[Ultrasound studies in varicocele]. / Ul'trazvukovye issledovaniia pri varikotsele.

Renal function, the anatomic and functional status of the vena cava inferior, renal arteries and veins, and spermatic veins were evaluated in healthy individuals and patients with varicocele before and 12 months after laparoscopic ligation of the left spermatic vein. The renal vessels were assessed by color Doppler ultrasonography and renal function was examined by complex radionuclide study with 99mTc-pentatech. There were no significant changes in the diameter of renal arteries and vena cava inferior and the right arterial blood flow velocities in healthy individuals and patients. No difference were found in the diameter of renal veins and in the blood flow velocity in renal arteries and veins. The enlarged renal veins and decreased mean blood flow velocity in the left renal vein in healthy persons and patients with varicocele and lower blood flow in the left renal artery than in the right one indicate left-sided renal hypertension that is attributable to left renal vein overload due to a great variety of collaterals and to compression at the site of "a forcepts". At the same time 12-month postoperative ultrasonic, Doppler and complex radionuclide studies revealed no significant changes in the diameter and blood flow velocity in the left renal vein.

[The prediction of the results of extracorporeal shockwave lithotripsy]. / Prognozirovanie rezul'tatov distantsionnoi udarnovolnovoi litotripsii.

The disease history, objective, x-ray and aggregatometry evidence has been analyzed for 188 nephroureterolithiasis patients to make the prognosis of extracorporeal impulse lithotripsy (EIL). If the concrements presented at x-ray picture as structurally homogeneous, medium-contrast, with even margins, fragmentation occurred after 3-4 sessions in 81% of the cases. Low or high contrast calculi with heterogeneous margins disintegrated after 1-2 EIL sessions. Flat calculi were easier to crush than round ones. A decline or absence of changes on the aggregatometry curves prompted the decision on efficacy of further EIL. The calculi which existed for 6 months maximum were the easiest to crush. The outcome of the previous EIL is also essential for prognosis. Inflammation and obesity worsen EIL results. Variant of EIL regimen and the number of impulses are also prognostically significant.

[The laparoscopic treatment of varicocele]. / Laparoskopicheskoe lechenie varikotsele.

Laparoscopic treatment of varicocele is described for 37 patients. The operation was performed under endotracheal, epidural and intravenous anesthesia with ligation of the testicular vein in 18 patients. Ligation with the dissection was conducted in 19 patients. On the first postoperative day 2 patients were given promedol (2%, 1.0 ml), the rest were injected baralgin (2-3 injections). The patients were discharged after 1-2 days of hospital stay and resumed their usual way of life 2-7 days after the discharge. One month later varicocele disappeared in 29 patients, diminished in size in 7 patients, pain relief occurred in 15 patients. Due to its advantages (simple performance, good visualization of the testicular vein, minimal use of narcotic drugs, short hospital stay, absence of serious complications) laparoscopic treatment may be considered as a method of choice.

[Extracorporeal shockwave lithotripsy in patients with the long-term presence of stones in the ureter]. / Distantsionnaia udarnovolnovaia litotripsiia u bol'nykh s dlitel'nym prebyvaniem kamnei v mochetochnike.

28 patients with long-standing ureteroliths (present in the ureter for 2 months and longer, size 0.8-1.5 cm) were exposed to extracorporeal impulse lithotripsy (EIL). 26 of them were found to have inflammation in the kidneys and upper urinary tracts. Comparative data on EIL effect show that patients with long-standing ureteroliths need more intensive and long EIL treatment, that fragmentation is more troublesome in oxalate monohydrates and phosphate stones with hydroxylapatite. 4 cases eventuated in operative intervention, in 3 cases ureterolith extraction was performed. EIL results in long-standing ureteroliths depend on the presence of renal and urinary tract inflammation, severity of periureteritis, chemical composition, density and structure of the stones.

[Role of radiographic signs of urinary calculi in the effectiveness of extracorporeal shock-wave lithotripsy]. / Rol' rentgenologicheskikh priznakov mochevykh kamnei v éffektivnosti distantsionnoi udarnovolnovoi litotripsii,

The value of X-ray signs of urinary calculi for the efficiency of shock-wave teletripsy (SWTL) was assessed in 188 patients with nephro-ureterolithiasis. The calculi were studied from the general X-ray film by means of a routine 4-5x magnifier. All the patients were divided into 2 groups. Group 1 comprised patients with effective SWTL, i.e. those undergone 1 or rarely 2 sessions. Group 2 included those with low effective SWTL, 2-4 sessions. Comparative analysis of X-ray films indicated that the calculi which were homogeneous in structure, moderate in intensity and had even edges in the general X-ray pictures in 154 (82%) cases were fragmented after 3-4 sessions (the average number of impulses were 7500, at 19.0 kV). With their heterogeneous structure, low and high intensity, irregular rough edges, they were fragmented after 1 or rarely 2 sessions in 34 (18%) patients. The number of impulses was fewer, on an average of 2300, the voltage was less -17.5 kV. It was noted that the pattern of the edges of a calculus and its geometric form are of highly value in the prediction of SWTL. Calculi having even edges were more frequently encountered in patients from Group 2 (in 81.1% of cases), but in patients of Group 1 they were only in 18.1%.

