[URETERS INPLANTATION METHOD INTO LOW-PRESSURE SMALL INTESTINE RESERVOIR].

Urine derivation after cystectomy or due to bladder functional impairment more has been a pressing problem in urology for more than a century. Various techniques of urinary derivation after cystectomy due to bladder cancer or non-cancerous diseases have been suggested. In the present day, more often, the artificial reservoirs are formed from the various intestinal segments. The article describes preoperative preparation of patients, surgical technique and efficiency of the specific method of implantation of ureters into low-pressure small intestine reservoir. Statistical data of Al. Tsulukidze National Center of Urology since 1987 and postoperative results and recommendations are presented.

SUCCESSFUL REPAIR OF IATROGENIC URETERAL INJURY IN A PATIENT WITH ECTOPIC CROSSED AND FUSED RIGHT KIDNEY BY URETEROURETEROSTOMY.

Congenital renal malformations are the most common congenital malformations in humans, the most common being horseshoe kidney with joined lower poles present in up to 0.25% of general population. To the contrary renal fusions with ectopia are amongst the rare malformations affecting 1 in 2000 examined cadavers. Males are affected slightly more often then females (3:2), left to right crosses being more frequent. The value of early diagnosis of asymptomatic renal malformation is uncertain, except when other abnormalities might point to them and they can affect the clinical management strategy (severe ear deformity with facial malformation, gynecological abnormalities). In females concomitant abnormalities of kidneys and paramesonephric duct derivatives are common, with up to 40% of women with uterine malformations reported to have various congenital renal abnormalities. Even though there are occasional examples of surgical repair of the injured kidneys with crossed-fused malformation the majority of surgical cases resort to renal resection. We presented a rare case of complex genitourinary malformation with crossed fused disk kidney diagnosed after the iatrogenic injury to the right ureter after emergent gynecological surgery. Rare pathology and presentation was diagnosed by IVP and confirmed during operation. We have constructed an ipsilateral ureteroureterostomy to drain the right portion of fused kidney. Urinary flow was satisfactory with no significant nephrostomy tube drainage next day, allowing the nephrostomy tube removal. Postsurgical evaluation by IVP has demonstrated a good flow from both kidney and no detectable anastomotic leaks. Postsurgical recovery was uneventful. After 2 years from operation IVP data did not changed. It must be noted, that Ectopic kidneys are frequently malformed and have an abnormal ureteral drainage leading to incontinence and frequent UTIs.

[Investigation of metabolic paramagnetic centers in the blood of patients with prostate adenocarcinoma prior to and after the plastic orchectomy].

Paramagnetic centers in the blood of patients with prostate adenocarcinoma have been studied prior to and after plastic orchectomy by EPR. It has been shown that significant alterations in blood paramagnetic centers occur after the surgery. These alterations point to an improvement of antioxidant properties of the blood. Specifically, the content of the Fe(3+)-transferrin complexes increased, and the number of inactivated adrenoreceptors, MetHb, and Mn(2+)-containing complexes decreased. It was found that, along with improvement of the antioxidant properties of the blood, a significant decrease in the intensity of lipid peroxidation in the blood of the patients occurs.

Characteristics of morphological change in erythrocytes during metaststic adenocarcinoma of the prostate before and after castration.

The objective of our study was to establish whether there is a direct link between displayed changes in Erythrocytes and hormonal shifts talking place in organism. For the experimental research we used a blood serum and erythrocytes of 15 men with metastasized adenocarcinoma before castration and a blood serum and erythrocytes of 15 men in 6 months after castration, also a blood serum and erythrocytes of practically healthy men. Age of patients varied from 60-75 years. Structural observation of erythrocytes was conducted by means of light microscope method, and quantitative calculation of steroid hormones was performed by means of the method of imunopherment analysis. Deep morphological changes of erythrocytes were observed in peripheral blood during metastasized adenocarcinoma of prostate gland before and after castration. At the same time during this pathology we detected sharp quantitative change of steroid hormones of testicular and adrenal glands. It was established that the deep morphological changes of erythrocytes in peripheral blood should be related to the cancerous processes occurring in organism (direct way); It was established that during the noted pathology hormonal shifts taking place in organism (indirect way) influence the course of erythropoiesis and cause changes of surface architectonics of erythrocytes, as a result of which pathological erythrocytes -cells with altered form and low functional activity, are formed.

