[SURGICAL TREATMENT OF PATIENTS WITH OBSTRUCTION OF PYELOURETERAL SEGMENT].

The article presents the operation results of 380 patients (170 (44,7%) men and 210 (55,3%) women) with obstruction of pyeloureteral segment at the period from 1996 to 2014. The middle age was 43,2±7,6 years old. Primary strictures took place in 302 (79,5%) patients and recurrent strictures - in 78 (20,5%). Open and laparoscopic plastic operations were performed in 248 (65,2%), endoscopic surgery - in 112 (29,5%), organo-removal surgery - in 20 (5,3%) cases out of 380 patients with obstruction of pyeloureteral segment. The hines Andersen open pyeloplasty was carried out in 142 (37,4%) patients with primary hydro- nephrosis out of 152. In addition, an antevasal pyeloureteral anastomosis was formed in 65 (17,1%) cases. Neivert operation was used in 8 (2,1%) cases because of extensive stricture of pyeloureteral segment. Kalp-De Vird pathwise pyeloplasty was fulfilled in 2 (0,5%) patients. Laparoscopic pyeloplasty was performed on 96 (16,7%) patients. These surgeries were carried out by transperitoneal approach using lateral position and 3 or 4 trocars. Endoscopic treatment of pyeloureteral segment was completed in 112 (29,5%) patients. Percutaneous endopyelotomy was used in 42 (11,0%) and retrograde - in 64 (16,8%) cases. Endoplasty of pyeloureteral segment was applied in 6 (1,6%). The efficacy of open pyeloplasty consisted of 93,7% and laparoscopic pyeloplasty - 94,6%. Good results after endopyelotomy were noted in recurrent strictures of pyelouretal segment.

[The use of NefroDoz in patients with urolithiasis who underwent extracorporeal shock wave lithotripsy].

The article presents the results of the multicenter clinical comparative open-label trial in three parallel groups, which was aimed to the evaluation of the efficacy and safety ofbiologically active food supplement NefroDoz after extracorporeal shock wave lithotripsy (ESWL) in patients with urolithiasis. NefroDoz was prescribed for the lithokinetic purpose. The study involved 114 patients from different regions of the Russian Federation aged from 18 to 75 years (mean age 45.56 +/- 12.49 years) with a diagnosis of urolithiasis who underwent ESWL. Patients were divided into 3 groups according to the type oftreatment. Evaluation of the effectiveness was performed using data from a blood test, urine analysis, and biochemical blood assay, ultrasound and KUB X-ray. The results showed that NefroDoz has diuretic, anti-inflammatory, and lithokinetic effects, and is effective and safe drug for the patients with urolithiasis who underwent ESWL.

[Sigmovaginoplasty in patient with testicular feminization syndrome].

The article presents the description of the clinical observation of the 36 years old patient with testicular feminization syndrome: genetic (karyotype 46 XY) and gonadal male sex, female external genitalia and the absence of derivatives of Mullerian ducts (uterus, fallopian tubes, the upper third of the vagina). At the first stage, testes were removed; then, vaginoplasty using segment of the sigmoid colon for possible sexual intercourse was performed. There were no complications. Currently, the patient's condition is satisfactory; she lives a regular sex life.

[The operative cystoscope with joystick control mechanism of flexible tools inserted into the urinary bladder and the ureter].

The authors developed an operative cystoscope with joystick control mechanism of ureter catheters and other flexible tools. This construction allowed control of flexible tools inserted into the bladder and the ureter in various directions, thus providing a necessary observation of the operative field at endoscopic operations on the bladder and ureter. This was one of the factors, which determined the operation success.

[Intestinoplasty of ureters].

The review provides a comparative evaluation of reconstructive surgery in patients with extensive restrictions of ureter using intestinal transplants. The questions relating to the main stages of intestinal reconstruction of ureters, forming intestinal transplant, technique of creating of anastomoses are discussed; a comparative analysis of long-term results and complications of intestinoplasty of ureters is performed.