[The role of urinary peptide hydrolase in the laboratory diagnosis of urological diseases]. / Rol' peptidgidrolazy mochi v laboratornoi diagnostike urologicheskikh zabolevanii.

The authors determined activity of leucine arylamidase (LA) or microsomal aminopeptidase locating in tubular cell microsomes and as a specific enzyme indicating parenchymal damage in the urine of 28 healthy subjects and 187 patients with nephroliths (103), renal injury (13 contusions, 11 rupture) before and after extracorporeal lithotripsy. Changes in LA were followed up spectrophotometrically. LA levels in healthy controls, nephrolithiasis patients free of pyelonephritis or with it in remission were similar, elevated in latent course and significantly elevated in complicated by inflammation nephrolithiasis, renal injury and in patients with associated pyelonephritis after lithotripsy. The highest LA activity was recorded in patients with renal injury and after lithotripsy with latent or active inflammation before lithotripsy. LA urinary content may serve indication of inflammation in the kidneys, parenchymal involvement. It is a helpful adjuvant diagnostic method in urology.

[The role of ultrasonic study in the diagnosis of the multilocular kidney cyst]. / Rol' ul'trazvukovogo issledovaniia v diagnostike mul'tilokuliarnoi kisty pochki.

The paper reports 5 cases of rare renal disease, multilocular cyst. Pathogenetic, pathomorphological, clinical and visual diagnostic aspects of the cyst presented in the literature are reviewed. Special emphasis is placed on diagnostic potential of ultrasound investigation. Current values of computed tomography and conventional X-ray urological techniques, difficulties in differential diagnosis of multilocular cyst with other cysts and renal carcinoma are shown. The authors think it valid to use combined radiological methods in determination of pathological process origin and its details, calcificates, in particular.

[The intraoperative ultrasonic control of the radicalness of transurethral resection in bladder cancer]. / Intraoperatsionnyi ul'trazvukovoi kontrol' radikal'nosti transuretral'noi rezektsii pri rake mochevogo puzyria.

72 patients with bladder cancer stage T1, T2 underwent transurethral resection of the bladder wall affected with tumor under ultrasound control of the removal radicality. The evidence obtained at transurethral ultrasound scanning was compared to the findings of histological examination of the tissue removed. The accuracy of the control made up 87.3%. This made it possible to follow tumor invasion from the tumor margins along the periphery in accordance with blastomatosis stage. The authors have developed a technique of transurethral resection of bladder wall under transurethral ultrasonic scanning as control of the removal radicality.

[The effect of the physicochemical structural properties of urinary calculi on the results of extracorporeal shockwave lithotripsy]. / Vliianie fiziko-khimicheskikh svoistv struktury mochevykh kamnei na rezul'taty distantsionnoi udarnovolnovoi litotripsii.

The relation of chemical composition and structure of uroliths to lithotripsy effects was evaluated with regard to the concrement size, location, time of the intraureteral persistence, etc. Besides, a prognosis of the remote impulse lithotripsy (RIL) outcome was attempted by x-ray picture and crystallization alterations in the urine. 54 patients with nephroliths and 73 patients with ureteroliths (overall 137 concrements) were examined. By RIL results, the patients were divided into 2 groups: those who benefited from RIL and those who failed it. Worse results were obtained in cases of oxalate concrements with radial-concentric structure and with phosphate ones composed primarily of hydroxylapathite. RIL efficacy was found to depend on a number of interrelated factors (chemical structure, location, size of the concrement, duration of its existence in the ureter). In long-standing ureteroliths the outcomes are associated with stone structure. The denser is the concrement the more probable is its strangulation and more apparent is periureteritis. Changes in crystallization can prompt RIL prognosis as well as it is possible by x-ray picture.

[The effect of remote-controlled shock-wave lithotripsy on kidney function]. / Vliianie distantsionnoi udarnovolnovoi litotripsii na funktsiiu pochek.

