[A new method of evaluation of split renal function based on contrast-enhanced multislice spiral computed tomography].

INTRODUCTION: Traditionally, evaluation of the split renal function is performed using nephroscintigraphy. However, as shown in several studies, there might be quite significant inaccuracy in the interpretation of dynamic nephroscintigraphy results. But due to the lack of alternative methods for evaluation of split renal function, nephroscintigraphy remains the method of choice. AIM: To investigate the feasibility of digital analysis of contrast-enhanced MSCT imaging for evaluation of the split renal function. MATERIALS AND METHODS: This is a prospective study conducted at the R.M. Fronshteyn Clinic of Urology from November 2015 to February 2017. The study comprised 31 patients with urolithiasis (n=7), hydronephrosis (n=9), kidney cancer (n=14) and urinary bladder tumor (n=1). During the preoperative period, the patients underwent contrast-enhanced MSCT, 3D-reconstruction, and digital analysis. The obtained data were compared with the results of dynamic nephroscintigraphy. RESULTS: Contrast-enhanced MSCT findings were not inferior to data obtained with dynamic nephroscintigraphy regarding information content (p<0.004). CONCLUSIONS: The new method of digital processing of three-dimensional contrast-enhanced MSCT allows for concomitant assessment of both the anatomical features of the kidney and renal function that may help to improve the accuracy of surgical planning to choose the optimal extension of the intervention.

[Herbal preparation Canephron N in the treatment of patients with urolithiasis].

Under current conditions, high-technology herbal preparations take an important place in the complex treatment of patients with urolithiasis. Canephron N (Bionorica, Germany) is one of these herbal drugs widely used in urology. The article presents the results of comprehensive evaluation of the effectiveness of the canephron N in patients with urolithiasis, who undergone extracorporeal shockwave lithotripsy, in the postoperative period and in the period of early (up to 3 months) metaphylaxis. It is shown that the use of the drug in complex treatment of patients with urolithiasis contributes to more rapid discharge of fragments of stones and effective improvement of renal function after removal of stones. The use of canephron N has great potential in the complex metaphylaxis of urolithiasis.

[Mechanism of action and efficacy of litium chloride in thermal ischemia of the kidney].

A protective effect of lithium chloride (LC) in thermal ischemia of the kidney of different duration was studied in rats. LC efficacy was estimated by functional activity of ischemic kidney in early and late reperfusion period, by damage to mitochondria of tubular epithelial cells and production of active oxygen forms (AOF) and nitric oxide (NO). LC has a marked anti-ischemic effect. In thermal renal ischemia for 40 and 60 min LC provides functional safety of the ischemic organ. In longer ischemia, 50% of the animals died. The mechanism of the protective action of LC is related to reduction of APK production, support of a high transmembrane potential of mitochondria and NO synthesis redistribution in the cells of tubular epithelium cells.

[Clinicobiochemical study of diagnostic value of the panel including 10 potential protein markers of prostatic cancer].

We tested diagnostic value of the panel of 10 specially selected proteins--potential markers of prostatic cancer. A double blind method and proteomic technologies were used in complex clinicobiochemical examination of 20 patients with benign and malignant tumors. The same diagnosis were obtained by clinicomorphological criteria and protein markers in 13 (65%) cases. The highest diagnostic efficacy was achieved in prostatic cancer--11 cases (79%) vs 14 by clinicomorphological criteria.

[Food additive urisan in combined treatment of urolithiasis].

Thirty three urolithiasis patients (13 males, 18 females aged 29-77 years, 2 children, duration of the disease 1-17 years) received food additive urisan in combined treatment of urolithiasis. Blood and urine biochemistry was studied by 11 parameters to evaluate renal function and lithogenesis before and after intake of urisan. Standard treatment was combined with intake of 2 capsules (1100 mg) of urisan twice a day at meal for 2-3 weeks. The data were processed statistically. It is shown that urisan contributes to intensification of renal filtration function, to reduction of hyperuricemia and urine pH, intensification of uric acid excretion, continuation of inflammation remission, attenuation of proteinurea in urolithiasis patients with exacerbation of chronic pyelonephritis.

[A universal clinico-statistical classification of urolithiasis].

