[New aspects of efficacy of using apparatus-programming complex "andro-gin" in the treatment of chronic prostatitis].

The results of usage of Andro-Gin unit in 187 patients with chronic prostatitis have shown that in most cases prostatitis is caused by bacteria. Andro-gin unit included in combined treatment of chronic prostatitis provides good results as it turns biofil bacteria into planktonic ones.

[Renal tumors and pregnancy].

The article presents a retrospective analysis of literature data on combination of renal tumors with pregnancy, three cases are reported. The diagnostic algorithm in such patients is based, first of all, on ultrasonography, in complicated cases MR imaging is used. Therapeutic policy depends on the tumor stage and size, pregnancy term. Urgent radical nephrectomy is recommended in trimester I and III. Follow-up with delivery may be employed upon 28 week pregnancy in trimester II. Basic therapeutic algorithm of renal angiomyolipoma is follow-up. To make a final conclusion on efficacy of therapeutic policy, it is necessary to conduct a multicenter prospective trial aimed at assessment of long-term results of each therapy.

[Spontaneous ruptures of renal tumors].

Spontaneous retroperitoneal hemorrhages are a rare but severe complication of retroperitoneal organs and tissues disorders. For the last five years we treated 10 patients (7 females and 3 males) with spontaneous subcapsular or paranephral hematoma resultant from renal tumor rupture. Morphologically, 4 tumors were renal angiomyolipoma and 6 tumors--renal cell carcinoma. Most characteristic symptoms consisted in acute lumbar pain on the affected side (100%) and the absence of macrohematuria in all the patients. Marked hemodynamic disorders of a hypotonic type were observed in 50% patients (4 patients lost consciousness). Left kidney tumor ruptures were more frequent (70%). An accurate preoperative diagnosis was made in 70% cases with application of ultrasonic investigation, computed tomography, MR imaging, Of 4 patients with renal angiomyolipoma, conservative surgery (enucleation, enucleoresection) was conducted in 3 (75%) patients. Of 6 patients with renal cell carcinoma, tumor removal with preservation of the kidney was feasible only in 1 (16.6%) patient, in the rest 5 patients radical nephrectomy was made. In 2 patients it was combined with venacavathrombectomy. Thus, patients with spontaneous rupture of renal tumors are characterized by absence of macrohematuria, prevalent location of the tumor on the left and in the middle segment of the kidney (90%), high diagnostic effectiveness of ultrasonography, no rise in local tumor recurrence consequently to rupture of the tumor tissue.

[Surgical treatment of bilateral renal cell carcinoma]. / Operativnoe lechenie dvustoronnego pochechno-kletochnogo raka.

The paper presents the results of surgical treatment of bilateral tumors of the kidneys. Bilateral neoplasms were detected in 28 of 1200 patients with renal cell carcinoma (2.3%). Synchronous tumors were found in 12 patients (42.8%), asynchronous--in 16 (57.2%). Operation on both the kidneys for tumor was carried out in 21 patients from 28 (75%). In both groups operations including enucleation of the tumors (60% in the group with synchronous cancer and 53.8%) in the group with asynchronous one) prevailed. All the patients were operated in two stages. Local relapses occurred in 6 of 21 patients (28.5%). A relapse after nephrectomy was observed in 2 patients (9.5%). Recurrent tumor in the remnant of the kidney after nephron-sparing surgery was observed in 4 patients (19%). General 5 year survival in patients with synchronous bilateral tumors was 38.5%, whereas 5-year cancer-specific survival reached 47.4%. For asynchronous cancer these parameters were 49.6 and 58.7%, respectively. It is emphasized that all patients with renal cancer after radical nephrectomy should be followed up and undergo annual check-up with US and/or CT lifelong to detect possible asynchronous tumor. Genetic studies are necessary to specify differentiation of the form of bilateral neoplasm.

[Local recurrence of renal cell carcinoma after nephrectomy]. / Lokal'nyi retsidiv posle nefréktomii po povodu pochechno-kletochnogo raka.

Despite significant advances in surgical oncourology, local recurrence of renal cell carcinoma (RCC) remains a serious problem both for the doctor and the patient. Our study of treatment outcomes in local recurrent RCC consisted in a retrospective analysis of 13 patients with a local RCC recurrence in the renal fossa treated with surgical resection alone between 1991 and 2003. Twelve patients demonstrated no evidence of distant metastases at the time of the recurrence. One patient had a synchronous metastasis to the contralateral adrenal gland. A mean recurrence-free interval was 14.6 months (range 2-96 months) after nephrectomy. 46% patients demonstrated symptoms of weight loss, fatigue and lumbar pains. The source of local recurrence in 2 patients was metachronous metastases to the ipsylateral adrenal gland, in 1 patients--a tumor thrombus in the remnant of the left renal vein, in 3--soft tissues of the renal fossa and in 7--metastases to the regional lymph nodes. 13 resections were performed with one intraoperative death and one immediate postoperative death. Splenectomy was made in 2 patients, resection of the stomach in 1, distal pancreatectomy in 1, resection of the inferior vena cava in 3, aorta in 1. The average blood loss was 800 ml (300-4500 ml). Up to now 6 patients survived. Of 5 decreased patients 4 died of progressive disease in 1, 4, 10 and 16 months. 1 patient died of cause unrelated to cancer recurrence in 14 months. Out of 6 alive patients 4 have no signs of the disease for, on the average, 31.6 months (range 4-78 months) and 2 patients have obvious progression of the disease (1--repeated local recurrence, 1--distant metastases) 9 and 15 months after the operation. We believe that an aggressive surgical approach to a local RCC recurrence can produce an increase in disease-free survival and significantly improve quality of life for such patients.

