Urologiia i nefrologiia最新文献

44 patients seeked medical advice for low urinary symptoms. Their examination consisted of digital rectal investigation, test for prostate-specific antigen (PSA) in the serum, transurethral ultrasonic investigation, fine needle multifocal biopsy of the prostate. Three groups were identified by the PSA levels. 7 patients of group 1 had PSA up to 6 ng/ml. Cancer was diagnosed in 3 of them, prostatic intraepithelial neoplasia (PIN) in 4 patients. 16 patients of group 2 had PSA within 7-10 ng/ml. In this group only 1 patient had cancer, the rest 15 had PIN. 21 patients of group 3 with PSA at least 10 ng/ml had cancer, benign prostatic hyperplasia, PIN (12, 2 and 7 patients, respectively). 3 patients with high-grade PIN and PSA above 10 ng/ml in 6 months were diagnosed to have adenocarcinoma, in 6 such patients signs of dysplasia disappeared after antiandrogenic therapy. Further investigations on diagnosis and treatment of PIN are desirable.

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.

The paper is concerned with general cost-effective approaches to management of BPH: problems of treatment and patients choice, cost of different treatments, examinations, time of the response onset, effective doses, regimens, side effects. Mathematical estimations show that of three groups of drugs (alpha 1-adrenoblockers, phytopreparations, finasteride), alpha 1-adrenoblockers are most effective as to minimal time to the start of clinical effect, while once-a-day regimen was the cheapest of the dose regimens. Of alpha 1-adrenoblockers, hemodynamically low-active preparations (tamsulosin) are preferable.

A surgical treatment of neuromuscular ureteral, dysplasia (NUD) is proposed which provides development of restenosis in vesicoureteral anastomosis and vesicoureteral reflux in maintenance of normal urodynamics of the upper urinary tracts. This organ-saving method can be applied at late disease. Multichannel impedance ureterography proved useful in definition of the operation's scope.

Causes and mechanisms of complications in urolithiasis are analysed with a focus on the role of occlusion of the urinary tracts in the onset of pyoseptic complications. Most severe of them is bacteriotoxic shock which is hard to treat and dangerous for essential body functions. The priority of the treatment must be reestablishment of urine passage. Additional tools of the treatment include wide-spectrum antibiotics, efferent detoxication, electrochemical blood oxidation, hyperbaric oxygenation, UV blood radiation.

15(2.4%) of 601 patients (392 have undergone transvesical adenomectomy, 111 had gunshot wound of the external genitalia and small pelvis organs, 98 had closed pelvic traumas, injuries of the urinary bladder and posterior urethra) were treated for persistent urinary fistulas with human allogenic fibroblasts growth cultures grown in the artificial medium. Before transplantation into the fistula tracts, the fibroblasts were grown in bioreactor on the microcarriers. Application of allogenic fibroblast growth culture has reduced hospital stay to 7.5 days. This method is simple and effective in inpatients. Use of allogenic fibroblasts allows to create bank of cell transplants for application in clinical practice.

Basing on original experience (2150 cases) and literature data, the authors review in detail current status of EL: indications and contraindications, complications, pediatric applications, use in anomalous and single kidneys, in single, multiple and coral concrements. Prospects for the future are outlined.

Ultrasonic transabdominal and transrectal investigations, computed tomography, endoscopic photodynamic studies, polyfocal biopsy of the urinary bladder were used in examination of 1238 patients which were diagnosed to have urinary bladder cancer. 894 patients underwent transurethral resection of the bladder. Morphologically, cancer of the urinary bladder has an inductory effect on intact parts of the bladder mucosa. This means that even most radical resection does not eliminate grounds for a new tumor growth. Radical cystectomy was performed in diffuse papillomatosis, multiple stage T2 tumors of high-grade malignancy, tumors at stage T3, T4, Nx, MO, in rapid recurrent tumors after conservative or operative treatment.

3-13-year follow-up results are presented for 83 adult patients operated in childhood for ureterohydronephrosis, hydronephrosis, vesicoureteral reflux. Positive results were obtained in adults operated in early childhood when renal and urinary compensatory mechanisms were stronger. In hydronephrosis and vesicoureteral reflux the results were better than in ureterohydronephrosis. Combined clinical, morphological and experimental investigations have revealed a direct relationship between renal, ureteral functional reserves in adult patients and age of the correcting operation in childhood, degree of intactness of the kidneys and urodynamics, regenerative ability of leiomyocytes.