surgery was contraindicated because of severe associated diseases in 90 patients. Short-term results showed that simultaneous elective operations are characterized neither by increased frequency of postoperative complications nor longer stay of the patients in hospitals. Medical, psychological and cost-effective benefits of simultaneous operations in the treatment of combined surgical pathology make simultaneous operations promising for wide clinical practice.

New biochemical mechanisms of the anticancer effect of Ukrain in the treatment of cancer of the urinary bladder.

The aim of this study was to elucidate the mechanisms of the anticancer effect of Ukrain by comparing the processes of formation of the pool of free amino acids and their derivatives in the blood plasma and tumor biopsy specimens and unchanged bladder tissue in 28 patients with T1N0M0 bladder cancer. The examination was carried out before and after Ukrain treatment (10 mg i.v./day, for 20 days), which was combined with systemic chemotherapy for bladder cancer. Twenty-eight patients served as controls and received systemic chemotherapy only. Compared with healthy donors, the blood plasma of patients with urinary bladder cancer showed decreased concentrations of thiol-containing free amino acids and glutamine (Gln) and increased levels of nonessential (glutamic acid, proline, alanine) and aromatic (phenylalanine) free amino acids. In contrast to conventional chemotherapy, treatment with Ukrain eliminated the blood plasma amino acid imbalance in patients with bladder cancer, concomitantly enriching the pool of free amino acids and their derivatives in unchanged urinary bladder tissue and decreasing concentrations of Gln and leucine (Leu), regulators of malignant cell proliferation and differentiation, by 30-50%. In this situation, the concentrations of Gln and Leu in tumor tissue and the surrounding healthy urinary bladder tissue correlated highly significantly and negatively (r = -0.95). In conclusion, Ukrain prevents active free amino acid transport into urinary bladder tumor tissue, inhibiting the activities of protein biosynthesis, gluconeogenesis and energy production. The combined decrease in Gln and Leu levels in urinary bladder tumor tissue is a specific sign of the antitumor effect of Ukrain and a mechanism of its cancerostatic action by controlling the processes of amino acid pool formation in the tumor.

Results of Ukrain monotherapy of prostate cancer.

This study included 15 patients with newly diagnosed prostate cancer with an average age of 71 years (62-85 years). The patients received Ukrain at a total dose of 100 mg (10 mg intravenously every second day, 10 injections altogether). After two to three injections of Ukrain, all the patients noted considerable subjective improvements in their state. Ukrain increased the amount of total T-lymphocytes, including "active" T-lymphocytes, decreased the content of T-suppressors and increased that of T helpers, correspondingly raising the T helper/T-suppressor ratio. Our results undoubtedly indicate the efficacy of Ukrain in the treatment of prostate cancer.

Ukrain therapy of stage T1N0M0 bladder cancer patients.

The aim of the present study was to evaluate the efficacy of Ukrain as a new treatment modality in 28 patients with stage T1N0M0 bladder cancer. The tumor dimensions varied from 0.5 x 0.5 cm to 3 x 4 cm. The first group (nine patients) was treated with a total dose of 100 mg Ukrain, the second group (10 patients) received 200 mg Ukrain, and the third group (nine patients) was treated with 300 mg Ukrain. In all patients Ukrain was administered i.v. at a dose of 10 mg per day. In the patients from the second and third group each course of treatment, consisting of 10 injections, was followed by 14 days of no treatment. Ukrain, at a total dose from 100-300 mg as neoadjuvant therapy in patients with T1N0M0 bladder cancer, resulted in either complete or partial regression of tumors in 60.7 +/- 9.2% of cases. The best treatment regime included three courses of Ukrain at 2-week intervals.

[Results of organ preserving treatment of T1,2 kidney tumors]. / Rezul'taty organosokhraniaiushchego lecheniia bol'nykh rakom pochki T1,2.

The results of organ-saving surgery performed for kidney tumor T1.2N0M0 in 21 patients are presented. The renal pole or a tumor-bearing sector of the parenchyma of the kidney was resected in all cases. Metastases developed in the retroperitoneal lymph nodes 6-9 months after pole resection in 2 cases of pT2N0M0 tumor in whom no lymphadenoctomy had been carried out. The remaining 19 patients have survived 6-48 months without any signs of recurrence or metastasis. Organ-saving surgery for kidney tumor T1N0M0 should be considered justified provided lymphadenectomy is performed.

