[The role of ozone therapy in prevention of pyoinflammatory complications after transurethral resection of prostatic adenoma].

The study of efficacy of ozone therapy (OT) in preparation of patients with prostatic adenoma (PA) and cystostoma for transurethral resection (TUR) of PA included 20 PA patients with cystostomic drainage who had undergone PA TUR and preoperative preparation with OT sessions. The control group consisted of similar patients but without ozone pretreatment. OT efficacy was assessed by the rate of pyoinflammatory complications (PIC), results of immunological examination, positive changes in prostatic secretion, urine analysis, total blood count, degree ofbacteriuria. In the study group PIC (acute urethritis) developed in 1 patient, in the control--in 6 patients (3 cases of acute urethritis, 2 cases of acute prostatitis and 1 case of acute epididymitis). OT led to lowering of mean values of leukocyturia from 18.1 +/- 0.6 to 14.3 +/- 0.7 on the day of operation, to 10.9 +/- 0.7 after 4 days and to 8.7 +/- 0.6 on postoperative day 8 versus from 18.8 +/- 0.8 to 15.4 +/- 0.7, to 15.8 +/- 0.6 and 13.5 +/- 0.6, respectively. Mean control count of leukocytes in prostatic secretion fell in both groups. OT reduced bacteriuria. Number of bacteria to the day of operation decreased in both groups, but complete elimination of the agent from urine on day 8 was not achieved in the controls. The study group exhibited a rise in the absolute count of blood leukocytes, lymphocytes and ESR diminishing. OT raised significantly the phagocytic count and activity, concentration of mature T-lymphocytes (CD3), T-helpers (CD4), cytotoxic T-lymphocytes (CD8), B-lymphocytes (CD20), T-NK-cells (CD16), T-lymphocyte activation markers (CD3+, CD16+, CD56+, CD3+, CD25+, HLADR+, CD3+. The concentration of IgG, IgM, IgA remained high. Thus, the results of ozone application before PA TUR appeared promising in prevention of postoperative PIC.

[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.

[Role of cytokines in the diagnosis of chronic prostatitis]. / Rol' tsitokinov v diagnostike khronicheskogo prostatita.

Chronic prostatitis affects 30-60% males and significantly deteriorates quality of their life. Clinical and experimental investigations have revealed changes in immune status in the onset and development of prostatic inflammation. As some other urologists, we made an attempt to determine the role of cellular immunity and immunoglobulins in the diagnosis of chronic prostatitis. The study was made in 30 patients with chronic abacterial prostatitis (mean age 42.5 years, duration of the disease 1.8 years). In addition to standard examination, all the patients have undergone analysis of the immune status and measurement of proinflammatory cytokines (TNF alpha and IL-12b) in biological media: blood serum, urine, ejaculate, prostatic secretion. The patients had moderate symptoms: IPSS--10.4 scores, life quality index--4.3 scores, on the average. Prostamol-uno was given to all the patients in a standard dose 1 capsule (320 mg) a day for 3 to 6 months. The results were processed statistically. A good effect of prostamoluno was registered in 26 patients, a satisfactory one--in 2. Two patients refused to take prostamol-uno because of lack of a prominent effect. The scores of IPSS lowered from 10.4 to 6.3 (by 39%), life quality improved by 42%. Ultrasound monitoring of the size of the prostate showed no significant changes in the size. Tolerance was good in all 30 patients. Side effects were absent. After 3 months of the treatment serum, urine, ejaculate and prostatic secretion cytokines changed. TNF alpha elevated while IL-1 beta level lowered almost to normal value. In 6 months both IL-1 beta and TNF alpha returned to normal values confirming stabilization of cytokine system and the end of inflammation. Cellular immunity did not change much. Thus, as inflammation in prostatic tissue is characterized by elevation of proinflammatory cytokines, in diagnosis of chronic prostatitis it will be valid to use markers TNF alpha and IL-1 beta as criteria of immune prognosis of prostatic exacerbation. Prostamol-uno does not induce changes in lymphocyte populations and impairment of immune status.

[Doksazozin "Cardura" in acute urinary retention caused by benign prostatic hyperplasia]. / Doksazozin "Kardura" pri ostroi zaderzhke mocheispuskaniia, obuslovlennoi dobrokachestvennoi giperplaziei prostaty.

Drug treatment of acute ischuria (AI) caused by benign prostatic hyperplasia (BPH) is discussed. Catheterization of the urinary bladder is the main treatment for AI. AI is caused by anatomical obstruction, hypertone of smooth myocytes, and energy imbalance of detrusor. Use of alpha 1-adrenoblockers in AI is pathogenetically justified, as the development of stable spasm of smooth-muscle structures of the prostate, vesical cervix, and prostatic compartment of the urethra resultant from increased functional activity of alpha 1-adrenoreceptors underlies the dynamic component of obstruction. alpha 1-Adrenoblocker doxazosin (cardura) was used for arresting AI caused by BPH after 12-h randomization and catheterization of the bladder. A prospective randomized placebo-controlled study was carried out on 36 patients. Spontaneous urination was restored in 55.5% patients, in 63.3% of these after doxazosin and in 16.6% after placebo. 37.9% of patients from the doxazosin group were discharged from hospital for outpatient therapy with alpha-blockers and the rest were operated on. Hence, doxazosin increases the chance of recovery of spontaneous urination for patients with AI caused by BPH and allows time and conditions for preparation of patients to surgery. Therapy with alpha 1-adrenoblockers after resolution of AI in patients with BPH can be effective and should be further investigated.

