[The results of long-term permixon treatment in patients with symptoms of lower urinary tracts dysfunction due to benign prostatic hyperplasia]. / Rezul'taty dolgosrochnogo primeneniia permiksona u bol'nykh s simptomami narusheniia funktsii nizhnikh mochevykh putei, obuslovlennymi dobrokachestvennoi giperplaziei predstatel'noi zhelezy.

The trial enrolled 155 patients (mean age 65 years) with documented benign prostatic hyperplasia and lower urinary tracts symptoms (LUTS) (IPSS > 6). All the patients received permixon in a dose 160 mg twice a day for 2 years. The data on 130 patients eligible for assessment were processed statistically by dynamics of IPSS, quality of life (QOL), index of sexual function (MSF-4), size of the prostate, urodynamic and biological parameters which were estimated in 6 (V6), 12 (V12), 18 (V18) and 24 months (V24). Clinical examination with registration of all side effects was made each 3 months. Permixon was found to noticeably reduce IPSS and QOL and increase maximal urine flow speed. The size of the prostate diminished insignificantly. Sexual function remained unchanged for 1 year and improved markedly within the second year (p = 0.001). Permixon had no effect on the level of prostate-specific antigen. Plasma hormones (testosterone, DHT, estradiol, LH, androstendion) did not change. Nine patients developed 10 side effects but they were unrelated to the treatment.

[Role of electrochemical potential in urinary tract function]. / Rol' élektrokhimicheskogo potentsiala v funktsionirovanii mochevykh putei.

Rhythmic changes produced by impulse waves, respiratory and other movements are able to convert mechanical energy of the urine in the pelvis to electric energy because urine is a high-concentration electrolyte. With filling and extension of the pelvic wall, when epithelial coating is transforming from multilayer to one-layer, its resistance to electric current lowers. Growing pelvic volume in the course of the pelvis filling is accompanied by increasing electrical potential in the pelvic wall in parallel with a decline in urothelial resistance. Accumulation of electrochemical potential in the submucous layer and interstitial intermuscular spaces is a powerful stimulator of the neuromuscular elements of the urinary tracts. Their rhythmic engagement is controlled by baroreceptor pelvic mechanisms and distal urinary tracts. Such a pace-maker is functional. It does not need special morphological structures, as its activity is determined by electrochemical potential accumulated rhythmically in the wall. This potential depends on composition and properties of the urine which are related to renal functions and homeostasis.

[Mineral water Volzhanka from Undorovski spring in combined therapy of patients with nephrolithiasis and chronic pyelonephritis]. / Undorovskaia mineral'naia voda "Volzhanka" v kompleksnoi terapii bol'nykh nefrolitiazom i khronicheskim pielonefritom.

Water loading is an essential component in therapy of nephrolithiasis, especially in the presence of small ureteral concrements or fragments after extracorporeal shock-wave lithotripsy. Saluretics, furosemide in particular, cause side effects. One of these is dyselectrolytemia due to potassium loss. Mineral waters have advantages in the treatment of nephrolithiasis and pyelonephritis as their drinking does not lead to electrolyte loss. Low mineral waters are highly diuretic, e.g. after drinking 1 liter of Volzhanka day-time diuresis increases by 300-400 ml. This relieves ureteral and calyceal-pelvic tonicity stimulating elimination of the concrements or their fragments after lithotripsy. Intake of Volzhanka proved effective in combined therapy of nephrolithiasis, calculous pyelonephritis, urate nephrolithiasis.

[beta 2-Adrenomimetics before and after extracorporeal lithotripsy]. / beta 2-Adrenomimetiki do i posle distantsionnoi litotripsii.