[Diagnosis and treatment of locally advanced cancer of the urinary bladder]. / Diagnostika i lechenie mestno-rasprostranënnykh form raka mochevogo puzyria.

The term "locally advanced cancer of the urinary bladder" is discussed. The data on examination and treatment of 375 patients are presented to work out criteria of diagnosis of the disease. Such patients have been shown to reveal extensive lesions from bladder tumor coupled with such homeostatic disorders as hypoamino-acidemia, endotoxicosis, metabolic acidosis, immunity deficiency and disturbed hemoglobin-mediated transport of oxygen. Early postoperative complication incidence can be cut by 30-47% and 3-year survival after cystectomy-increased by 19% provided said homeostatic disturbances are corrected and immuno- and biostimulation is carried out. The best results in the treatment of locally advanced urinary bladder cancer (T2(m)N0M0) were recorded among cases of organ-saving therapy-65-70% have survived 5 years. Only 36.4% of patients with tumor (T3abN0M0) who received complex treatment (cystectomy + preoperative homeostatic correction) have survived 5 years. None of the patients with tumor (T4N0M0) has survived 3 years; therefore, only radiation and chemotherapy should be recommended in such cases.

[Comparative evaluation of effectiveness of some methods of treatment in locally invasive cancer of the urinary bladder]. / Sravnitel'naia otsenka éffektivnosti nekotorykh metodov lecheniia mestno-rasprostranennykh form raka mochevogo puzyria.

Five-year survival cumulative results have been used to assess the efficacy of treatment for locally extended carcinoma of the urinary bladder using different methods: radiation + resection of bladder + chemotherapy; radiation + cystectomy with ureterosigmoanastomosis+chemotherapy; radiation + cystectomy with ureterocutaneostomy + chemotherapy; chemoradiation treatment. In the group of patients with tumors T2(m)NoxMo, the best cumulative results for survival (65 and 70%) were obtained in cases of organ-saving surgery. In tumor T3a, bNox(+, -)Mo group, the best results for survival (31.3%) were registered in patients who had undergone cystectomy. Five-year survival level was not attained in patients with tumors T4a, bNox, IMo, which makes the case for chemoradiation treatment application.

[The fate of bladder cancer patients who refused radical treatment]. / Sud'ka bol'nykh rakom mochevogo puzyria, otkazavshikhsia ot radikal'nogo lecheniia.

Survival of 117 operable male patients who had refused treatment was compared to that of 267 male patients who had undergone radical therapy. It was shown that treatment did not influence five-year survival of patients with T cancer. The same tendency was observed for T4 tumors. Radical treatment was associated with a significantly longer survival in T2-3 cancer patients. In the T1-2 tumor group, mean survival following diagnosis was affected by patient age whereas the relationship was far less apparent in cases of T3-4 cancer.

[The dispensary care and work disability expertise of bladder cancer patients following cystectomy]. / Dispanserizatsiia i vrachebno-trudovaia ékspertiza bol'nykh rakom mochevogo puzyria posle tsitéktomii.

A question of the principles and methods of medical prophylactic survey in patients with bladder cancer who have undergone cystectomy with subsequent ureterosigmoid anastomosis and ureterocutaneostomy is not currently developed. On a basis of 79 follow-ups of patients with bladder cancer after cystectomy, a procedure of prophylactic survey in the setting of regional oncologic dispensary and district polyclinic was worked out. It is stressed that it is necessary to follow up the patients for a possible relapse and metastasis development as well as complications of the upper urinary tract and kidneys and metabolic shifts (acidosis, dyselectrolytemia). From this viewpoint we propose a scope of essential examinations during the medical prophylactic survey. Our results of the patients follow-ups after cystectomy are also given. Recommendations for the patients working ability estimation are proposed and it is noted that the estimation is to be carried out on a strictly individual basis because the patient's rehabilitation depends on many factors. But the main principles of such patients' working ability estimation are submitted in schemes of a working ability examination. They depend on the stage of the process and on the method of urine drainage after cystectomy.

[The free amino acid content of the blood serum in bladder cancer patients]. / Soderzhanie svobodnykh aminokislot v syvorotke krovi bol'nykh rakom mochevogo puzyria.