[The effect of endovascular helium-neon laser therapy on the immune status of patients with acute calculous pyelonephritis]. / Vliianie éndovaskuliarnoi gelii-neonovoi lazernoi terapii na immunnyi status bol'nykh ostrym kal'kuleznym pielonefritom.

Cellular immunity was assessed in 48 patients with acute calculous pyelonephritis exposed to intravenous He-Ne laser therapy. It was found that endovascular He-Ne laser therapy in the study regimens corrects immunological abnormalities arising in acute calculous pyelonephritis.

[The mathematical modelling of water-osmotic equilibrium during the performance of hemodialysis]. / Matematicheskoe modelirovanie vodno-osmoticheskogo ravnovesiia vo vremia provedeniia gemodializa.

The model has been designed by the authors to prevent complications as a result of redistribution of liquid between cellular and extracellular spaces arising in the patient's body in the course of hemodialysis. Because movements of the liquid between the spaces depends on the osmolality gradient, two principal systems were identified: body water system and system of osmotically active substances. The latter incorporates sodium and potassium salts and urea. The model is based on 6 differential equations. The least squares method derived individual parameters of the model. Using the model, the physician can regulate to optimal the regimen of hemodialysis: blood flow rate, speed of ultrafiltration, concentration of sodium and potassium in dialysate.

[Effectiveness of cefpirome in the treatment of complicated infections of the upper and lower urinary tracts]. / Effektivnost' tsefpiroma pri lechenii oslozhnennykh infektsii verkhnikh i nizhnikh mochevyvodiashchikh putei.

Two hundred and two isolates of gram-positive and gram-negative pathogens of urinary tract infection were tested for their susceptibility to cefpirome. In 64 to 97 per cent of the cases the susceptibility was high and exceeded that of other cephalosporins used in the treatment of urological patients. Cefpirome was used in the treatment of 26 patients with signs of urinary tract infection: 19 patients with pyelonephritis and 7 patients with prostatitis. The antibiotic was administered intravenously in a dose of 1 g twice a day for the treatment course of 5-7-10 days. The clinical and bacteriological efficacies amounted to 92 and 87 per cent respectively. The drug tolerance was good. The results demonstrated that cefpirome was useful in the empirical therapy of urinary tract infection.

[Outlook and experience in using ofloxacin in urology]. / Perspektivy i opyt primeneniia ofloksatsina v urologii.

Ofloxacin was used in the empirical and etiotropic therapy of patients with severe urinary tract infection. The trial was based on the previous experience with ofloxacin in the treatment of various forms of urological infection with determination of the pathogen susceptibility and study of the drug pharmacokinetics in patients with normal and impaired renal function. For the first 3 to 5 days in the present study ofloxacin was administered in a dose of 200 mg twice a day followed by its oral use in the same dosage for 3 to 5 days. The treatment schemes were corrected by the bacteriological findings (mainly when Pseudomonas aeruginosa strains were isolated). The results of the treatment of more than 200 patients showed that ofloxacin was highly efficient. By the clinical and bacteriological indices the drug proved to be efficient in 96 and 88 per cent of the cases respectively. In the treatment of patients with noncomplicated urinary tract infection good results (the clinical and bacteriological efficacies of 96 and 88 per cent respectively) were observed when ofloxacin was used orally in a single dose of not more than 400 mg once a day for 3 to 5 days. In the patients with chlamydiosis the drug was used in the same dosage for 10 days. Ofloxacin was also shown to be highly efficient when used prophylactically in transurethral surgical operations on the prostate and in open urological operations.

[Beta 2-microglobulin kinetics during hemodialysis with different membranes]. / Kinetika beta 2-mikroglobulina vo vremia gemodializa s razlichnymi membranami.

Dialysers F6 (polysulphon membrane) and Altra Nova-170 (acetate cellulose-H membrane) were tested for effects on concentration of beta 2-microglobulin (beta-2 MG) in the course of hemodialysis. F6 produced a rise in beta-2 MG levels (50.0 +/- 7.7 to 59.2 +/- 9.5 mg/l). Altra Nova-170 induced no significant changes in these levels. Dialyser F6 seems to stimulate generation or release of beta-2 MG the input and output amounts of which indicate that the process may be confined to dialyser interior. On hemodialysis minute 15 a sharp fall in beta-2 MG concentrations was registered in the use of either device. This phenomenon resembles leukopenic effect of cellulose membranes. Hemodialysis kinetics of beta-2 MG is likely to depend on leukocyte activation.