[Long-term results of organ-preserving surgeries for renal cell carcinoma]. / Otdalennye rezul'taty organosokhraniaiushchikh operatsii pochechno-kletochnogo raka pochki.

The paper presents long-term results of conservative surgical treatment of 148 patients with renal cell carcinoma (RCC). Cancer-specific survival, local recurrence and distant metastases rates were estimated. Overall cancer-specific survival reached 91.8%. For patients with imperative indications this survival was 79.6%, for elective patients--98%. Recurrent RCC was observed in 10(6.8%) patients: imperative group--8(5.4%), elective group--2(1.3%). Distant metastases were detected in 7(4.7%) patients. The elective group had no metastases. General level of multifocality of sporadic renal cancer was 6.7%, for tumors < 4 cm--1.2%. The basic criterion of the decision on organ-saving operation is tumor size under 4 cm. The size of the primary tumor determines the level of local recurrences and distant metastases. To select the optimal group of patients, genetic markers of tumor multifocality should be identified.

[Radical nephrectomy for the kidney tumor with the thrombus invading vena cava inferior]. / Radikal'naia nefréktomiia po povodu opukholi pochki s prorastaniem tromba v nizhniuiu poluiu venu.

The results of treatment were analyzed in 92 patients with the kidney tumor in whom the thrombus invasion into vena cava inferior was revealed. Ultrasonographic scanning and magnetic resonance tomography were most informative methods in the diagnosis. The staging of the tumoral thrombus invasion was elaborated depending on which the surgical tactics was choosen. The procedure technique was depicted and the operations schemes were adduced. The vena cava thrombectomy performance is absolutely indicated in patients without metastases in lymph nodes and distant organs. The five-year survival index for this patients was 55-60%.

[Surgical treatment of kidney cancer with tumor thrombus invasion of the inferior vena cava]. / Operativnoe lechenie raka pochki s invaziei opukholevogo tromba v nizhniuiu poluiu venu.

The paper presents original experience in the examination and surgical treatment of 61 patients with renal carcinoma thrombing the inferior vena cava. The thrombi are classified as floating (8) and occlusive (53). Subhepatic, retrohepatic, supradiaphragmatic and intracardial thrombi are distinguished by location of the thrombus top. The staging and the scope of cavatomy in respect to the thrombus occlusion site in the vena is specified. It turned out that the higher thrombic invasion is, the more serious is surgical invasion and worse are long-term outcomes. The conclusion on feasibility of effective treatment of the above condition is made.

[The invasion of kidney tumors into the veins]. / Invaziia opukholei pochek v veny.

Comprehensive angiographic examinations of 101 patients operated on for parenchymatous cancer recorded intravenous invasion of the tumour in 29 per cent of the examinees. Roentgenological, macro and microscopic investigations of intraorganic vascular architectonics were studied on 52 removed tumour-affected kidneys. The findings evidenced the outflow of the major blood amount from the tumorous tissue through the collateral collector and subcapsular veins to paranephric ones with a subsequent dilatation of the latters. Arteriographically evidenced tumorous lacunae turned to be muscle-free arterial vessels different from arteriovenous shunts. So the concept of shunt frequency is doubtful and embolism of giant hypervascular tumours of the kidney without embolism of pulmonary arteries is possible. More common passage of tumorous thrombi into vena cava inferior in case of right-sided tumours can be explained by a shorter length of the right renal vein. Besides, the left free growth of the thrombus is hindered by pulsing "aortomesenteric forceps" that enclosed the left renal vein.

[Morphologic changes of the kidneys in patients with vasorenal hypertension]. / Morfologicheskie izmeneniia pochek u bol'nykh s vazorenal'noi gipertenziei.

A study is presented of the state of blood vessels and parenchyma of the kidneys in patients with vasorenal hypertension. Morphological changes of the renal parenchyma at different stages of the disease are described. The authors compared clinico-morphological findings and give practical recommendations for the improvement of diagnosis of the disease and timing of surgical treatment of vasorenal hypertension.

[Regional phlebography in patients with recurrences of varicocele]. / Regionarnaia flebografiia u bol'nykh s retsidivami varikotsele.

Diagnostic potentialities of phlebography were studied in 50 patients with varicocele recurrences. Two methods of phlebography: transfemoral renospermaticography and transscrotal orthograde testiculophlebography--were employed. The main cause of recurrence development was shown to be the abnormality of venous outflow from the testicle in the region of the left renal vein, testicular vein and in the pelvic veins. The effectiveness of both methods was 71.9 and 94.4%, respectively, their combined use provided additional information.