[The prevention of the acute urine retention and lower urinary tract infection after rectum surgery].

The possibilities of the prevention of the acute urine retention in patients with the prostatic enlargement after the rectum surgery. The method was successfully used in 106 patients.

[Endosurgery in treatment of urinary bladder cancer in elderly patients].

Treatment of 162 patients with micro- and macrohematuria was analyzed. Urinary bladder cancer was diagnosed in 156 of them (men--127, women--29). All patients received endoscopic treatment (transurethral resection). An average age of patients was 74.4±7.9 years. 142 (91.1%) of patients were older then 60 years. The transitional cell carcinoma was diagnosed in 118 patients. The urinary bladder cancer recurrence was diagnosed in 13 (9.2%) patients steged T1 and in 24 (16.9%) staged T2. Only 2 patients with T3 stage of the disease were considered to be unsuitable for endoscopic transurethral resection and received an open argon tumor vaporization.

[Emergency oncourological surgery in senile patients].

Many questions of treatment tactics in senile patients remain not quite clear. It is necessary to work out an algorithm of surgical treatment depending on severity of somatic status of the patient and life prognosis. It is difficult to make a decision concerning the necessity and perspectivity of palliative surgical treatment of oncological patients at late stages. Taking into account the complicacy in prediction of dynamics of malignant growth, active surgical tactics with thorough supervision of senile patients with grave somatic status is preferable.

[Clinical aspects of diagnostics and surgical treatment of acute primary purulent destructive pyelonephritis].

79 patients with the acute primary non-obstructive pyelonephritis were treated during 2003-2006. 24 (30.3%) patients were operated on with the diagnosis of acute primary purulent destructive pyelonephritis. Organopreserving operations were performed in 23 (95.8%) of patients. The early diagnostics of purulent destructive complications of pyelonephritis, using the developed diagnostic algorithm, and modified operative technique allowed to increase the rate of organopreserving operations, avoid reinterventions and decrease the risk of intraoperative complications.

[An original modification of wedge resection of the kidney in renal cell carcinoma].

Organ-preserving surgery was made in 133 patients with renal cell carcinoma. An original modification of renal resection with administration of the drug tachocomb was conducted in 22 patients. Short- and long-term surgical outcomes demonstrate advantages of the surgery supported by the results of postoperative monitoring including ultrasound angiography, computed and magnetic resonance imaging.

[Postoperative cystitis in children]. / Posleoperatsionnyi tsistit u detei.

Operative intervention on the urinary bladder in children entails postoperative reactive cystitis. Biopsies of urinary bladder mucosa were studied morphologically. Basing on these morphological findings and clinical evidence, three leading variants of the mucosa changes were distinguished: focal squamous cell metaplasia; excess of the lymphoid tissue and lymphangiectasia; hemangiectasia. These morphological changes aggravate the course of postoperative cystitis. UHF-therapy and magnetic-laser radiation beginning postoperative day 4 and 7, respectively, reduce inflammation developing in postoperative cystitis. This indicates effectiveness of the above combined therapy which can be also used for prevention of acute inflammation episodes in postoperative period.

[Morphological reasons of development of recurrent cystitis in children]. / Morfologicheskie predposylki razvitiia retsidiviruiushchego tsistita u detei.

Chronic cystitis was diagnosed in 36% of children with neuromuscular ureteral dysplasia, in 69% of those with vesicoureteral reflux, in 42% of girls with urolithiasis. Recurrent inflammation was registered in 96, 11% of patients with fibrinous cystitis and catarrhal cystitis, respectively, and in 62% of girls with bullous cystitis. Histological examination of 130 biopsies of bladder mucosa from girls with frequent recurrences of chronic cystitis provided a clear morphological picture of each endoscopic cystitis form. In bullous cystitis there are 2 congenital variants of mucosal structure: overdevelopment of lymphoid tissue as massive lymphoid follicules and lymphangioectatic form. Catarrhal cystitis is characterized by vascular angiomatosis. All the patients with fibrinous cystitis had squamous cell epithelial metaplasia. Morphological findings evidence that fibrinous cystitis is the most severe and unfavorable form of cystitis, bullous cystitis is less severe while catarrhal cystitis is favorable.

[The surgical treatment of urinary incontinence in children]. / Operativnoe lechenie nederzhaniia mochi u detei.

