[The first domestic lithotripter URAT-: to the 30th anniversary of introduction].

This article is a historical overview of our recent past describing the enormous theoretical and experimental contribution of the research staff members who took part in the development of the first domestic lithotripter "Urat-".

[Official statistics on urological morbidity in the Russian Federation].

Official medical statistics have been analysed corcerning overall urological morbidity in the Russian Federation (RF) and in some particular regions of the RF. The analysis covered morbidity and mortality from urogenital diseases including glomerular, tubulointersticial and other diseases of the kidneys and ureter, prostatic diseases, male infertility, cancer of the urinary bladder and prostatic gland. It was found that information on urological and oncourological morbidity in the literature is available but its amount is not satisfactory. It is necessary to introduce innovations in organization of medical statistical service, in registration of urological diseases, in particular. Active screening for urological cancer in the RF does not meet requirements and potentialities of modern health care. Special screening programs must be designed to reduce mortality and improve follow-up of urological patients.

[Combined litholytic therapy of urate nephrolithiasis].

The authors present the analysis of therapy of 72 patients under 70 years of age (40 males - 55.6%, 32 females - 44.4%) with urate nephrolithiasis. Recurrent nephrolithiasis occurred in 51 (70.8%) patients, metabolic disturbances were registered in 38 (52.8%) patients. Efficacy of litholytic therapy with blemoren was 58.3%. In the rest cases the concrements were removed by extracorporeal shock-wave lithotripsy (ESWL). The authors believe that in concrements more than 2 cm in size ESWL should be made in the presence of internal stent, while litholytic therapy prior to ESWL improves treatment results even if ineffectiveness of the former.

[The role of phytotherapy in pre- and postoperative period in patients with urolithiasis].

Effects of a biologically active food additive Prolit (PT Industry Djamu Borobudur, Indonesia) on the urinary system and metabolic status of patients with urolithiasis were studied. Total urinalysis, biochemical blood and urine tests by 12 indices, ultrasonic investigation of the kidneys, excretory and plain urography were made in 30 patients aged 23 to 70 years (7 females, 23 males). Prolit was given in a dose 1125 mg three times a day for 1-6 months. Prolit decreased hypercalciuria and urinary pH. A trend was observed to lowering of the degree of leukocyturia, hyperuricemia, hyperuria and hyperoxaluria. Urolithiasis recurrences were absent in 10 cases of 12 (83%), in 18 of 20 patients (90%) concrements did not increase in size. Prolit had no side effects.

[Residual kidney stones and their treatment]. / Rezidual'nye kamni pochek i ikh lechenie.

416 case histories of patients with different forms of urolithiasis aged 6 to 70 years who had undergone sectional nephrolithotomy (83, 19.9%), pyelonephrolithotomy (24, 5.8%), pyelolithotomy (146, 35.1%), percutaneous nephrolithotomy (163, 39.9%) were analysed. Residual nephroliths occurred in 108 (25.9%) patients. 98 of them were subjected to extracorporeal lithotripsy (ELT). To determine minimal possible interval between the operation and ELT, changes in the levels of lipid peroxidation products and concentration of alpha-glutathione-S-aminotransferase were studied. The results allowed the authors to optimize ELT after operative interventions for uroliths. In the course of 206 ELT sessions the residual uroliths were destroyed in 96 (97.9%) patients. After one session a complete fragmentation was achieved in 19 (19.4%) patients, after two sessions--in 64 (65.3%) patients, after three sessions and more--in 15 (15.3%). Pyoinflammatory complications developed in 8 (8.2%) patients while retrospectively such complications were encountered in 16 of 50 patients (32%). One month after ELT, the control examination found neither nephroliths nor their fragments in 85 (86.7%) patients, in patients with large and multiple stones elimination rate 1.5 months after the treatment was 69.5%. It is inferred that ELT is an effective method of residual uroliths elimination and is a method of choice in the treatment of such patients.

[Complications of open surgical procedures in urolithiasis and their prevention]. / Oslozheneniia otkrytykh operatsii pri lechenii mochekammenoi bolezhni i puti ikh profilaktiki.