Dynamics of the protein spectrum changes in blood erythrocytes of male patients with prostate adenocarcinoma after plastic orchiectomy.

We have studied erythrocytes electrophoresis profiles in patients with prostate adenocarcinoma before and after plastic orchectomy and in healthy men to detect changes in the protein spectrum of erythrocytes. Our investigations have shown that during this pathology protein spectrum of erythrocytes structure undergoes substantial changes. This is demonstrated by losing of 35 KD molecular weight protein fraction and by appearance of 36 KD molecular weight protein fraction on the erythrocytes electrophoregram. It should be noted, that after plastic orchectomy we can see the relative normalization of erythrocyte's electrophoresis picture and it's approaching to the data of the control group (losing of 120 KD protein fraction and appearance of 48 KD protein fraction), which indicates to the normalization of the condition of the whole organism. It was detected that the synthesis of lower molecular protein fractions, on the one hand is influenced by rising of accantocytes percentage and on the other hand by the activation of the lipid oxidation process in erythrocytes membrane.

Dynamics of the structural and electrical characteristics of erythrocytes in men with metastatic adenocarcinoma of the prostate before and after plastic orchiectomy.

The changes of electrophoretic mobility of erythrocytes in the practically healthy men and in men with metastatic prostate cancer before and after castration were studied. The electrophoretic mobility of erythrocytes was investigated in laboratory conditions by Kharamanenko and Abramson micro methods. Experimental data were processed by means of standard variation statistics MINITAB (Basic statistic) p

[Kidney protein complexes that inhibit gene expression in the nuclei of homotypic cells].

The comparative study of protein complexes (PCs) isolated by alcohol extraction from white rat and human nephrocytes (post-operational material) have been performed. It has been shown that PCs of white rat cells inhibit RNA synthesis in the nuclei of intact as well as nephrectomized (unilateral nephrectomy) animals. The same effect has been shown while studying the PCs of patients with hydronephrotic kidneys. At the same time the inhibition of transcription has not been detected in case of RCC kidney cancer cell PCs. The chromatography studies revealed that the active component of PCs (12 kDa protein factor) which had been detected earlier has not been shown up in cancer cells of human kidney.

[Effects of nebivolol on endothelial dysfunction in patients with diastolic dysfunction of left ventricle].

The aim of our research was to assess the role of vasoactive factors of endothelium (NO and endothelin-1) during diastolic dysfunction of the left ventricle and to determine the effects of nebivolol in the early treatment period of endothelial dysfunction. In the investigation were included 36 male patients (mean age 49+/-6 years) with LVDD due to CAD (22 patients) and essential hypertension (14 patients) as well as in 18 male patients (control group, 12 patients with CAD and 6 with hypertension) without LVDD of matched age, who underwent 2 week treatment with 5 mg nebivolol (Nebilet, Berlin-Chime) . The endothelial dysfunction was assessed by (a) a noninvasive method, brachial artery ultrasound during reactive hyperemia, measured by flow-mediated vasodilatation (FMD), which indirectly reflects the amount of NO and (b) measurement of the amount of ET-1 in the plasma by method of an enzyme-linked immunoassay (ELISA). According to the results of our studies FMD (%) was increased by 73% among the patients with DD of LV whereas among the patients without DD was increased by 66% (p<0,05). Furthermore, statistically none significant decrease of endothelin-1 levels were observed and no difference was found among the groups of patients. Importantly, statistically significant increase of early ventricular filling was found: E/A ratio with Doppler echocardiography at the end of 2 week period treatment reached 1,10+/-0,04 vs. 0,92+/-0,01 before the treatment (p<0,05). Positive correlation was found between FMD (%) and the relaxation capability of the left ventricle (r=0,38, p<0,05). Based on these results we can conclude that endothelial dysfunction might be indicator of LVDD, and by treating the former we can prevent the diastolic dysfunction.