[Extracorporal surgical treatment of patients with renal cell carcinoma].

Municipal multidisciplinary hospital No 2, Saint-Petersburg The article presents results of 9 extracorporal renal resections for carcinoma with the following autotransplantation. The mean duration of operation was 297.8 minutes and the mean period of hypothermic ischemia consisted of 112,6 minutes. A postoperative follow-up (max 4 years) revealed that there isn't noted any dissemination of the tumor and functional condition of the transplanted kidney was satisfactory. The extracorporal renal resection with the following autotransplantation could be performed according to absolute indication of organ saving and technical impossibility of renal resection in situ. In the case, when experienced surgeons carry out the operation, the existing risk of postoperative complications is low in spite of large volume and traumatic character of surgery in interdisciplinary approach.

[Rehabilitation of patients with "forgotten" stents].

The treatment of patients with large calculi, formed on both ends of the long-standing stent, remains difficult problem of modern urology. We observed 6 patients with long-term (16 to 24 months) standing stents. Large calculi on both ends of the drain were detected in 5 patients, fragmentation of stent--in 1 patient. Indication for stenting was ureteral calculus in 4 patients, staghorn stone of the left kidney in one pregnant woman 26 years old, and the stent was installed during orthotopic cystoplasty in 1 patient. At the first stage, contact laser lithotripsy of calculus on cystic end of the stent was performed, and distal portion was removed with forceps. 2-3 weeks after, PCNL was performed and renal end of the stent was removed. Patient with fragmentation of stent underwent ureteroscopy, and parts of the drainage were removed. To remove the stent, on average 1.8 endourological intervention was required. Results of operations in all cases were successful. Endourological operations are an effective method for the treatment of patients with large calculi, formed at both ends of the "forgotten" stents.

[Extracorporeal partial nephrectomy for kidney neoplasms].

The results of 11 extracorporeal partial nephrectomies for neoplasm with subsequent autologous transplantation of kidney are presented. In 4 patients, resection was performed ex vivo in the presence of a large centrally located tumor in a solitary kidney. Another two patients had bilateral tumor process. In 2 patients, a large, centrally located tumor in solitary kidney was the indication for extracorporeal resection. 3 patients had elective indications for the operation. Early postoperative complications occurred in 5 patients. 3 patients had oligoanuria. One patient developed postoperative bleeding; one patient developed obliteration of the upper third of ureter. Recurrence of renal cell cancer has not been identified; the functional state of the kidney vessels and vessels of upper urinary tract was regarded as satisfactory. Good results of these operations indicate the feasibility of expanding the indications for extracorporeal organ-sparing surgery.

[The results of intestinoplasty of ureters].

The article presents the immediate and long-term results of intestinoplasty of extensive uretral obstructions. From 2001 to 2012, 47 patients underwent intestinoplasty, and 3 patients--sigmoureteroplasty. 33 patients (66%) had unilateral lesions, and 17 (34%)--bilateral lesions. Postoperative complications occurred in 14% of cases. Early complications occurred in 6 (12%), late complications--in 1 (2%) patient. Complications requiring surgery occurred in 3 (6%) patients. The results of re-operations were successful. Deaths were not recorded. The observation period ranged from 3 months to 11 years. All patients achieved the restoration of urodynamics and normalization of kidney function. Intestinoplasty in extensive uretral obstruction is the operation of choice, as it allows to restore the flow of urine from the kidney, improves its function, arrests the chronic pyelonephritis and rescues patients from permanent renal and ureteral fistulas.

[Results of open multicenter study of the safety of doxazosin in combination with indigal in men with stages I-II prostatic adenoma].

The article presents a method of conservative treatment of men with I-II stage prostatic adenoma using a combination of doxazosin and indigal, which has antioxidant, antiproliferative and anti-inflammatory properties, that allowed improving urodynamic parameters and reducing the progression prostate adenoma, minimizing the adverse effects of treatment.

