[The role of functional condition of pelvic inferior muscles and corticospinal tract in urination disorders in prostatic diseases].

The article analyses problems of diagnosis and treatment of neurogenic disorders of urination in the group of patients operated for prostatic pathology, the role of the conduction system of the corticospinal tract and conductive potential of perineal muscles in the above patients. Main standard electromyographic parameters were established by the data of examination of 7 controls--latency of the cortical and segmental evoked motor response, time of central motor conduction, amplitude of potentials of motor unities. Fifteen patients with prostatic diseases showed severe disorders of both corticospinal conduction and perineal muscular contraction. Patients with prostatic cancer or adenoma treated with different methods had denervation changes in pelvic inferior muscle in unaffected corticospinal conduction. Denervation changes after surgical treatment for prostatic cancer and delay of reinnervation, recovery of nervous control may be determined not only by the fact of operation but also by the course of the underling disease. Examination of the pelvic inferior muscles demonstrated that HIFU is a traumatic treatment of prostatic cancer because of extention of the physical impact beyond the prostate on muscular-nervous structures. These denervation muscular changes should be taken into consideration in assessment of the patient's condition and choice of treatment policy.

[ABTU-01 andromed device in the treatment of erectile dysfunction].

The compression-decompression method was used in the treatment of vasculogenic erectile dysfunction in 42 patients. The barotherapeutic urological unit (ABTU-01) Andromed was used. The alternation of compression and decompression of cavernous bodies stimulates synthesis and maximal realization of biological effects of nitric oxide the abnormal synthesis and release of which due to endothelial dysfunction are among the leading causes of erectile dysfunction. The efficacy of the method was 90-93%, duration of the effect--from 7 to 12 months depending on the kind of vascular disorders.

[Modern technologies in diagnosis and treatment of patients with late stages of hydronephrosis].

To evaluate the role of modern ultrasonic, x-ray and radionuclide methods in staging hydronephrosis; that of stimulators of stem cells of the bone marrow in combined therapy of patients with late hydronephrosis, we examined and treated 18 patients with late-stage hydro- and ureterohydronephrosis. All the patients were operated. Preoperative preparation included drainage of the upper urinary tract and stimulation of bone marrow stem cells. Organ-saving surgery was conducted with a satisfactory functional result in 14 of 18 patients. Modern methods of investigation provide an objective assessment of structural-functional condition of the kidneys and upper urinary tract in patients with late hydro- and ureterohydronephrosis, may evidence for possible reversibility of registered uro- and hemodynamic alterations. Preoperative use of stimulators of bone marrow stem cells promotes activation of repair processes in renal parenchyma which is essential for efficacy of a further reconstructive operation.

[Treatment of prostatic cancer with high intensity focused ultrasound (HIFU) using Ablatherm device].

High intensity focused ultrasound (HIFU) is a method of delivering acoustic energy to a focal point and thus destroying it, causing coagulation necrosis. Repeating the fires, the whole needed volume of organ can be treated without damaging the surrounding tissue. A total of 122 patients with biopsy-proven prostatic cancer (and 2 more patients had only high-grade PIN) have been treated in our clinic for 3.5 years using the Ablatherm device. Seventy one of them entered this study. They were followed up for six months to three years at a regular interval. Follow-up PSA measurements and control sextant biopsies were made. The median PSA nadir 1.5-3.0 months after treatment ranged from 0.10 ng/ml (in low-risk localized prostate cancer group) to 2.50 ng/ml (in patients with disseminated process). Negative control biopsies were registered in 74-77.7% patients with local prostatic cancer and in 60-68% patients with disseminated process. Of all the patients, 90% had undergone transurethral resection of the prostate before HIFU treatment. Such combination improved the efficacy of HIFU and significantly reduced treatment-related morbidity. Urinary stress incontinence grade 2 was observed in 1.6% and grade 3--in 0.8% of all the patients. No other severe complications occurred. The erectile function was preserved in 71.2% patients. Our results demonstrate efficacy and safety of HIFU. HIFU does not exclude other treatment options and can be repeated. HIFU seems to be a valid alternative treatment for patients with contraindications for radical surgery.

[Transurethral electroresection of prostatic adenoma under transrectal ultrasonic control].