Leucine arylamidase (LAA) excretion in circadian urine of 79 patients suffering from nephroureterolithiasis was measured before and after the session of remote impulse lithotripsy (RIL) to investigate the effect of the impulse on renal function. The stones were localized in the calyces, pelvis and upper third of the ureter. The patients were divided into 2 groups: 43 patients with noncomplicated nephroureterolithiasis (group 1) and 36 patients with complicated one including 12 subjects exposed to the second RIL (group 2). The enzyme excretion was significantly reduced in group 1 patients. Its activity recovered in group 1 within 6-7 days, in group 2 for 10-14 days. After the second RIL procedure LAA activity in the urine enhanced more rapidly, especially in group 2 patients. In calyceal, intrarenal pelvic and fused kidney location of the stone, LAA activity got more elevated than in the extrarenal pelvis or in the upper third of the ureter. It is demonstrated that RIL exhibits a short-term effect on the kidneys which depends on the presence of inflammation, the number of sessions, stones location and the number of impulses.

[Algorithms of x-ray and ultrasonic diagnoses in urology]. / Algoritmy rentgeno- i ul'trazvukovoi diagnostiki v urologii.

Roentgenourologic methods and ultrasonic scanning (USS) should be combined in the radiologic diagnosis of urologic diseases. USS should be the first stage of examinations of urologic patients, and its results should be taken into account when planning and carrying out excretory urography. USS can be repeated before more sophisticated roentgenourologic examinations in order to single out the "zones of interest"; special programmes are possible for the purpose-pharmacoechography, dopplerography, etc. Development of tentative algorithms of x-ray and ultrasonic diagnosis of the major urologic diseases will help optimize the diagnostic process.

[Transabdominal and transurethral scanning in the diagnosis of the bladder cancer stage]. / Transabdominal'noe i transuretral'noe skanirovanie v diagnostike stadii raka mochevogo puzyria.

Diagnostic potential in staging cancer of the urinary bladder was evaluated in 54 relevant patients aged 37-74 for transabdominal versus transurethral ultrasound scanning. In transabdominal scanning stages T2 and T3 cannot be distinguished separately, stage T1 was recognized definitely in 66.6%, T2-T3 in 65.6%, T4 in 70% of cases. Transurethral scanning appeared valid in staging T1 in 91.6%, T2 in 88.8%, T3 in 92.8%, T4 in 90% of cases. Histological studies in 54 patients showed that transurethral scanning can provide accurate results in staging cancer of the urinary bladder in 90.7% of cases. The findings support clinical value of the method as highly informative in staging cancer of the bladder. Basing on both transabdominal and transurethral scanning, ultrasound picture for each stage of the cancer was characterized.

[Clinico-roentgenologic characteristics of postoperative osteitis of the pubic bones]. / Kliniko-rentgenologicheskaia kharakteristika posleoperationnogo osteita lobkovykh kostei.

The paper is concerned with clinicoroentgenological analysis of postoperative osteitis of the pubic bones (OPB) in 29 patients with urological diseases. The development of OPB follows operative complications, mainly of pyoinflammatory type. Clinically OPB develops as a pyoinfectious process. X-ray signs present a picture of inert osteomyelitis of the pelvic bones, caused by low virulent urinary infection. Its characteristic feature is superficial spreading of osseous destruction to a large extent with the affection of the adjacent of the pelvic joints. The probable routes of infection dissemination are venous (in injury of the pelvic plexus veins) and by continuity (as a result of urinary pelvic cellulitis).

[Differential x-ray and ultrasonic diagnosis of filling defects of the calyceal-pelvic systems of the kidneys]. / Differentsial'naia rentgeno- i ul'trazvukovaia diagnostika defektov napolneniia chashechno-lokhanochnykh sistem pochek.

The order of radio- and ultrasound diagnosis in the filling defects of the renal calyceal-pelvic systems, resulting from radionegative concrements, "vascular imprints", papillary tumors, and renal tumors affecting the calyceal-pelvic system, should be as follows: excretory urography, ultrasound scanning of the kidneys, retrograde pyelography with a double contrast study (a patient in a vertical posture), and angiography. Reliable diagnostic information obtained at the 1st or 2nd stages of investigation, permits the use of less invasive methods like excretory urography and ultrasound scanning. Retrograde pyelography with a double contrast study is recommended in a suspected pelvic papillary tumor. Angiography is indicated for suspected pathological vascular changes and for a planned operation.

[Intracavity thermo- and gamma-therapy of uterine cancer]. / Vnutripolostnaia termogamma-terapiia raka matki.

Some methodological problems of the use of intracavitary UHF hyperthermia combined with intracavitary gamma-beam therapy in combined radiation therapy of uterine cancer patients are considered. Indications for the use of this method and radiobiological substantiation of thermoradiotherapy for this group of patients are discussed. The advantages of the proposed method of thermoradiotherapy have been noted on the basis of immediate clinical observations, endoscopic, x-ray and morphometric findings.