Successful disintegration of the calculus in nephrolithiasis patients is impossible without normalization of the upper urinary tracts urodynamics in dyskinesia. We employ combined treatment with high-selective beta-2-adrenomimetic hexoprenalin (hinipral) to improve migration of the concrement fragments and therefore to prevent ureteral occlusion, acute pyelonephritis and renal colic. Hexoprenalin (hinipral) is taken 6 tablets a day or intravenously in drops (5 ml per 100 ml of saline) 3-5 days before and for 10-12 days after extracorporeal shock-wave lithotripsy. Adjuvant use of hexoprenalin in combined treatment of nephrolithiasis complicated by ureteropelvic dysfunction allows effective conduction of lithotripsy.

[Drug-induced polyuria in the surgical treatment of patients with nephrolithiasis]. / Medikamentoznaia poliuriia pri operativnom lechenii bol'nykh nefrolitiazom.

Recently, drug polyuria has found wide application in diagnosis and treatment: to detect latent urinary insufficiency, to assess functional performance of the contralateral (unaffected) kidney in nephrolithiasis and calculous pyelonephritis, to stimulate elimination of fragments of the disintegrated concrement, to check up suture impermeability after surgical repair of the urinary tracts, to outline afunctional zone in hydronephrosis. Clinical experience gives grounds for use of saluretics at certain stages of pyelolithotomy for mobilization of intrarenal pelvis and its dissection, removal of the calculus and subsequent suturing of the intrarenal pelvis. Therapeutic polyuria can also facilitate ureterolithotomy.

[Drainage of the urinary tract as preparation for extracorporeal lithotripsy]. / Drenirovanie mochevykh putei kak podgotovka k distantsionnoi litotripsii.

Upper urinary tract drainage in patients with chronic calculous pyelonephritis (CCP) results in not only successful anti-inflammatory and antibacterial treatment but also in more effective and safe ESWL. In 21 CCP patients with upper urinary tract drainage by means of catheter-stent, ESWL was performed using Lithostar-Plus (Siemens). Active inflammation with marked pyuria, bacteriuria and even moderate upper urinary tract dilation were indications for the upper urinary tract drainage with catheter-stent before and during ESWL in CCP patients. Upper urinary tract drainage with catheter-stent contributed to effective treatment of chronic pyelonephritis and allowed to perform ESWL. There were neither attacks of acute pyelonephritis nor upper urinary tract obstruction after catheter-stent removal. The catheter-stent allows to create closed drainage system with active evacuation function as it functions in physiological conditions. ESWL in patients with upper urinary tract drainage using catheter-stent is more effective and has lower risk of complications.

[Intravenous tumor invasion in renal cancer]. / Opukholevaia vnutrivenoznaia invaziia pri rake pochki.

Intravenous tumor invasion occurred in 84 out of 600 patients who had been operated on for carcinoma of the kidney. The inferior vena cava was thrombosed by a tumor in 54 patients. Ultrasonic examination, computed tomography, and venocavography were used in establishing the diagnosis of intravenous invasion. It is stressed that information on the upper border of the thrombus in the inferior vena cava must be obtained before the operation, and that in block on the inferior cavogram transatrial venocavography is absolutely indicated. The presence of absence of growth of intracaval tumor masses into the wall of the inferior vena cava is an important moment determining peculiarities of the operation. In the authors experience such invasion was encountered in 30% of patients. Fifty-two patients had subdiaphragmatic thrombosis of the inferior vena cava and 2 patients had supradiaphragmatic thrombosis. In addition to radical nephrectomy, 28 patients underwent resection of the lateral surface of vena cava inferior, 17--thrombectomy from vena cava inferior, and 8--resection of a segment of this vein. Postoperative lethality was 9.5%, 5-year survival was 40.8%. It was found that venous invasion without growth of the tumor into the fibrous capsule of the kidney and without lymphogenous and distant metastases has no negative effect on the prognosis if the tumor masses had been removed completely from vena cava inferior. The authors believe operations on patients with renal carcinoma and venous tumor invasion in stages T2N0M0, T3N0M0 and T2-3N1-2M0 to be advisable.

[Proscar (finasteride, MSD) in the treatment of patients with prostatic hyperplasia]. / Proskar (finasterid, MSD v lechenii bol'nykh s giperplaziei predstatel'noi zhelezy.