236 operative interventions for urolithiasis have been performed in 234 patients. Of them, 187 (79.9%) patients developed complications. Intraoperatively complications resulted from opening of the pleural and abdominal cavities (20 patients, 8.5%) and intraoperative blood loss < 500 ml (19 patients, 8.1%). In one case a nephrectomy was made because of repeated hemorrhage early after the operation. Among the postoperative complications most frequent were acute pyelonephritis (34, 14.5%) and aggravation of renal failure (11, 4.7%). The former demanded extracorporeal detoxication in 9 cases, in the latter hemodialysis was not required. Residual comcrements occurred in 28 (12%) patients. 17 of them had to undergo extracorporeal lithotripsy. Thus, open urological interventions in urolithiasis are now conducted in advanced disease, provoking complications. This raises responsibility of the surgeons who must take maximal preventive measures and use novel technologies in management of the complications.

[Effects of impaired urodynamics and contractile function of the upper urinary tract on elimination of stone fragments after extracorporeal lithotripsy]. / Vliianie narushenii urodinamiki i sokratitel'noi funktsii verkhnikh mochevyvodiashchikh putei na otkhozhdenie fragmentov kamnei posle distantsionnoi litotripsii.

The authors analyze effects of amplitude, tone and frequency of ureteral contractions on elimination of stones fragmented after extracorporeal shock-wave lithotripsy (ECSWL) in 30 patients with concrements in the kidneys and ureters. Before ECSWL the patients had indications for renal pelvis cathetarization. The measurements were made with multichannel impedance ureterography. According to initial dilatation of the upper urinary tracts (UUT), the patients were divided into 3 groups. It is shown that urodynamic UUT disorders determine effectiveness of ECSWL in urolithiasis patients: the greater is the dilatation the more probable are unsatisfactory results of ECSWL. Ureteral contractile activity is essential for rehabilitation in early postoperative period after ECSWL in patients with unrevealed UUT dilation: high amplitude of ureteral contractions in low tone is good for the fragments elimination, while high tone may result to the fragments ejection into the kidney. Low contractility may contribute to development of stone path. In patients with pronounced UUT dilation ureteral contractility is less important for ECSWL effectiveness than the wall tone and retrograde ureteral peristaltic movements. ECSWL results are better in patients with low tone of UUT wall. High UUT tone, especially in combination with retrograde peristaltic ureteral contractions registered prior to ECSWL indicates high probability of residual stones and additional fragmentation procedures irrespective of initial UUT dilation.

[Role of biochemical methods in follow-up and treatment of patients with urolithiasis]. / Rol' biokhimicheskikh metodov v dinamicheskom nabliudenii i lechenii bol'nykh mochekamennoi bolezn'iu.

4-6-year follow-up using different tests covered 15 patients with urolithiasis and 11 control subjects aged 25 to 66 years. All the patients underwent 1 to 5 sessions of extracorporeal lithotripsy and one patient underwent open surgery. Clinical and biochemical findings on the groups were compared to the evidence of Litos test. Initiation of antirecurrence therapy should be based on the information gained with different methods, primarily, biochemical. Follow-up of the patients including biochemical control over their metabolic condition must be conducted for at least 5 years.

[Effects of mineral water TIB-2 on metabolic processes in urolithiasis patients]. / Vliianie mineral'noi vody "TIB-2" na obmennye protsessy u bol'nykh mochekamennoi bolezn'iu.

Natural low-mineralized hydrocarbonate-calcium-magnesium mineral water (total mineralization 2 g/l) in bottles has been examined for therapeutic effects on metabolism in urolithiasis patients. The complex of biochemical blood and urine indices indicative of the renal function and concentration of lithogenic components was studied in 52 patients (age 23-68 years, 23 males and 29 females). Ten of them had nephrostoma. All the patients have undergone extracorporeal lithotripsy or other operations for renal or ureteric calculi. In nephrostoma patients urine samples were obtained both from nephrostoma and urinary bladder. The tests were made before the treatment and on the treatment day 3-5 and 10-12. TIB-2 mineral water was taken 3 times a day in a dose 200 ml 30-45 minutes before meal. The data were statistically processed. From the data obtained it was concluded that mineral water TIB-2 normalizes azotemia and clearance of endogenic creatinine, plasma values of calcium and uric acid, enhances urinary elimination of uric acid and calcium oxalate microcrystals that is TIB-2 improves metabolism of lithogenic substances and ions. Indications to drinking mineral water TIB-2 for urological patients are formulated.