[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.

[The clinical efficacy of the new drug agent ligentén in urology patients]. / Klinicheskaia éffektivnost' novogo lekarstvennogo sredstva ligenténa u urologicheskikh bol'nykh.

A clinical trial was made of a new gel ligenten intended for local urethral anesthesia and treatment of infection and inflammation in the lower urinary tracts. Ligenten was given to 52 patients to manage bladder, prostate, urethral infection and inflammation, for local prophylaxis before cystoscopy, urethral bouginage and transurethral surgery. Apparent advantages of intraurethral introduction of the analgetic compared to instrument lubrication are demonstrated. Ligenten was also effective against chronic cystitis, cystalgia and urethral syndrome in females, especially in ulcerative cystitis. The gel exhibited adequate antiinflammatory and analgetic effect. As a prophylactic means, it prevents inflammation in cystoscopy, urethral catheterization and transurethral operations. No severe side effects have been reported.

[The prevention of infectious-inflammatory complications in the postoperative period in percutaneous surgical interventions in patients with urolithiasis]. / Profilaktika infektsionno-vospalitel'nykh oslozhnenii v posleoperatsionnom periode pri perkutannykh khirurgicheskikh vmeshatel'stvakh u bol'nykh s mochekamennoi bolezn'iu.

The paper describes a number of modifications in the operative procedures, pre-, intra- and postoperative antibacterial treatment introduced to decrease the number and severity of infectious-inflammatory complications of endourological surgery for urolithiasis; presents the results of anti-bacterial prophylaxis of urinary infection aggravation in 29 patients suffering from urolithiasis combined with renal anomalies. Antibacterial treatment was performed with ftorquinolone drug ciprinol (ciprofloxacin hydrochloride) made in Slovenia. 18 patients received ciprinol twice a day at a dose 500 mg 3-5 days before the operation and within 5-7 postoperative days. The other 11 patients received the drug intravenously (100 mg in drops) in parallel with initial anesthesia and during 1-2 postoperative days. It was continued orally within the next 5-6 postoperative days. The analysis of ciprinol pharmacokinetic profile showed its concentrations in the blood and urine to surpass minimal inhibitory concentration for the majority of the isolated microorganisms. Out of 18 patients treated with oral ciprinol, postoperative aggravation of pyelonephritis occurred in 3 (16.7%) versus 8 (40%) cases out of 20 controls. 11 patients on intravenous ciprinol developed no complications. The conclusion is made on high efficacy of preoperative antibacterial preparation and of intraoperative antibacterial therapy continued for some time after the surgery in cases of percutaneous endoscopic surgical interventions for urolithiasis attended by chronic urinary infection. The antibacterial treatment brings about a 2-3-fold decrease in the occurrence of postoperative inflammatory complications.

[The efficacy of Ligenten gel in the prevention and treatment of infectious-inflammatory diseases of the urogenital organs]. / Effektivnost' gelia Ligentena pri profilaktike i lecheniia infektsionno-vospalitel'nykh zabolevanii mochepolovykh organov.

A new therapeutic in the form of a gel named ligenten was studied. The gel active components are lidocain, gentamicin and ethonium. Ligenten was shown to have a marked local anesthetic action when administered transurethrally. As a prophylactic agent the gel was highly active against the majority of the causative agents of renal infections due to cystoscopy, catheterization and bougienage of the urethra. Ligenten provided a sufficient anesthetic effect in transurethral operations but did not prevent superinfection due to the hospital strains. Marked antiinflammatory and reparative actions of the gel especially in the treatment of ulcerous cystitis were observed.

[Sulbactam/ampicillin in the treatment and prevention of urologic diseases]. / Sul'baktam/ampitsillin v lechenii i profilaktike urologicheskikh zabolevanii.

Efficacy and safety of unasyn, a combination of sulbactam and ampicillin, was studied in the treatment of 66 patients with infections of the urogenital organs. The drug was administered intramuscularly, intravenously and orally. The treatment course averaged 7-14 days. The dose of the drug for the intravenous and intramuscular administration was 1.5-3 g 4 times a day and that for the oral administration was 0.75 g 2 times a day. The strains of gram-positive cocci, Escherichia coli and Proteus spp. proved to be highly sensitive to the drug: 80-83, 43 and 53 per cent of the sensitive strains respectively. 25-75 per cent of the strains showed beta-lactamase activity that was most frequently detected in Proteus spp. and Staphylococcus spp. The maximum concentrations of ampicillin and sulbactam determined by liquid chromatography were respectively 18 +/- 5.7 and 11 +/- 2.42 micrograms/ml in the blood and 700 and 350 micrograms/ml in the urine. A satisfactory bacteriological effect of the treatment was observed in 93 per cent of the cases. A complete elimination of the initial pathogens was stated in 57-73 per cent of the cases. No side effects were recorded.