[In vitro effects of cAMP- and cGMP-stimulating drugs on the relaxation of the prostate smooth muscle tissue contraction induced by endothelin-1].

Results from experimental studies suggested a significance of the nitric oxide (NO)-cGMP- and cAMP-pathways in the control of the function of the smooth musculature of the human prostate. In addition, it has also been assumed that the vasoconstrictory peptide endothelin-1(ET-1) may play a role in the dynamic component of benign prostatic hyperplasia (BPH) and the so-called lower urinary tract symptomatology (LUTS). Nevertheless, up till now, little is known as to potential interactions between the contraction of prostatic smooth muscle mediated by ET-1 and the relaxation induced by NO and cGMP. Thus, it was the aim of the study to elucidate the effects of drugs interfering with the cGMP-pathway on the tension induced by ET-1 of isolated human prostate tissue, as well as contractile responses of isolated strip preparations to ET-1 and angiotensin-II (AT-II). Macroscopically normal human prostate tissue from the transition zone was obtained from male patients who had undergone surgery for localized cancer of the prostate or urinary bladder. Using the organ bath technique, the ability of ET-1 and AT-II to contract isolated prostate strips was evaluated. In another set-up, the effects of the NO-donor S-nitrosogluthatione (GSNO) and C-type natriuretic peptide(CNP), known as an endogenous ligand of the membrane bound guanylyl cyclase, (1 nM-1/10 microM) on the tension induced by 0.1 microM ET-1 of human prostate strips were investigated. The adenylyl cyclase stimulating agents forskolin and NO-donor natrium nitroprusside (NNP) were used as reference compounds. While AT-II failed to contract the prostate tissue, ET-1 induced stable and reproducible contractions of the tissue strips. The tension induced by 0.1 microM ET-1 was dose-dependently reversed by the drugs. The rank order of efficacy was forskolin >NNP>CNP(1 microM)>GSNO. R(max) values ranged from 55% (forskolin) to 35% (GSNO). Forskolin was the only compound which reached an EC50 value. Our results demonstrate that drugs in terfering with the cGMP- and cAMP-pathways can reverse the tension induced by ET-1. These findings are in support of the hypothesis that both cGMP and cAMP contribute to the control of the prostate smooth muscle tension and may provide new strategies for the future pharmacotherapy of LUTS und BPH.

[Comparative study of the influence of renal endogenic factors on the proliferation activity of epithelial cells].

The proliferation activity of monolayer culture of Madin Darby Canine Kidney (MDSK) cells is suppressed by a thermostable protein factor of renal tissue of white rats and of humans. Under the influence of renal factors (RF), a decrease in cell number, and suppression of DNA synthesis and mitotic activity in MDCK cells occur. The inhibition of proliferative activity of cultured cells under the influence of RF was substantiated also by MTT assay. It was established that the inhibitory influence of RF is stipulated by suppression of RNA synthesis. It follows that RF may inhibit division of MDCK cells via suppression of gene expression in G1-phase. Similar factors were obtained from renal cells of different systematic groups of organisms (snail, frog, fish, pigeon, guinea pig, swine).

Flow-mediated dilation in patients with left ventricular diastolic dysfunction.

