[Choice of surgical correction of urodynamics in ureteral tuberculosis].

To determine an optimal choice of surgical correction of urodynamic disorders and time of its conduction in ureteral tuberculosis, we made a retrospective analysis of 271 case histories of primary patients with tuberculosis of the kidneys who had x-ray picture of ureteral lesions, hydro- or ureterohydronephrosis. We used the following methods of this correction: calycoureteroanastomosis (n = 7, 2.5%), plastic reconstruction of the pelvoureteral segment (n = 9, 3.3%), ureteroureterostomy (n = 6, 2.2%), ureterocystostomy (n = 125, 46.1%), ureteroileoplasty (n = 6, 2.2%), ureteroileocystoplasty (n = 12, 4.4%), intestinal cystoplasty with ureteral transplantation (n = 86, 31.7%). Three-four months was an optimal preoperative preparation (treatment with antituberculous drugs). Long-term administration of the drugs (up to 1 year and longer) and late surgical urodynamic correction leads to complete dysfunction of the kidney which may result in removal of this organ (35%). Palliative operations (cystostomy, nephrostomy, ureterostomy, ureterocutanestomy) often invalidate the patients and degrade quality of their life (n = 20, 7.4%). Only high qualification of the surgeon in reconstructive plastic surgery provides good results of medical rehabilitation.

[Capacities of rapid diagnostic methods in renal tuberculosis].

The paper comparatively assesses routine and new medical technologies (metachromatic urine test, polymerase chain reaction, chromatographic mass spectrometry, and enzyme immunoassay) for detection of Mycobacterium tuberculosis and tuberculosis antibodies. It is shown that molecular biological and immune assays may be used only for rapid diagnosis and screening, followed by a full-scale phthisiourological study as the detection of markers of Mycobacterium tuberculosis and tuberculosis antibodies cannot be a criterion for establishing renal tuberculosis. The authors consider that the conventional microbiological tests whose validity is beyond question in case of positive results are the most established and practice-tested canons of phthisiourological diagnosis.

[Current methods in diagnosis of the kidney tuberculosis].

Conventional and updated medical technologies of detecting M. tuberculosis (MT) and tuberculosis antibodies (TAB) were compared. It is shown that molecular-biological and immunological methods can be used only in rapid diagnosis and screening. They should be followed by further examinations as urine MT makers and blood TAB are not criteria for final diagnosis of renal tuberculosis. Routine microbiological methods are most precise in the above diagnosis. Diagnosis of initial forms of renal tuberculosis is still unsolved problem. Low professional skills of outpatient service urologists in the field of urogenital tuberculosis explain late detection of urinary tuberculosis.

[Treatment of renal tuberculosis].

Three groups of parameters of 4 tuberculostatics effects on tuberculosis of the kidneys and general condition were singled out basing on comparative efficacy of 3 and 4 mycobacterial drugs: more effective, equally effective and negative. Higher efficacy manifested with greater number of cases of leukocyturia elimination and conversion of cultivable mycobacteria into uncultivable ones, more obvious morphological signs of tuberculous inflammation involution. Equal efficacy of 3 and 4 drugs was characterized by the same rate of mycobacteriuria continuation and detection of mycobacteria in caverns from the removed tuberculous kidney. The negative effect of medication consisted in increased intolerance of the drugs, involvement of the liver and kidneys, toxico-allergic reactions. Indications for initial use of 4 mycobacterial drugs in new cases of tuberculosis are early forms of tuberculosis of the kidneys in normal nitrogen-excretory function and absence of hepatic insufficiency. This treatment must be recommended with caution for old patients. The conclusion is made that WHO recommendation to use initially four drugs for treatment of urogenital tuberculosis is not well grounded and physicians should decide on the treatment regimen after consideration individual characteristics of the patients.

[Comparative evaluation of therapeutic effects of 3 and 4 antitubercular agents at the initial stage of the treatment of renal tuberculosis]. / Sravnitel'naia otsenka terapevticheskogo vozdeistviia 3 i 4 protivotuberkuleznykh preparatov na initsial'nom étape lecheniia tuberkuleza pochek.

Three groups of the parameters of the therapeutic effects of 3 and 4 antituberculous drugs on renal tuberculous inflammation were identified. The primary effect of 4 drugs was much frequently manifested itself by the normalization of urinalysis and the transfer of cultured to uncultured Mycobacterium tuberculosis (MBT). The equivalent effect of 3 and 4 drugs was characterized by the similar rate of continuation of specific mycobacteriuria, by the detection of MBT in the cavernous contents from the removed tuberculosis-afflicted kidney and by the equivalent morphological characteristics of tuberculous inflammation involution. The negative impact of the therapeutic action of 4-component chemotherapy appeared as a much larger number of cases of intolerance of antituberculous drugs, hepatic and renal failures, and toxic-and-allergic reactions.