[Initial results of the clinical use of a novel Russian lithotriptor LitURAT-UR]. / Pervye rezul'taty klinicheskogo primeneniia novogo otechestvennogo litotriptora "LitURAT-UR".

By its performance characteristics LitURAT-UR lithotriptor is different from previous units made in Russia or abroad. Besides the double stone-directing system (ultrasound + x-ray), LitURAT-UR is furnished with two interchangeable generators of shock-wave impulses (electrohydraulic and electromagnetic) allowing effective destruction of any urolith. The TV system is able to control the interelectrode space and to change it in the course of lithotripsy. Efficiency of the new lithotriptor in different clinical forms of urolithiasis reached 93.1%. Thus, universal, effective and low-traumatic characteristics of the lithotriptor LitURAT-UR hold much promise for urological practice in Russia.

[Extracorporeal shock-wave lithotripsy (ESWL) in removal of stones in anomalies of kidney and upper urinary tracts]. / Distantsionnaia udarnovolnovaia litotripsiia v lechenii kamnei pri anomaliiakh pochek i verkhnikh mochevykh putei.

The authors analyze the results of ESWL (URAT-P unit) for urolithiasis performed in 106 patients (49 females and 57 males) aged 16-67 years with anomalous kidneys and upper urinary tracts. 28, 1, 11, 14, 24, 4, 22 and 2 patients had horseshoe, L-shape, solitary, lumbar distopic, double, sponge, cystic kidneys, congenital megacallicosis, respectively. The stones ranged in size from 7 to 30 mm. Bilateral urolithiasis was in 7 patients. The number of impulses averaged 1745 +/- 168.4 per the procedure. The average number of ESWL procedures per stone was 1.4 (1-4). The stones were completely eliminated after one ESWL session in 78(73.6) patients, after two sessions in 23(21.7%) patients, after three sessions in 4, after for in 1 patient. Complications developed in 18 patients: urinary tract obstruction and attack of acute pyelonephritis (15 and 3 patients, respectively). Within 2-10-year follow-up recurrences arose in 12 patients who were retreated. Thus, ESWL is a method of choice in the treatment of urolithiasis patients with malformations of the kidneys and upper urinary tracts. Good results of ESWL are achieved in strict adherence to principles of the patients' selection, preoperative preparation technique, individual approach to patients in postoperative period, follow-up to detect complications and recurrences.

[Kidney function based on dynamic nephroscintigraphic data in the late period after extracorporeal lithotripsy]. / Funktsional'noe sostoianie pochek po dannym dinamicheskoi nefrostsintigrafii v otdalennyi period posle distantsionnoi litotripsii.

Dynamic nephroscintigraphy (DSG) was performed in 112 patients aged 14 to 76 years who had undergone 1 to 6 sessions of EL for unilateral or bilateral nephrolithiasis. A total of 254 EL sessions on 119 kidneys were performed. DSG was conducted before EL and at least 12 months after elimination of the stone fragments. The improvement of secretory renal function occurred in 68(57%) patients, aggravation was registered in 17(14.3%), unchanged renal function was in 34(28.6%) patients. Out of 17 cases of aggravation EL was responsible for only 3 of them. The others were due to other factors (progressive chronic pyelonephritis, acute pyelonephritis, hematoma, etc.). The conclusion is made that EL is a low-traumatic treatment of urolithiasis which is a method of choice in making decision on therapeutic policy in urolithiasis.

[Functional state of the upper urinary tract during and after extracorporeal lithotripsy]. / Funktsional'noe sostoianie verkhnikh mochevyvodiashchikh putei vo vremia vypolneniia i posle distantsionnoi litotripsii.

Ureteral motility reaction to extracorporeal lithotripsy was studied in patients with urolithiasis. This reaction depended on the initial function of the urinary tracts. Multichannel impedance ureterography provides objective information on ureteral function. Individual approach is necessary in the treatment of urolithiasis patients.