The aim of the study was to evaluate the endothelium dependent FMD of the brachial artery in patients with LVDD. Endothelial function was assessed in 36 male patients (mean age 49+/-6 years) with LVDD due to CAD (22 patients) and essential hypertension (14 patients) as well as in 18 male patients (control group) without LVDD (12 patients with CAD and 6 with hypertension) of matched age. Our studies had showed significant decrease of FMD in patients with LVDD compared to those without LVDD (4.67%+/-1.68 vs. 6.12%+/-2.54, p<0.05). At the same time FMD in both groups appeared to be significantly lower than in healthy subjects. Post-ISDN vasodilation was almost similar in both groups of patients and lower than in controls. The post-ISDN vasodilatation did not differ regarding presence of LVDD or causative disease (CAD or arterial hypertension) and its extent was lower than in healthy controls. A weak correlation was found between FMD and post-ISDN vasodilatation (r=0.231, p>0.05). Data obtained suggest that endothelial dysfunction exists in patients with diastolic dysfunction. Based on these results it is considered that patients with early stages CAD and arterial hypertension depressed FMD might be indicator of LVDD.

[Sensitivity of PCR method for detection of mycobacteria tuberculosis in patients with lung tuberculosis].

Both hospitalized patients and outpatient clinic patients at the National Centre of Tuberculosis and Lung Diseases of Georgia have been investigated. The group of patients with the tuberculosis of urogenital system, has been studied (newly detected cases), 70 cases in total. The examination of the urine was carried out by the Polymerase Chain Reaction (PCR) method in order to detect Kochi bacillus and by three-time bacterioscopy of urine on acid resistant bacterium. Mycobacterium tuberculosis in urine has been detected in 57 (81,43%) patients by PCR method, and by urine bacterioscopy acid fast bacilli (AFB)(+) in 36 (51,43%) patients. 50 hospitalized patients were examined as a separate group. They had the tuberculosis of lungs and insignificant pathological changes in urogenital system. Among them there was active bacillus secretion in 45 cases by phlegm bacterioscopy AFB(+). Out of 50 patients the mycobacterium tuberculosis in urine was detected in 30 (60%) cases by PCR method. It should be mentioned that according to the urine two-time bacterioscopy, carried out on 50 patients, has not been detected AFB(-) bacillus secretion. It may be concluded that the PCR method is advantageous in detecting of Kochi bacillus in urine. Introduction of this method in medical practice will give us the possibility to determine the risk-group for development of tubercular changes in urinary system associated with lung tuberculosis, in order to control such patients and to carry out the adequate urological examinations.

[Detection of mycobacteria tuberculosis in patients with urogenital tuberculosis by PCR method].

The study was carried out in hospital patients as well as in outpatients at the National Centre of Tuberculosis and Lung Diseases of Georgia (2002-2004). The group consisting of 32 patients with tuberculosis of urogenital system has been studied (newly detected forms). Except clinical laboratory, culture and X-ray contrast methods, two additional methods were used in testing of this group of patients. The examination of their urine, at the same time, was carried out by the Polymerase Chain Reaction method in order to detect Kochi bacillus and by three-time bacterioscopy of urine for acid resistant bacteria. Mycobacterium tuberculosis in urine has been detected in 26 (81,25%) patients by PCR method, and by urine bacterioscopy--acid fast bacilli (AFB+) in 18 (56,25%) patients. The histo-morphological investigation of specimens obtained by surgery confirmed the TB diagnosis in all patients. This study on patients suspected of Tuberculosis of genital-urinary system gives us an opportunity to update the diagnostic algorithm by including the modern molecular methods. This algorithm will help in timely detection of Tuberculosis, in selection of adequate therapy and in prevention of the further progression of the disease.

Activity and content of antioxidant enzymes in prostate tumors.