The article reviews the defects of a statistical classification of urolithiasis in ICD-10. The main defect is the discrepancy of clinical diagnoses in case histories with statistical codes of ICD-10. A new coded classification of urolithiasis reflecting basic clinical characteristics of urolithiasis (a type and size of the stones, function of the kidneys, x-ray positivity and infection of the stones, chemical structure of the stones) is proposed. This coded classification can raise significance of statistical information about urolithiasis and optimize standards of the diagnosis and treatment of this disease.

[Agreed terminology--a criterion of objective assessment of the results of extracorporeal shock-wave lithotripsy].

The decision on administration of extracorporeal shock-wave lithotripsy for uroliths should be based on the clinical picture, physicochemical properties of the urolith and anatomofunctional state of the kidneys and upper urinary tracts. Information about the treatment conducted should be maximally complete and significant as this allows objective interpretation of the treatment results and design of further treatment. Usage of agreed terminology facilitates the analysis of the protocols, guidelines and assessment of treatment results in clinic and prophylactic centers.

[Assessment of metabolic disturbances risk factors in urolithiasis children with questionnaire survey].

Risk factors of metabolic disturbances in children with urolithiasis were studied in 38 children aged 1.7 to 14 years. The information for the disease history was obtained from the parents of the children participating in the study. The parents filled in special questionnaire which has detected that 14.2% of fathers and 72% of mothers had chronic diseases; when pregnant, 81.5% mothers had toxicosis and gestosis, 23% suffered from various viral and bacterial infections treated for a short time with drugs; 63% mothers did not keep diet before pregnancy but pregnancy and lactation made 77% of them pay due attention to their food and diet regime. Breast feeding lasted for the first 2-6 and 1-2 months in 38 and 50% mothers, respectively. Feeding was mixed from birth in 23% babies. Development of metabolic disturbances in children leading to urolithiasis depends on many factors closely linked with environment pollutants, life style of the parents, gynecological health of mothers, intercurrent diseases. Immunogenetic, hereditary mechanisms are involved in triggering urolithiasis in children.

[Identification of AGR2 protein, a novel potential cancer marker, using proteomics technologies].

A comparative analysis of the proteins in prostate tissues of the patients operated for hyperplasia (n = 7) or cancer (n = 5) was performed aiming to search for protein diagnostic markers. Differences in several minor proteins were detected using two-dimensional electrophoresis according to O'Farrel; among them, an additional protein with a molecular weight of 19 kDa and an isoelectric point of 9.0 was observed in four of the cancer cases. Mass spectrometry allowed this protein to be identified as the androgen-induced secreted protein AGR2. The possibility of using AGR2 as a diagnostic marker of prostate cancer is discussed.

[Quality of life of elderly patients with nephrolithiasis].

Clinical findings have been analysed for 105 presenile and senile patients with nephrolithiasis. A total of 168 operations have been made: open intervention (n=22), percutaneous nephrolitholapaxia (n=12), extracorporeal lithotripsy (n=134). Quality of life was assessed according to the questionnaire survey (an original visual graphic questionnaire on the patient's attitude to his/her disease and the treatment, questionnaire on the doses of analgetics and antibiotics, conventional questionnaire EQ-SD. It was found that elderly patients note a statistically significant fall in frequency of pains (renal colics, lumbar pains, subfebrile condition), in the dose of analgetics and antibacterial drugs 6-12 months after removal of the concrement. Removal of the concrement had a positive influence on quality of life of patients with urolithiasis. Extracorporeal lithotripsy had a weaker emotional effect on the patients than open surgical interventions. It is suggested to remove nephroliths if contraindications are absent.

[New approaches to molecular diagnosis of prostatic cancer].

We compared prostatic proteins in patients operated for adenoma or cancer. 630 protein fractions were obtained from each tissue sample after fractionation by two-dimentional electrophoresis according to O'Farrell. Comparison of the samples from adenoma and cancer showed their difference by 7 proteins among which were isoforms of glyceraldehydes-3-phosphate-dehydrogenase, alpha-collagen and several little known proteins. Most of the cancer patients had the protein with molecular mass 19 kDa and isoelectric point 9.0. By the results of mass-spectrometry this protein was identified as androgen-induced secreted protein AGR2. This protein is considered a potential oncomarker. Prospects of some postgenome technologies for detection of new diagnostic markers of prostatic cancer are discussed.

[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.

[Operative treatment of kidney calculi]. / Operativnoe lechenie korallovidnogo nefrolitiaza.