[Comparative clinical and morphofunctional evaluation of the intestinal and colonic gastric orthotopic urinary reservoirs at different times of functioning].

The complex clinical and morphological evaluation of different variants of orthopic urinary reservoir (OUR) at different times of functioning was performed. During 1996-2012, orthotopic cystoplasty was performed in 265 patients (ileocystoplasty--in 204, gastrocystoplasty--in 24, and sigmocystoplasty--in 29 patients). There were 207 (77%) men and 61 (23%) women aged 22-75 years (mean age, 57.5 +/- 1,3 years). Cold biopsy over time (1 to 6) was performed in 105 patients. The total number of biopsies was 150. Duration of morphological study was 2-12 years. Clinical examination included assessment of acid-base balance and electrolyte balance of within 3-24 months, evaluation of urodynamic parameters (OUR volume, daytime and nighttime continence, micturition volume), assessment of the frequency and the nature of infection, resistance of microorganisms to antibiotics and the symptoms of inflammatory reaction in period 1-90 months after surgery. Morphological study included histological, histochemical, immunohistochemical, and morphometric methods. Application of a set of clinical, morphological, immunohistochemical examinations is a premise for individual choice of cystoplasty, and creates the preconditions for the correction of the process of adaptation to the OUR, regardless of its form in the early and later stages of its functioning. Due to the good adaptation to the new conditions in all three types of OUR and absence of trends to malignant transformation of its mucosa, the ileocystoplasty is method of choice for creation of OUR, and gastrocystoplasty and sigmocystoplasty are alternatives.

[Extravaginal transposition of the urethra in the treatment of post-coital cystitis].

From 2005 to 2013, 106 patients with post-coital cystitis underwent surgery. Of these, vaginal ectopia of urethral meatus was diagnosed in 19 (17.9%), and hypermobility of the distal urethra in 87 (82.1%). 28 (26.4%) women underwent the traditional plasty of distal urethra by O'Donnell method (group 1) and 78 (73.6%) patients underwent surgery using new method of extravaginal transposition of the urethra developed in our clinic (group 2). In group 1, satisfactory results were obtained in 23 (82.1%) patients, poor results--in 5 (17.9%) patients; in group 2, in 77 (98.7%) and 1 (1.3%) patients, respectively (p < 0.05). The disappointing results were attributable to the divergence of seams, reverse bias of urethra and recurrence of the disease. The use of method of extravaginal transposition of the urethra compared with a standard method allows to reduce the trauma of surgery, improve reliability of fixing the urethra, reducing the risk of its restriction and disease recurrence.

[Therapy of rapid ejaculation using dietary supplement "NeyroDoz": results of a multicenter non-randomized clinical study].

The main aim of the study was to determine the effectiveness of a multicomponent dietary supplement NeyroDoz in patients with rapid ejaculation. We examined 50 patients with rapid ejaculation (premature ejaculation), who were recruited in 9 clinical centers in different regions of Russia. These patients received NeyroDoz, 2 capsules twice a day for one month, followed by a control observation for 1 month. In study group of patients, symptomatic improvement was achieved in 45 (90%) of 50 patients at 4-week observation target date. In assessing the impact of NeyroDoz on different groups of symptoms, it was found that it significantly increases the average time of sexual intercourse by 2 times, increases the orgasm brightness, reduces the severity of psychosomatic component and has a positive effect on all components of the copulative cycle. In assessing the afterimpression, this effect was maintained throughout the period of follow-up.

[Laparoscopic plasty in primary stricture of pyeloureteral segment].