The drug proskar (finasteride) belongs to 5 alpha-reductase blockers breaking the steps of prostatic adenoma pathogenesis. Proskar (Merck and Co. Inc., USA) was given to 38 patients with prostatic adenoma stage I and II (residual urine < 50 ml) admitted to urological clinic of the Moscow Medical Academy in 1993-1995. Daily dose was 5 mg. In patients with associated inflammation it was treated prior to proskar administration. To reject carcinoma, patients with elevated levels of prostatic specific antigen (< 4 ng/ml) were subjected to polyfocal biopsy of the gland. In any case, these patients received antiandrogens flutamide or androkur. Subjective response was achieved in 33 of 38 patients (86.8%). Better urination was reported in 29 patients (76.3%). Abdominal and transrectal ultrasonic scanning registered a decrease in the size of the prostate in 25 (65.8%) patients. Proskar was well tolerated, sexual disturbances occurred only in 2 patients. Proskar is effective in therapy of prostatic adenoma stage I. However, its intake must be long and regular, otherwise recurrent clinical symptoms and further growth of prostatic adenoma are possible.

[Lymphadenectomy in kidney cancer]. / Limfadenéktomiia pri rake pochki.

Metastases of renal carcinoma (RC) to lymph nodes were revealed in 121 (18.1%) patients from 667 operated on RC subjects. The frequency of lymph node involvement increases with T: T1--7.5%, T2--10.8%, T3--21.5%, T4--53.3%. In 42 patients the metastases were found only morphologically. In carcinoma of the right kidney the metastases most frequently affected paracaval and interaortocaval lymph nodes, in left kidney carcinoma para-aortal lymph nodes. Preoperative diagnosis of RC metastases to the lymph nodes is not feasible in N1, doubtful in N2 and quite possible in N3. Computed tomography is the most informative procedure as it detects lymphogenic metastases in 82% in N2 and 96% in N3. Overall 5-year survival of RC patients with lymph node metastases was 34.1% (T1N1--80%, T2N2--66.6%, T3N1--41.9%, T3N2--23.5%. All the patients with N3 died within 3 years. The authors think it necessary to perform regional and juxta-regional lymphadenectomy in any surgical intervention for RC in visually unaffected lymph nodes, in N1 and solitary N2. In multiple N2 and in N3 lymphadenectomy is useless.

[Comprehensive treatment with ofloxacin in pyo-inflammatory urologic diseases]. / Kompleksnaia terepiia s ofloksatsinom gnoino-vospalitel'nykh urologicheskikh zabolevanii.

Fifteen patients with various forms of pyelonephritis and chronic cystitis were treated with ofloxacin. The drug was used in the complex antiinflammatory and detoxification therapy and in cases with indicated hemotransfusion. Ofloxacin was administered intravenously during the first days of the treatment with its later oral use. High efficacy of ofloxacin was observed in the patients with acute purulent renal affections accompanied by pyo-intoxication when the treatment was started with the drug parenteral administration.

[The therapy of chronic nonobstructive pyelonephritis]. / Terapiia khronicheskogo neobstruktivnogo pielonefrita.

Combined therapy for chronic nonobstructive pyelonephritis introduced by the authors includes such components as etiological, pathogenetic, resistance-stimulating. The cure was achieved in 60% of the patients.

[The selection of the treatment method in stenosis of the pelviureteral segment in nephrolithiasis]. / Vybor metoda lecheniia stenoza lokhanochno-mochetochnikovogo segmenta pri nefrolitiaze.