The aim of the study was to improve the results of transurethral prostatic resection (TUPR) by introduction of intraoperative transrectal ultrasonic investigation (TRUSI) and to determine topographic-anatomic features of the prostate, intraorgan relations of adenomatous nodes and surgical prostatic capsule on-line in TUPR. A total of 64 patients with prostatic adenoma (PA) of the second degree aged 52-79 participated in the study. All of them have undergone TUPR. The patients were divided into two study groups (15 patients with volume of the prostate 36.5-78.6 cm3 and 17 patients with prostate size 80-4-141.2 cm3) in which TRUSI was performed and two control groups (n = 14, size 34.9 to 79.2 cm3 and n = 18, size 81.7-130.8 cm3, respectively) who have not undergone intraoperative TRUSI. PA clinical symptoms were similar in all the groups. Intraoperative TRUSI was conducted in 3 stages (in the beginning, middle and end of surgery) in two planes--transverse and sagittal. Postoperative complications required repeated endoscopic interventions in 2 and 4 patients of groups 2, 3 and 4, respectively. Control TRUSI on day 7 after TUPR registered mean volume of the prostate to be 19.3 +/- 1.4 cm3 in group 1, 39.8 +/- 2.1 cm3 in group 2, 28.1 +/- 1.6 cm3 in group 3, 47.7 +/- 3.2 cm3 in group 4. Maximal flow rate 1 month after TUPR was, on the average, 21.4 +/- 1.4 ml/s, 18.8 +/- 1.1 ml/s, 18.3 +/- 1.6 ml/s and 15.5 +/- 1.2 ml/s in groups 1, 2, 3 and 4, respectively. Thus, intraoperative TRUSI provides information which helps the surgeon to orient in the course of surgery and minimize the threat of perforation of the prostatic capsule; minimizes intraoperative complications and enhances efficacy of radical transurethral electroresection of prostatic hyperplasia improving long-term outcomes of the operation.

[A phytogenic drug kanefron H in patients with chronic cystitis and urolithiasis].

To evaluate efficacy of kanefron H (KH) in combined therapy of chronic cystitis and urolithiasis (after extracorporeal shock-wave lithotripsy-ESWL), we examined 48 women suffering from chronic cystitis. The patients were divided into two groups by the presence of pyuria: 20 patients of group 1 had pyuria, 28 patients of group 2 had no pyuria. Each group was subdivided into two groups in relation to KH. Subgroup 1a received phosphomycin as monotherapy, subgroup 1b--phosphomycin with KH (2 pellets 3 times a day for 30 days). Subgroup 2a was initially treated with anti-inflammatory drugs, local medication physiotherapy, circulation improving drugs for 10 days. Then the patients were followed up for a months without any treatment. Subgroup 2b received the same initial course but it was followed for 30 days with KH. 79 patients with urolithiasis (uroliths and ureteroliths) have undergone ESWL. 45 entered KH group (2 pellets 3 times a day), 34--the control group (spasmolytic and anti-inflammatory therapy). KH in combined treatment of chronic cystitis raises efficacy of the initial therapy (antibacterial or combined, made in the absence of pyuria), promotes achievement of longer disease remission, elimination of concrement fragments from the urinary tract. Long-term administration of KH induce no side effects. Thus, KH can be recommended in chronic cystitis and urolithiasis in patients exposed to ESWL as an effective and safe drug.

[Magnetic resonance urography: possibilities and prospects]. / Magnitno-rezonansnaia urografiia: vozmozhnosti i perspektivy.

A new technique of urinary tracts visualization--magnetoresonance urography (MRU)--for a year (2000) was applied in examination of 25 patients aged 17 to 63 years with ureteral concrements (n = 11), ureteropelvic stenosis (n = 10), ureteral stenosis (n = 2), urinary bladder tumor (n = 1), Ormond's disease (n = 1). MRU provides the same information about the obstruction and dilatation of the urinary tracts as excretory urography (EU). In cases of EU contraindication (allergy, renal failure) or lack of contrast substance excretion, MRU allows to avoid additional invasive diagnostic procedures. It also enables visualization of non-dilated urinary tracts in medicinal polyuria. Non-invasiveness, no need to contrast, absence of radiation load open wide perspectives for MRU application in various groups of patients including pregnant women.

[Lung resection in drug resistant tuberculosis patients]. / Rezektsiia legkikh u bol'nykh tuberkulezom s lekarstvennoi ustoichivost'iu.

Three and seventy-one case histories of patients operated on for different forms of pulmonary tuberculosis in whom their Mycobacteria tuberculosis (MT) were resistant to bactericidal drugs (BD) were analysed. Fibrocavenous or cavernous pulmonary tuberculosis was detected in most patients (73.3%). Various postoperative complications occurred in 20% of the patients operated on, in them empyema with bronchial fistula was stated in 6.5% of cases. The immediate outcomes of lung resections were satisfactory in 90% of patients and poor (progressive tuberculosis, uncorrected empyema) in 6%, mortality was 4%. Comparing these data with the outcomes of 6033 resections whose efficiency was 96.4% and mortality 1.4% leads to the conclusion that MT resistance to BD negatively affect the outcomes of resections.

[Results of surgical intervention depending on duration of preoperative treatment of pulmonary tuberculosis patients]. / Rezul'taty khirurgicheskogo vmeshatel'stva v zavisimosti ot prodolzhitel'nosti dooperatsionnogo lecheniia bol'nykh tuberkulezom legkikh.