262 cases of coral nephrolithiasis (CN) treated for the last 5 years (mean age 51.6 years) have been analysed. Of them, 46 (17.9%) patients have undergone 2 to 4 operations, 14 (5.4%) patients had bilateral nephrolithiasis. Open surgical interventions (section nephrolithotomy, pyelonephrolithotomy) were performed in 31 and 106 patients, respectively. All of them had a severe form K-3 or K-4. Extracorporeal shock-wave lithotrophy (ESWL) was conducted in 72 (27.5%) patients with coral concrements K-1, K-2. 'Mean number of the procedures per a stone was 4.2. Transcutaneous puncture nephrolithotripsy (TPNT) was made in 53 (20.2%) patients (K-2, K-3). The results of the treatment were assessed at discharge and 12 months after it. The efficacy of the treatment was judged by completeness of the stone elimination, postoperative complications and interventions to correct these complications. Open operations eliminated the stones completely in 71.2% patients, in combination with ESWL--in 91.6%, TPNT--in 78%, in combination with ESWL--in 94.5%. Efficacy of ESWL as monotherapy + stent reached 68.1%. Open operations entailed complications in 41.6% (of them 68.5% in section nephrolithotomy), TPNT--in 18.2%, ESWL--in 16.3%. Coral nephrolithiasis should be treated by skilled specialists in clinics furnished with modern facilities, combination of which minimizes traumatic complications and raises treatment efficacy.

[New approach to improving efficacy and objective assessment of the extracorporeal lithotripsy]. / Novyi podkhod k povysheniiu éffektivnosti i ob''ektivizatsii distantsionnoi litotripsii.

Clinical trials of the generator EMSE 220F XXP were conducted on the lithotriptor Dornie C" in the Research Institute of Urology from September 2203 to January 2004. Extracorporeal lithotripsy (ECL) was made in 158 patients (66 women and 92 men, age 11-89 years) with different clinical forms of nephrolithiasis. The analysis of nephrolith fragmentation showed high disintegration power of the generator in all nephrolithiasis forms (97.4%). Maximal energy intensity in ECL of nephrolithis was under 7 units, of ureterolithis--10 units. The number of additional sessions averaged 11.4%, mean Edose was 49.2 J. Complications of early postoperative period was detected in 4 (2.5%) patients. In two of them (1.3%) subcapsular hematomas 180 cm3 in size were detected. The other two patients developed exacerbation of pyelonephritis early after operation. It was managed conservatively. Thus, EMSE 220F-XXP is a novel, highly effective source of generation of shock-wave impulses providing finely divided fragmentation of uroliths in 97.4% cases. A mean Edose 49.2 J effectively destructs urinary concrements of any location with a minimal risk of postoperative complications. Maximal intensity regimes should be used carefully with consideration of a high risk of traumatic complications.

[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.

[Long-term results of treating children with kidney and ureteral stones with extracorporeal lithotripsy]. / Otdalennye rezul'taty lecheniia detei s kamniami pochek i mochetochnika distantsionnoi litotripsiei.

Long-term outcomes of urolithiasis treatment with extracorporeal lithotripsy (ECLT) have been analysed for 132 children using, as the basic criterion, data of dynamic nephroscintigraphy. The results of ECLT were considered regarding characteristics of the concrement, inflammatory process, parameters of the shock wave. It was found that low-energy restruction regimens in minimal number of impulses per session and adequate intervals between them prevent irreversible changes in renal parenchyma in response to focused shock waves. Monitoring and adequate treatment late after ECLT lead to recovery of renal function if obstructive complications and stone formation are found early and if the course of the inflammation is controlled.

[Results of clinical use of the polyfunctional lithotripsy device "Dornier-U 50"]. / Rezul'taty klinicheskogo primeneniia polifunktsional'nogo litotriptora "Dornier-U 50".

The review of the results of clinical application of a polyfunctional lithotriptor Dornier-U50 in urolithiasis patients is presented. The treatment of 324 patients produced good results of lithotripsy in uroliths of any location in generating high-energy shock waves. Complete fragmentation was achieved in 86.4%, partial one--in 11.7%. Complications occurred in 9% of which 5.3% were cases of upper urinary obstruction. The Dornier-U50 lithotriptor can be used for both extracorporeal lithotripsy (under x-ray and ultrasound targeting) and various endoscopic operations under x-ray telecontrol. This allows maximal utilization efficiency of this equipment in diagnosis and treatment in urological hospitals.