Ureteropelvic stenoses in nephrolithiasis are suggested to be considered reversible and irreversible depending on the lesions of the upper urinary tracts and the adjacent fat. To ascertain reversibility of the stenosis, use was made of the progesterone test in view of progesterone ability to dilate the ureter. No retention changes in the upper urinary tract in the reversible stenosis can serve an indication to impulse lithotripsy. Large stones and all cases of irreversible stenosis indicate validity of open surgery the scope of which is decided intraoperatively after isolation of the ureteropelvic segment from the periureteral fat and upon the indigo carmine test. In the absence of dysfunctional zone in the segment the patients may be subjected to ureterolysis and pyelolithotomy. If such zone is detected it is possible to make pelvic and proximal ureteral resection, pyeloureterostomy. The technique of the latter surgery in the intrarenal pelvis is detailed.

[Use of pyelomanometry and roentgenological and television uroscopy in determining the time for nephrostomy closing]. / Pielomanometriia i rentgenotelevizionnaia uroskopiia v opredelenii srokov likvidatsii nefrostomy.

To evaluate objectively the degree of the urodynamics recovery in patients with nephrostomy in the postoperative period and to determine the optimal times of removing the nephrostomy drainage tubes, a ++video-urodynamic study was carried out. It consisted in combined antegrade X-ray TV ++pyelo-ureteroscopy and ++trans-fistula pyelomanometry. To measure the degree of the effect of retroperitoneal pressure on urodynamics, intraperitoneal pressure was also evaluated. The volumetric rate of the perfusion of the radiographic contrast substance ranged from 1 to 7 ml/min. As many as 108 patients with nephrostomy were examined within different times after the operation. Urodynamics was regarded as recovered, if the difference between pelvic and intraperitoneal pressure did not exceed 12 cm H2O, with the volumetric rate of perfusion being different. In 76/108 patients (70.4%), adequate passage of urine in the ++upper urinary tract was determined, which allowed one to attempt nephrostomy closing. In 32/108 patients (29.6%), the results of the study were viewed as unsatisfactory which required continuation of the draining of the pelvi-calyceal system by the nephrostomic drainage tubes. Repeated investigation carried out after 5-10 days revealed the normalization of the urodynamic characteristics. No complications were recorded after the nephrostomic drainage tubes were removed.

[The muscle compressing the ureter and its role in the closure mechanism of the ureteral-bladder segment]. / Myshtsa, prizhimaiushchaia mochetochnik, i ee rol' v zamykatel'nom mekhanizme mochetochnikovo-puzyrnogo segmenta.

The authors indicate an important role of the locking mechanism of the vesicoureteral segment in the prevention of the retrograde regurgitation of urine into the upper urinary tracts, namely vesicoureteral reflux. They pay special attention to the fact that the knowledge of the structure of the terminal part of the ureter helps select certain appliances preventing the development of the reflux. However, the known data fail to satisfy the clinicians and explain the appearance of the reflux in some cases. Therefore, the authors have undertaken an original morphological investigation of the terminal part of the ureter, observing the vesicoureteral complexes of 32 human cadavers. Micropreparation of the vesicoureteral segments was performed with the use of a 2.5-4X binocular magnifier. The study revealed a muscle previously undepicted. Regarding it as the ureter-pressing one, the authors designated it as "musculus appressor ureteris". Formed by the muscular fibres of the detrusor and situated 1-2 cm more proximal than the ostium ureteris, it arches through the submucosal segment of the ureter and is connected with the musculature of the urinary bladder on the both sides of the ureter. Its width is about 6-8 mm and its thickness is 1.5-2 mm. The authors explain its function and role by the locking system of the vesicoureteral segment, which is proved by the development of the reflux in case the ureteral ostium and the above muscle are dissected. The authors emphasize the fact that it is necessary to extremely accurately cut the anterior wall of the terminal part of the ureter.

[Effect of prazosin on human prostatic adenoma tissue]. / Vliianie prazozina na tkan' adenomy predstatel'noi zhelezy cheloveka.

The effect of prazosin on epinephrine-induced contractions of human benign prostatic hyperplasia strips was studied. It was shown that prazosin has a pronounced adrenoblocking activity (EC50 = 5.10(-9) g/ml) but fails to affect strip contractions induced by KCL. It is suggested that prazosin can be used in the treatment of patients suffering from benign prostatic hyperplasia.