[Extracorporeal shock-wave therapy in the treatment of Peyronie's disease]. / Primenenie ékstrakorporal'noi udarno-volnovoi terapii v lechenii bolezni Peironi.

The authors analyse the results of treatment of 28 patients with Peyronie's disease using extracorporeal shock-wave lithotripsy (ESWL) performed on Dornier U15 lithotriptor. A total of 2-6 sessions were made, maximal number--12. The efficacy was controlled by clinical indices and ultrasonic investigation (Doppler mapping of the blood flow). ESWL proved to be efficient in the treatment of Peyronie's disease (PD), primarily, in patients with early disease before appearance of severe fibroplastic alterations. Less plaque vascularization by energetic Doppler mapping due to ESWL is an important diagnostic criterion of PD treatment efficacy. Conservative treatment is not indicated in marked deformities and plaque calcification, erectile dysfunction. Moreover, any injection into the tunica albuginea, especially complicated by hematomas may be a damaging factor which triggers fibrous inflammation. Such patients should be treated surgically. If the patient is interested in immediate results or is not interested in continuation of sexual life, the treatment is prognostically uneffective. Thus, ESWL is an effective, safe method of PD treatment but requires further study and accumulation of clinical experience.

[The use of plasmapheresis in treating urology patients]. / Ispol'zovanie plazmafereza v lechenii urologicheskikh bol'nykh.

The paper presents the results of plasmapheresis inclusion into a combined therapy of pyelonephritis. Out of 79 patients treated, 42 had urosepsis, 25 developed pyelonephritis in pregnancy, 12 had complicating chronic renal failure. Uroseptic patients were examined for hemostasis, the rest for immune status. There were symptoms of DIC syndrome in the former and immunity suppression in the latter. After the combined therapy with plasmapheresis, latent hypercoagulation and intoxication disappeared, uroseptic manifestations reduced. The above treatment of pregnancy pyelonephritis stopped inflammation, promoted activation of the immune system. In patients with chronic renal failure adjuvant plasmapheresis enhanced cellular and humoral immunity, neutrophil function, the number of middle-size molecules in the blood diminished. The latter improved renal function in decreasing uremia.

[The treatment of the disseminated intravascular coagulation syndrome in urosepsis patients]. / Lechenie sindroma disseminirovannogo vnutrisosudistogo svertyvaniia krovi u bol'nykh urosepsisom.

The hemostasis system has been assessed in 42 patients in the age range of 18 to 60 years with secondary urosepsis. All patients had been operated for upper urinary tract obstruction or suppurative destructive renal and retroperitoneal lesions. Hemostasis was examined before and after the operation using coagulation screen. Middle-molecular peptides were assayed in the patients before and after plasmapheresis. Revealed hemostatic disorders were treated with heparin, antibacterial agents and infusion of fresh frozen plasma. Plasmapheresis is indicated in patients who are unresponsive to antibacterial therapy and surgical drainage of suppurative lesions. Postoperative hemostatic disorders presented as both hypo- and hypercoagulation, with thrombinemia in most cases. The patients with urosepsis showed latent hypercoagulation phase of DIC. By removing acute phase proteins, plasmapheresis prevented fibrinolytic failure. Exfusion of small volumes of plasma did not affect antithrombin III levels and produced a coagulation-anticoagulation balance. Declining levels of middle-molecular peptides after plasmapheresis were indicative of detoxication, presenting as better clinical status and improvement of laboratory findings.

[Use of plasmapheresis in multimodality correction of hemostasis disorders in patients with calculous pyelonephritis]. / Plazmaferez v kompleksnoi korrektsii narushenii gemostaza u bol'nykh kal'kuleznym pielonefritom.

As many as 142 patients with calculous pyelonephritis were examined for the system of hemostasis. It is shown that pyelonephritis is characterized by hypercoagulation shifts according to the echitox test, by the high content of fibrinogen and its degradation products, thrombinemia, a decrease of the antithrombin III level, and by high heparin resistance of plasma. At the same time there was a reduction of fibrinolysis. Thirty-six patients with the most pronounced disorders of hemostasis underwent multimodality treatment including plasmapheresis which favoured an improvement of the patients' status. The body temperature declined, the signs of intoxication disappeared, and the well-being improved. Hypercoagulation tended to disappearance, whereas the content of fibrinogen and its degradation products decreased. The level of antithrombin III rose and plasma resistance to heparin disappeared. At the same time the characteristics of the paracoagulation tests identifying thrombinemia remained unchanged. No noticeable changes in fibrinolysis were recorded. It is suggested that plasmapheresis should be widely used in multimodality treatment of pyelonephritis.