The article presents the results of laparoscopic pyeloplasty in 72 patients with primary stricture of pyeloureteral segment (PUS). The study included 34 men, 38 women; mean age was 32 +/- 4,6 years. The operation was performed by transperitoneal approach in side position of patients. 4 trocars were used. There were no conversions to open surgery. Urinary leak after surgery was observed in 4 patients; in 3 patients it has discontinued independently, and in one patient it has required a repeat laparoscopy and suturing of anastomotic defect. Due to recurrent narrowing of the PUS, two patients underwent retrograde endopyelotomy, and one patient--open pyeloplasty. The effectiveness of laparoscopic pyeloplasty in these series was 94.4%. Impediments for performing laparoscopic pyeloplasty included small pelvis size, the presence of inferior polar vessels, and frequent exacerbations of chronic pyelonephritis, which led to the development of adhesive process in the PUS. Thus, laparoscopic pyeloplasty is the treatment of choice in patients with primary constrictions of PUS and is as effective as open plasty of PUS.

[The use of ProstaDoz in patients with chronic prostatitis. Results ofa multicenter nonrandomized clinical study].

The main purpose of the study was to determine the effectiveness of a multicomponent dietary supplement ProstaDoz in patients with chronic prostatitis. The study included 50 men with clinical symptoms of a chronic prostatitis, which were observed in 9 clinical centers in different regions of Russia. All patients have received 2 capsules of ProstaDoz twice a day for 1 month, followed by dynamic observation for 4 weeks. Symptomatic improvement was achieved in 46 (92%) patients. Evaluation of effects of ProstaDoz on various groups of symptoms has revealed that it reduces pain, promotes urination normalization and improvement of quality of life. These effects were maintained during all follow-up period.

[Supine percutaneous nephrolithotripsy].

MATERIALS AND METHODS: The report included the results of PNL in 64 patients. In 34 of patients (Group I), the surgery was performed in the prone position, and in 30 patients (Group II) - in semilateral (supine) position. The study included patients with one or more pelvic stones larger than 2.5 cm and requiring only a single percutaneous approach, with a body mass index less than 30 kg/m2 and the absence of contraindications to the PNL in the prone position. Average size of stones was 3.2 cm in Group I, and 3.0 cm in Group II. For the comparative analysis between the two groups, timing of surgery, intra- and postoperative complication rates, extent of blood loss and length of hospital stay were evaluated. RESULTS: Analysis of the results of PNL performed in prone and supine position of patient showed the absence of statistically significant difference in the effectiveness of the surgery, extent of blood loss, and length of hospital stay between the two groups. Significant difference was observed only in the timing of surgery (Group I, 68 min; Group II, 43 min). CONCLUSION: When performing PNL in patients with uncomplicated nephrolithiasis in prone and supine position of patients on the operating table, significant difference was observed only in the timing of surgery.

[Application of a device for evacuation of fragments of biological tissue and uroliths in endoscopic operations].

The proposed evacuator allows prevention of regurgitation of fragments of resected tissue of destructed bladder stones from the lower cavity of the device to the upper one, and then to the urinary bladder and, thus, it reduces loss of the biological material fragment for morphological investigation as well as the bladder stones fragments for an analysis of their chemical composition and structure, more effectively and quicklywash off the urinary bladder during endoscopic operations.

[Long-term results of appendicouretheroplasty].

The article presents the long-term results of 15 operations for replacement of urethral strictures of various locations by appendix. One patient undergone plastics of top third of the right ureter, other undergone replacement of it pelvic part, and replacement of left ureter was performed in 3 cases of replacement of pelvic part. Surgical technique was modified in 12 cases by using a cut area from head of blind colon for better appendicocystanastomosis. The follow-up period ranged from 3 months to 14 years, on an average 6.1 +/- 3.2 years. Postoperative complications requiring surgical correction occurred in 2 (13.3%) patients. Urinary tract patency was restored in all cases. Thus, good short-term results are obtained for the 2 (86.7%) patients, and good long-term results--for all patients. Fatal cases were not registered. Results of our clinical observations suggest the possible success of replacement of the any part of right ureter and left pelvic ureter by appendix.