[Ways of prevention of kidney lesions during nephrolithotomy or extracorporeal lithotripsy in nephrolithiasis]. / Puti profilaktiki povrezhdeniia pochek pri vypolnenii nefrolitotomii ili distantsionnoi litotripsii po povodu nefrolitiaza.

Outcomes of nephrolithiasis treatment depend not only on renal dysfunction resultant from abnormal urine passage and concomitant infection but also on intraoperative mechanical trauma and ischemia. To compare renal damage induced by nephrolithotomy with that of shock-wave lithotripsy and effects of chemotherapy, 54 patients with nephrolithiasis were divided into 2 groups and 2 subgroups. Patients of group 1 underwent nephrolithotomy, those of group 2--extracorporeal shock-wave lithotripsy (ESWL). Subgroups "a" in both groups received no chemotherapy, subgroups "b" were treated with alpha-tocopherol, pentoxifylline, indomethacin. ESWL was found less traumatic. Postoperative drug prophylaxis promoted more pronounced inhibition of lipid peroxidation products and urinary enzymes activity, contributing to lessening of the operative trauma. Anti-ischemic protection of the kidneys also improved renal function.

[The role of dynamic observation in the prevention of recurrences of stone formation]. / Rol' dinamicheskogo nabliudeniia v profilaktike retsidivov kamneobrazovaniia.

26 patients with recurrent and non-recurrent urolithiasis treated surgically or by lithotripsy and 14 patients free of urolithiasis were examined biochemically by 9 metabolic blood and urine parameters and using Litos test proposed by urologists of the Moscow Regional Research Clinical Institute for detecting lithogenesis in the kidneys. The comparison of the findings obtained with biochemical and Litos tests showed that these tests are mutually complementary. Monitoring of urolithiasis patients should be complex, i.e. including biochemical examination for disbolism and urinalysis by means of Litos test.

[Lomefloxacin in the treatment and prevention of urogenital infection]. / Lomefloksatsin pri lechenii i profilaktike infektsii mochepolovykh organov.

A new antibiotic from fluoroquinolone series maxaquine (lomefloxacin) made in USA (Searle [correction of Surl]) has been tried in the treatment of urogenital infection (chronic cystitis, prostatitis, pyelonephritis, acute epididymitis, chlamydial urethroprostatitis) as well as to warrant antibacterial preparation before extracorporeal lithotripsy. The duration of the treatment course (3-28 days) was oriented to nosological form. The 24-h dose ranged from 400 to 800 mg. Side effects manifested with dyspepsia in 4 patients, worsening of memory in 2 patients. Photosensitization did not occur. Maxaquine clinical efficacy is similar to aminoglycosides and is superior to cephalosporins of the third generation. As for fluoroquinolone antibiotics, maxaquine can be compared to cyprofloxacine. The drug proved effective against urethroprostatitis and urethrocystitis of chlamydial origin. The responses to maxaquine favour its application in hospitals as second-line drug, whereas outpatiently it can be used for short-term empiric therapy.

[Accelerated elimination of the stone fragments after extracorporeal shockwave lithotripsy]. / Uskorenie éliminatsii fragmentov kamnia posle distantsionnoi udarno-volnovoi litotripsii.

As shown in experiments on 40 Chinchilla male rabbits, sinusoidal modulated currents (SMC) and ultrasound (US) are able to enhance bioelectrical activity of the ureteral smooth muscles. Activation of the muscular wall biopotential is followed by 0.15-0.2 s contraction. The above effect was used by the authors in rehabilitation of 120 patients after ECIL. SMC and US were included into the physiotherapeutic complex. The above patients whose concrements after the fragmentation diminished to less than 7 cm in size were divided into 2 groups. Sixty patients of group 1 received spasmolytic drugs, sodium chloride or iodine-bromine baths and dynamic amplipulse therapy. Sixty patients of group 2 in addition to the above treatment were exposed to local vibration and US. All the patients were given antibacterial drugs. The percent of patients with complete urolith evacuation in group 1 amounted to 91.7%, with partial evacuation 8.3% (96.7 and 3.3% in group 2, respectively). Dynamic nephroscintigraphy demonstrated that after relevant physiotherapy renal function improved, leukocyte and red cell count in the urine and ferrum, alkaline phosphatase levels in the serum decreased.