AIM: To investigate the antioxidant enzyme system in blood of men with benign hyperplasia of prostate (BHP) and with prostate adenocarcinoma (CaP). METHODS: The spectrophotometrical methods were applied to study content and activity changes of superoxide-dismutase (SOD), catalase (CAT), ceruloplasmin (Cp), tripeptide glutathione (GSH), glutathione-peroxidase (GSH-Px), and glutathione-reductase (GR). Lipid peroxidation was evaluated using thiobarbituric acid (TBA)-test. Blood plasma and erythrocytes of men with prostate tumors served as the material for the studies; n = 15 for each group. RESULTS: SOD activity was increased in BHP (24.65 +/- 1.20 U/microl) and decreased in CaP (11.45 +/- 0.89 U/microl), CAT activity remained unaltered in BHP (12.41 +/- 0.85 mcat/ml) and was slightly declined in CaP (9.52 +/- 0.56 mcat/ml). Cp was increased in both kind of tumors, especially in CaP (54.27 +/- 7.22 mg%), as well as GSH (0.736 +/- 0.07 microM/l) and GR (0.031 +/- 0.002 microM/g.Hemogl/min). GSH-Px was sharply increased in BHP (0.67 +/- 0.05 microM/g.Hemogl/min) and reduced in CaP (0.16 +/- 0.01 microM/g.Hemogl/min). CONCLUSION: The development of BHP reflects relatively weakly on blood system as activity and content of antioxidant enzymes are not revealing marked changes in this disease. The significant changes are revealed in case of CaP, showing the reduced functional state of blood antioxidant enzyme system.

Right colonic reservoir with submucosally embedded tapered ileum--'Tiflis pouch'.

Seventeen patients with invasive bladder cancer aged between 44 and 67 years underwent radical cystectomy and construction of the continent urinary reservoir from 20 to 25 cm cecoascendum reconfigurated a.m. Heineke-Mikulicz. and submucosally embedded tapered ileum as a continence mechanism--'Tiflis pouch'. There were no perioperative mortalities and only minor complication but abdominal wound dehiscence occurred with a subsequent hernia in 1 obese patient. One patient died of urethral recurrence and malignancy progression 14 months after surgery. During the follow-up period of 9-37 months, all renal units remained unobstructed. Eleven of 15 preoperatively dilated units improved. No case of pouch stone formation, stomal stenosis or difficulties with catheterization was observed. All patients are continent but 4 need catheterization at 3-hour intervals. The functional capacity is in the range of 310-560 ml. The Tiflis pouch is a capacious reservoir in which the continence state is satisfactory, perioperative complication rate is low and quality of life is high.

[The results of the diversion of urine into a large-intestine reservoir]. / Rezul'taty derivatsii mochi v tolstokishechnyi rezervuar.

Cystectomy for bladder cancer with derivation of the urine into the colon was performed in 35 patients (30 males and 5 females). Postoperative lethality was 11.4% (4 patients). The best outcomes in cases of partial and/or complete failure of the ileocecal valve were obtained when forming the invaginate in the stomal ileum. Examination following the surgery was conducted in 31 patients. Of them, preoperative passage from the upper urinary tracts was impaired in 22 (71%) because of the tumor spread into the ostium urethritis. Postoperative defect from the upper urinary tracts was recorded in 7 (22.6%) patients, while normal function of the kidney was registered in 24 out of 31 patients (77.4%). A complete retention of the urine was achieved in 27 of 31 patients (87.1%). With time, the capacity of the colon reservoir increased up to 750 +/- 57.9 ml to the end of the second postoperative year. The right part of the colon, cecum or ascending colon as well as the proximal third of the transverse colon as the reservoir served satisfactorily.

[A method for forming a large-intestine reservoir for the urine]. / Metodika formirovaniia dlia mochi tolstokishechnogo rezervuara.

Eighteen patients with cancer of the urinary bladder underwent cystectomy with formation of a large intestinal reservoir for urine. The terminal large intestinal portion, 15-20 cm, the cecum, the ascending colon, and the hepatic angle of the colon were excluded to produce a reservoir from the intestinal tube. Appendectomy was performed. The continuity of the intestinal tube was restored via ileotransversostomy. The ureters were retroperitoneally grafted into the cecum by using antireflux and antistricture techniques. The ileocecal valve was clinico-anatomically examined. A device restraining urine was formed on an individual basis in relation to the function of Bauhin's valve. Cutaneous urinostoma ("dry") was formed epicutaneously in the right iliac region below the umbilicus. Three patients died in the postoperative period. Complete urine keeping was observed in 14 of 15 patients. The maximal capacity of the reservoir is 500 ml, the pressure is 30-40 cm H2O. Homeostasis and intestinal function were found to be normal.