The paper reports examination, treatment and follow-up data on 8 children aged 4-13 suffering from total enuresis, who failed previous conservative or operative treatment. Upon examination enuresis was attributed to trauma or malformations of the neck of the urinary bladder (NUB) or urethra (in 2 and 6 patients, respectively). Out of the latter, NUB congenital defect was in 4, total epispadia in 1, spina bifida in 1 patient. Urodynamic studies showed the absence of detrusor-sphincter dyssynergia and confirmed organic nature of NUB lesion. Six children underwent NUB electromyography which recorded no uniform, preformed complexes with adequate voltage. All the children were operated on: NUB reconstruction according to Davis, bilateral uretero-cystostomy according to Coen. An immediate postoperative response was seen in 7 children who were able to retain urine for 40 min-2.5 hours. Long-term response (6 months-3 years) was achieved in 7 children who recovered normal uresis. Total enuresis persisted in 1 patient with spina bifida. 2.5-3 years after the treatment the bladder capacity increased in spite of its resection by 1/3.

[The early stages of chronic kidney failure in children with congenital obstructive uropathies and results of surgical treatment]. / Rannie stadii khronicheskoi pochechnoi nedostatochnosti u detei s vrozhdennymi obstruktivnymi uropatiiami i rezul'taty operativnogo lecheniia.

Ninety-six children, aged 4 to 14, with congenital obstructive uropathies were subjected to 131I-hippuran renography, followed by mathematical processing of renographic curves, the measurement of blood mean molecular levels, and blood and urinary immunochemical tests before, and 1 month as well as 1 year after surgery. Intraoperative renal biopsy was taken from 20 patients with unilateral hydronephrosis. Latent chronic renal failure (CRF) was identified where a deficiency of total renal clearance of 131I-hippuran (20 to 56%) was combined with a rise in blood mean molecules from 0.3 to 0.41 conventional units at 254 nm. Latent CRF was detected in 40 of 64 children with unilateral uropathy and in all 32 patients with bilateral uropathy. In patients with unilateral hydronephrosis, the presence of CRF was unrelated to the morphological pattern of pyelonephritis in the affected kidney. Children with latent CRF showed high levels of urinary IgG and albumin and blood mean molecules. One year after the operation, renal function improved in patients whose contralateral kidney had no secretory deficiency. One year after surgery, renal reabsorption mechanisms tended to recover in CRF-free patients only. The clinical pattern of latent CRF and its elimination following surgery were unrelated to roentgenologic markedness of hydronephrosis and VUR, but were dependent on the recovery of compensatory mechanisms in the contralateral kidney. By the end of the first postoperative year, latent CRF was diagnosed in 31% of children with unilateral hydronephrosis (as compared to the preoperative 68%), 43% (vs. the preoperative 60%) of children with unilateral VUR, and in 44% (vs. the preoperative 50%) of patients with unilateral neuromuscular ureteral dysplasia.(ABSTRACT TRUNCATED AT 250 WORDS)

[Cohen's operation in the treatment of vesico-ureteral reflux in children]. / Operatsiia Koéna pri lechenii puzyrno-mochetochnikovogo refliuksa u detei.

The present study is a review of the results of Cohen's operation performed on 43 ureters in 32 children. Treatment results were assessed through the comparison of cystographic and 131I-hippuran renographic findings obtained before and after surgery. Urodynamic recovery in the affected ureter was demonstrated in all children. One year after surgery, there was no improvement in the activity of the resected kidney in 37% of patients. In the remaining patients, secretion improved by 10-13% in the affected kidney. Seventeen children returned for follow-up examination 2 years after surgery. The activity of the affected kidney and the contralateral one improved in 13 of 17 patients. There was no upper urinary retention due to ureteral stricture in any of the children. The rate of recurrent vesico-ureteral reflux (VUR) was 5.3%. Augmentation or persistence of purification deficiency in the affected kidney, detected in 12 patients at first postoperative follow-up, was qualified as a result of aggravated chronic pyelonephritis rather than that of surgical complications related to methodologic specifics. This assumption was verified by the results of the next follow-up examination 2 years after surgery. Therefore, Cohen's method can be recommended for large-scale application in the treatment of VUR in children and is expected to essentially reduce the rate of relapses and improve the standards of surgical care of children with this grave disease.