[Transabdominal laparoscopic nephrectomy and renal cyst fenestration]. / Transabdominal'naia laparoskopicheskaia nefréktomiia i fenestratsiia kist pochek.

Since November 1994, when the first laparoscopic nephrectomy was made in Russia, 36 laparoscopic operations have been made on the kidney. 11 were nephrectomies, 21 were fenestrations of renal cysts, 4 transabdominal laparoscopies were unsuccessful.

[Laparoscopic nephrectomy in a patient with a parenchymatous form of nephrogenic hypertension]. / Laparoskopicheskaia nefréktomiia u bol'nogo s parenkhimatoznoi formoi nefrogennoi gipertonii.

The years following the first laparoscopic nephrectomy in man performed in 1990 were evidencing wide spread of transabdominal laparoscopic approach in operative interventions on the kidney, adrenals, ureter, urinary bladder, in iliac lymphadenectomy for prostatic and bladder cancer, in the treatment of varicocele, etc. Since 1993 we have made 4 nephrectomies using laparoscopic approach. The first operation in a 18-year-old male with parenchymatous hypertension lasted 7 hours, the following operations took from 2 hours 47 min to 1 hour 30 min. No complications occurred. Postoperative stay in hospital was, on the average, 7.2 days. The laparoscopic approach in urology and surgical nephrology of adults and children needs detailed studies, specification of indications and contraindications prior to its introduction into wide practice.

[Comparative evaluation of two methods for the uretero-cystic anastomosis]. / Sravnitelnaia otsenka dvukh metodov mochetochnikovo-puzyrnogo anastomoza.

Comparative analysis of two types of ureterocystic anastomosis in kidney transplantation showed the advantages and shortcomings of the method developed at the Moscow Regional Scientific Research Clinical Institute. The new anastomosis fundamentally differs from the traditional Mebel-Shumakov method in the absence of sutures between the ureter and the bladder mucosa. This feature makes it possible to avoid injury to the bladder mucosa which is often changed in prolonged anuria and reduce the edema and ischemia of the terminal part of the ureteral graft. This facilitates adaptation of the anastomosis to polyuria which often occurs in the early postoperative period. The relatively simple techniques shortens the time needed for the operation. These advantages of the new method of ureterocystotomy are manifested by decrease of the total number of urological complications and the relative incidence of serious early urological complications like fistula of the ureterocystic anastomosis and necrosis of the ureter which most often lead to loss of the transplant and sometimes to death of the patient. The use of the anastomosis developed at the Clinical Institute, however, is attended by a relatively high incidence of ureteral stricture in the late-term postoperative period, evidently due to prolonged contact of urine with the bladder muscular coat and the ureteral adventitia. Thus, the more favorable results of ureterocystic anastomosis formed by the method developed at the Clinical Institute allow it to be recommended for further use in kidney transplantation.

[Acupuncture in the combined treatment of pyelonephritis]. / Akupunktura v kompleksnom lechenii pielonefrita.

In the treatment of pyelonephritis which continues to cause problems in practical uronephrology, the main efforts of the clinicians are now directed at enhancement of the patients resistance, improvement of renal blood flow and urodynamics. Acupuncture (AP) is thought capable to meet the above requirements. It was used in combined treatment of 102 pyelonephritis cases (51 with acute and 51 with chronic manifestations) showing intact renal function. According to radionuclide renography, a positive trend in the secretion and urodynamics of the upper urinary tract was demonstrable in 50% of the patients. Dynamic nephroscintigraphy reported a positive response in 60% of cases versus 25% in those treated without AP. AP promotion of earlier recovery or remission, reduction of the scope of chemotherapy, good short- and long-term response permit this modality to be recommended for application in urological and nephrological practice.

[The diagnosis and treatment of cystic diseases of the kidneys by using transcutaneous puncture methods under ultrasonic monitoring]. / Diagnostika i lechenie kistoznykh zabolevanii pochek s pomoshch'iu chreskozhnykh punktsionnykh metodov pod ul'trazvukovym kontrolem.

Presented in the paper are the methods of ultrasonic diagnosis and percutaneous paracentetic treatment of cystic kidneys under ultrasonic monitoring. Paracenteses were performed in 172 patients: 59 with polycystic and 113 with cystic kidneys. If the cysts located in the middle or lower segments of posterior, lateral or inferior drainage that was pushed through the guide into the cyst lumen. A thin-needle aspiration was used and the drainage avoided if the cyst located in the anterior part of middle or upper renal segments. Cystography and cystomanometry associated with the determination of the cyst tension index followed elimination of the aspirates for cyto- and bacteriological investigations. Paracentesis was accomplished under the ultrasonic monitoring of the position of a needle tip. The cavity of the cyst was sclerosed with 96% spirit in 84 patients; strong radiopaque agents were used in 8 and medicinal cyanacrylate glue in 13 patients. The drainage of the cysts with a long-term exposure to sclerosing agents (from 2 to 24 hrs) was employed in 32 patients. Postaspiration relapses were documented in all the patients with intrasinus cysts and cysts, whose major portion was surrounded by parenchyma. In the patients with other patterns of cyst location, the postaspiration relapses were noted in 94.4 per cent. A four-year follow-up of 13 patients who sustained the glue application registered 2 relapses which were successfully cured by a repeat application of the glue.(ABSTRACT TRUNCATED AT 250 WORDS)