[Role of polymerase chain reaction in diagnosing tuberculosis of the bladder and male sex organs]. / Rol' polimeraznoi tseppnoi reaktsii v diagnostike tuberkuleza mochevykh i muzhskikh polovykh organov.

Detection of M. tuberculosis DNA by polymerase chain reaction (PCR) and standard technique was compared in 76 new cases of urogenital tuberculosis. In the urinary test PCR confirmed tuberculous etiology of the disease and corresponded to M. tuberculosis detection in 27 (60%) of 45 patients with urinary tuberculosis. M. tuberculosis DNA detection rose significantly in patients with mycobacteriuria (71%) and in examination of aspirates from isolated renal cavern, blocked kidney, epididymis, prostate and seminal vesicles. Treatment for 1 month and longer transforms the positive result into the negative one. Of 16 patients with tuberculosis of male sexual organs M. tuberculosis DNA were detected by PCR in prostatic secretion in 43.7%, in ejaculate in 93%. This did not correlate with detection of M. tuberculosis. Thus, PCR is recommended for instant diagnosis and screening before further examination and cannot be the only method in identification of urogenital tuberculosis.

[Regeneration of post-tuberculous bladder after intestinal plastic surgery]. / Regeneratsiia posttuberkuleznogo mochevogo puzyria posle kishechnoi plastiki.

The effects of regeneration of the urinary bladder on the intestinal transplant were assessed in conducting detrusor resection after creation of an artificial reservoir for urine in 107 patients with posttuberculous microcystis. It was found that the condition of the intestinal transplant depended on severity of anatomic changes and the scope of detrusor resection. The best results of creation of a new artificial reservoir for urine are achieved if the bladder, as a cause of regenerative process and unfavourable factor for operation outcome is totally removed.

[Urinary bladder cancer in patients with tuberculous and post-tuberculous cystitis]. / Rak mochevogo puzyria u bol'nykh tuberkuleznym i posttuberkuleznym tsistitom.

125 patients with tuberculous and posttuberculous cystitis were examined using cytological test of the aspirate from the bladder for atypical cells and histological investigation of the biopsy. Cancer of the bladder has developed in long-term chronic tuberculous or posttuberculous cystitis in 4% of the cases. The best objective method of the diagnosis was histological examination of the biopsy obtained from cancer-suspected sites of the bladder mucosa.

[Urogenital tuberculosis in the Ukraine population]. / Tuberkulez mochevykh i polovykh organov sredi naseleniia Ukrainy.

The prevalence and incidence rates of urogenital tuberculosis in the Ukraine in the past 10 years were studied. They tended to decrease in the first period (1988-1992) and to become stable in the second period (1993-1997), being equal to 10.71 and 1.0 per 100,000. In the past 5 years, the incidence of urogenital tuberculosis tended to increase among urban residents as compared to rural ones. These changes show a total trend in the population living in the radioactively polluted area.

[Intravascular laser radiation of blood in the multimodality treatment of patients with urogenital tuberculosis]. / Vnutrisosudistoe lazernoe obluchenie krovi v kompleksnom lechenii bol'nykh tuberkulezom mochepolovykh organov.

Laser therapy was performed in 45 patients with tuberculosis of the urinary system and male genitals. The radiation was found to have a positive action on the patients' general condition and short-term immunomodulating effect. Following a month, immunological parameters became baseline or near-baseline. In the course of 5 years there was an exacerbation of tuberculosis in 2 (4 +/- 3%) patients who had received laser therapy and in 8-18% routinely treated without laser therapy.

[The ultrasonic diagnosis of renal tuberculosis]. / Ul'trazvukovaia diagnostika tuberkuleza pochek.

Informative value of ultrasonography potential in the diagnosis of nephrotuberculosis was studied by comparison with conventional x-ray and intraoperative findings in 78 relevant patients. Three patterns of renal ultrasonic architectonics changes in nephrotuberculosis were revealed: 1) focal heterogeneity of renal parenchyma, 2) pseudocystic type, 3) hydronephrotic transformation. It is concluded that ultrasonography is superior to routine diagnostic methods, but is recommended for use in combination with standard methods of phthisiourological diagnosis.

[The chemotherapy of patients with prostatic tuberculosis]. / Khimioterapiia bol'nykh tuberkulezom predstatel'noi zhelezy.

The authors examined the efficacy of various chemotherapeutic regimes in the management of patients with tuberculosis of the prostate. The data of bacteriostatic secretion activity of the prostate showed that the most effective regimes were as follows: 1) isoniazid and ethambutol followed by galvanization of the prostatic region, then rifampicin suppository containing dimexid; 2) isoniazid and rifampicin suppository containing dimexid; oral ethambutol. Proper curative measures depending on the clinicomorphological types of the tuberculous prostate and their duration are also given. Using the proposed regimes in 68 patients provided 80.7-96.6% positive responses. The authors advise to carry out seasonal courses of chemotherapy using mainly the method of rectal administration of anti-tuberculous agents, dimexid and tissue electrophoresis.