The content of 18 amino acids in the blood serum was studied in 57 patients with T2-4 carcinoma of the bladder according to the stage of the process and the functional condition of the kidneys. Dysaminoacidemia was found in patients with T2 bladder carcinoma, which did not need correction; marked hypoaminoacidemia was encountered in stage T3-4 tumors. Chronic renal insufficiency (intermittent and terminal stages) is conductive to significant decrease of the blood amino acid level. The content of amino acids is lower in the postoperative than in the preoperative period. The degree of reduction of the amino acid content in blood was found to be dependent on the volume of the operation. The reduction of the amino acid content is more intense after cystectomy than after resection of the bladder. Correction of the blood amino acid content in the preoperative period in patients with T3-4 carcinoma of the bladder reduces the incidence of postoperative complications. Correction of hypoaminoacidemia with polyamine proves effective in patients with maintained renal nitrogen excreting function. In development of azotemia in patients with bladder carcinoma, substitution transfusion therapy for correction of hypoaminoacidemia becomes effective only after restoration of the nitrogen excreting function of the kidneys.

[Changes in protein metabolism and the free amino acid profile in bladder cancer]. / Izmeneniia belkovogo obmena i fond svobodnykh aminokislot pri rake mochevogo puzyria.

Protein metabolism status was assessed by standard procedures versus tumor stage and nitrogen-excreting function of the kidneys in 250 cases of urinary bladder cancer. In addition, 18 amino acids in the blood were assayed in 63 patients. Standard methods of examination identified protein metabolism disturbances in patients with stage III-IV renal failure whereas amino acid profile showed changes at a much earlier stage. Patients with T3-4 tumors revealed decreased blood amino acid levels. Renal failure and surgical trauma caused the level of most amino acids checked to decrease. The need for correction of the amino acid profile of the blood before and after surgery is discussed.

[Causes of the functional disorder of the kidneys in patients with bladder cancer after cystectomy with ureterosigmoid anastomosis]. / Prichiny narusheniia funktsii pochek u bol'nykh rakom mochevogo puzyria posle tsistéktomii s ureterosigmoanastomozom.

Cystectomy with ureterosigmoid anastomosis by modified Goodwin's technique was performed in 47 patients with local vesical cancer. Pre- and postoperative functional status of the kidneys was assessed by means of renography, excretory urography and laboratory tests. Unilateral or bilateral renal dysfunction developed within 12 to 18 months after surgery in 22.2% of patients with good pretreatment renal status. In cases of preoperative renal impairment, it improved postoperatively in just 35% of the patients. Rectoromanoscopy, contrast sigmoidography and excretory urography demonstrated pathological conditions in the area of ureterointestinal anastomoses (strictures, gaping or anastomositis) or sigmoid changes (sigmoiditis, kinking or stenosis in the perianastomosis area) in 83.3% of patients with impaired postoperative renal function. These conditions lead to hydroureteronephrosis, intestinoureteral refluxes and progress or development of pyelonephritis as a result. It is concluded that the state of ureterointestinal anastomoses and the sigmoid should be assessed specifically in postureterosigmoid anastomosis patients with impaired renal function. The surgical techniques and the degree of ureteral dilatation can make an important contribution to pathologic conditions developing around the anastomoses. Good functional activity of the kidneys and the absence of upper urinary dilatation are the principal prerequisite for ureterosigmoid anastomosis.

[Short- and long-term results of cystectomy in localized bladder cancer]. / Neposredstvennye i otdalennye rezul'taty tsistéktomii pri mestno rasprostranennykh formakh raka mochevogo puzyria.

Long-term results of cystectomy involving formation of ureterosigmoid anastomosis and ureterocutaneostomy were studied in 51 cases of cancer of the urinary bladder. Half the patients with T2 tumors and 23%--with T3 tumors survived for 3 years and longer. Tumor process generalization caused death long after operation in 64.2%, while renal failure--in 32.1%. During 1-2 years of follow-up, such pathological changes in uretero-intestinal anastomoses as abnormally large diameter of ostium ureteris and cicatricial stricture were identified in 14 cases and stricture of uretero-cutaneous stoma--in 2 cases. The best results in formation of ureterosigmoid anastomosis were obtained by application of transsigmoid procedures which assured reflux prevention, retention change-free ureters alone being eligible for use in anastomosis.