The case histories of 428 patients operated on for tuberculosis were analyzed. Three groups were identified. They were as follows: 1) 121 patients untreated with bactericidal drugs before surgery; 2) 247 patients treated less than 6 months before it; 3) 160 patients treated more than 6 months before surgery. Various complications due to resection of the lung were observed in 30 (7%) patients undergone surgery. They were 6.6, 6.8, and 7.5% in Groups 1, 2, and 3, respectively. A clinical effect was achieved in 99.8% of cases. The late outcomes of surgical intervention were studied within 1 to 10 years in 354 patients, including 102, 119, and 133 patients in Groups 1, 2, and 3, respectively. Progressive and recurrent tuberculosis was revealed in 7 (6.8%), 11 (9.2%), and 18 (13.5%), respectively. Thus, immediate and late outcomes of surgical treatment were not worse in patients with tuberculomas untreated with bactericidal drugs before surgery than in those who receive long-term therapy that substantially reduces the duration of therapy, which is a most important task of modern phthisiology. So patients should be operated on when they are found to have pulmonary tuberculomas without signs of a progressive tuberculous process.

[Transpubic approach in radical prostatectomy]. / Translobkovyi dostup pri radikal'noi prostatéktomii.

Surgical interventions in prostate apex and urethral membranous part are difficult because these structures are in the depth of the small pelvis. Transpubic approach permits easy manipulations in this area. There are the following variants of this approach: symphysotomy, pubectomy, resection of superior horizontal rami of pubic bones, resection of inferior horizontal rami of pubic bones, clinoid resection of pubic bones. The simplicity, adequacy and convenience of different surgical manipulations are the advantages of transpubic approach. The clinoid resection of pubic bones is the optimal variant of this approach. In provides an adequate approach to operated organs, the integrity of pelvic ring is saved, as a result of which there are no severe orthopedic disorders in the nearest and remote postoperative periods. For determination of indications to transpubic approach, the comparative study of the transpubic and low-median approaches in radical prostatectomy was carried out in 50 male cadavers according to parameters proposed by Sozon-Yaroshevich in 1954. The type of constitution, height of symphysis, size and shape of the prostate puboprostatic ligaments, adhesion of ligaments to prostate, prostate position against symphysis, size of small pelvis venous vessels were taken into account. It was established that the angle of surgical action in wound in low-medium approach was 35-50 degrees, in transpubic approach--by 25-30 degrees more. Incline angle of surgical manipulation axis, which reflect the correspondence of surgical section to exposed organ's disposition, is very important in case of organ's immobile position. This angle in low-medium approach was 40 +/- 5 degrees, in transpubic--80-90 degrees. Dorsal venous plexus and urethrals membranous part are approachable if the prostate size is small, but if the prostate volume is more than 30 cm3 and symphysis is high (> 7 cm), it is very difficult to manipulate in this zone in low-medium approach. Transpubic approach warrants thorough and careful prostatectomy. Methods leading to disturbance of pelvic ring integrity (symphysotomy, pubectomy) have no advantages. Clinoid resection ensures the optimum view of operative field and satisfy the main requirements of surgical approach.

[Blood metalloproteins of pro-oxidant and antioxidant action in psoriasis]. / Metalloproteiny krovi prooksidantnogo i antioksidantnogo deistviia pri psoriaze.

Molecular mechanism of pathogenesis of psoriasis related with intensity of formation of oxygen active forms high concentration, depends on balance of pro-oxidant and antioxidant systems activity and leads to quantitative changes of toxic agents of peroxidation processes in blood. Observed results show disorders in Cu, Zn-superoxide dismutase activity and contents of ceruloplasmin, transferrin and new revealed pro-oxidant metalloproteins-cytochromes b558(III), b558(IV), b5, O2(-)-generating lipoprotein suprol and indicate of disturbances in intensity of lipid peroxidation processes. They are considered as obligatory but not specific link in molecular mechanisms of different etiology of oxidative stress formation being as important argument in pathogenesis of various diseases as well as psoriasis.

[The selection of the treatment method in stenosis of the pelviureteral segment in nephrolithiasis]. / Vybor metoda lecheniia stenoza lokhanochno-mochetochnikovogo segmenta pri nefrolitiaze.

Ureteropelvic stenoses in nephrolithiasis are suggested to be considered reversible and irreversible depending on the lesions of the upper urinary tracts and the adjacent fat. To ascertain reversibility of the stenosis, use was made of the progesterone test in view of progesterone ability to dilate the ureter. No retention changes in the upper urinary tract in the reversible stenosis can serve an indication to impulse lithotripsy. Large stones and all cases of irreversible stenosis indicate validity of open surgery the scope of which is decided intraoperatively after isolation of the ureteropelvic segment from the periureteral fat and upon the indigo carmine test. In the absence of dysfunctional zone in the segment the patients may be subjected to ureterolysis and pyelolithotomy. If such zone is detected it is possible to make pelvic and proximal ureteral resection, pyeloureterostomy. The technique of the latter surgery in the intrarenal pelvis is detailed.