Urologiia i nefrologiia最新文献

A clinical diagnostic scale of infravesical obstruction (IVO) in patients with benign prostatic hyperplasia is proposed which provides the diagnosis of IVO in BPH patients with probability up to 89% basing only on clinical evidence obtained at a detailed urological examination (size of the gland, size and index of the prostatic transitional zone, residual urine, micturition urine, maximal micturition rate).

2560 children with the reflux were observed, 224 of them were operated. Long-term positive results after Koan's operation were noted in 97.7% of the patients. Different plastic operations were assessed, technical operative mistakes analyzed.

The authors analyse the effects of ESWL on renal function in 180 patients with nephrolithiasis. Renal performance was judged by the level of enzymes. Pharmacological defense of the kidney was made with isradipine and lipostabil given for 12 weeks before lithotripsy and 4 weeks after it. Isradipine proved a good corrector of renal function after lithotripsy as it decreased enzymuria, promoted normalization of the activity of alkaline phosphatase, gamma-glutamyl transferase, alpha-glucosidase and lactate dehydrogenase to the end of the first postoperative month. This indicates quicker recovery of renal parenchyma after ESWL. Lipostabil also improved enzymic indices. Its moderate protective action on renal parenchyma normalized levels of some enzymes one month after ESWL.

The activity of mitochondrial respiration and oxidative phosphorylation (OP) was studied in white rats subjected to nephrotomy. The suture was made with absorbable surgical threads such as catgut plain, biofil (from dura mater spinalis of the cattle), dexon II (polyglycolic acid). The use of catgut plain inhibits biosynthetic processes 7 and 14 days after operation. Hyperbaric oxygenation enhances oxidative phosphorylation in postoperative renal tissue sutured with different biological and synthetic absorbable surgical threads (catgut, biofil, dexon II) and prevents sharp depression of the above processes in the course of catgut biodegradation. This fact is of great importance for reduction of normal functional and metabolic activity of the operated kidney.

Renal enzymuria was measured in hemophiliacs: enzymes of tubular epithelium, associated with cytomembrane, lysosomal, cytosolic, marker of glomerular defect. The enzymological markers indicated impairment of nephron tubular component in all the examinees. Patients with hematuria had also defects in glomerular apparatus. A direct relationship existed between the severity of calciuria and activity of membrane-associated enzymes of canalicular epithelium.

The role of neoadjuvant chemotherapy for invasive transitional cell carcinoma (TCC) of the bladder is not determined yet. M-VAC and CMV regimens have a complete response rate of 10-47% with an overall response reaching 80%. In 16.7-35% of all the responders and 42.9-92% of the complete responders a functioning bladder can be preserved. The influence of neoadjuvant chemotherapy on long-term survival is questionable. Nevertheless, the authors conclude that neoadjuvant chemotherapy is feasible in patients with invasive TCC as it improves the results of following surgery and in some cases enables an organ sparing operation.

Contractility of different portions of the intestine used for partial or complete replacement of the bladder was studied on the circular fragments of non-inbred rats' intestine. The contractility was studied at rest, in response to electric stimulation, addition to the solution of growing concentrations of cholinomimetic or adrenomimetic drugs, to depolarization of smooth cell membrane with hypersodium solution. It was established that contractility of the large intestine contrary to that of the small intestine is characterized by diminished amplitude of spontaneous contractions. In addition of cholino- and adrenomimetics, amplitude of the phasic and tonic reactions in the large intestine fragments compared to those of the small one was decreased. The conclusion was made that the large intestine is preferable for taking transplants partially replacing urinary bladder to correct its reservoir function whereas small intestinal grafts are more suitable for total replacement of the detrusor.

The authors have performed urodynamic investigations pressure-flow in 39 males (mean age 57.9 +/- 1.8 years) to detect infravesical obstruction. Interpretation of the findings rested upon Abrams-Griffits index (AGI) derived by the formula AGI = PdetQmax - 2xQmax, where Qmax is the maximal speed of urine flow and PdetQmax is detrusor pressure when the maximal urine flow is reached. Definite conclusion on the presence or absence of infravesical obstruction was feasible for 21(53.8%) of 39 examinees, was not possible for 18(46.2%) patients. Statistical processing yielded non-linear relationship between PdetQmax and Qmax (cubic parabola) requiring correction for AGI (coefficient K calculated according to the formula K = 58.7 - 0.00554x(Qmax)3). This correction for nonlinearity K allowed classification of 11 out of 18 patients who were initially indefinite. By standard AGI technique, the uncertainty zone made up 46.2% while correction for nonlinearity reduced this zone to 18.0% (p < 0.008). Thus, the account for nonlinearity of the relationship between PdetQmax and Qmax may contribute to a rise in diagnostic value of urodynamic investigations.