[Heterotopic urine derivation in females with urinary bladder extrophy].

Fifteen females aged from 17 to 31 years with bladder extrophy (the condition after ureterosygmostomy) have undergone heterotopic urine derivation with creation of a cutaneous urine-retention catheter mechanism. Surgery was indicated in progressive decline of renal function in the presence of renal reflux, total urine incontinence in the failure of pelvic floor muscles and rectal sphyncter apparatus. Creation of cutaneous urine-retention catheter mechanism was made by the following techniques: heterotopic plastic repair from the ileocecal angle by Mainz pouch I (11 patients, 73.4%); heterotopic W ileocystoplasty by Abol-Enein (4 patients, 26.8%). Implantation of both ureters was conducted by Wallace technique in 4 (26.7%) cases. In 7 (46.6%) patients ureteral implantation was performed with antireflux defense by the method of cross dublicate creation. Four (26.7%) patients with small intestinal derivation have undergone extramural implantation of the ureters according to Abol-Enein. The results show that conversion of ureterosygmostomy in heterotopic urine derivation with one-stage genital reconstructive interventions decreases the number of potential complications, improves surgical outcomes and provides much better medico-social rehabilitation. Heterotopic intestinal continent derivation of urine is an operation of choice in women with urinary malformations. In such patients orthotopic urine derivation is impossible.

[Intestinal replacement of the urinary bladder with creation of continent cutaneostomy].

Continent urine derivation with creation of cutaneous urine-retaining catheter mechanism was conducted in 28 patients. Indications for surgery were the following: contracted urinary bladder in combination with long obliteration of the urethra, urinary bladder extrophy (the condition after ureterosygmostomy), urinary bladder cancer, arteriosclerotic urinary bladder. Creation of cutaneous urine-retaining cather mechanism was performed according to the following methods: urine derivation by Minez pouch I (with creation of appendistoma) was made in 14 patients; extending intestinoplasty by Minez pouch (creation of intestinal reservoir from ileocecal angle with catheter appendicostoma) was made in 8 patients; extending ileoplasty with catheter ileostoma by Huder--2 patients; creation of a reservoir of the ileum with catheter ileocutaneostoma by extramural technique of Ald-Enein--2 patients; extending intestinoplasty with catheter ileostoma--2 patients. Implantation of the ureters was made using principles of antireflux defense.

[Radical treatment of invasive bladder cancer]. / Radikal'noe lechenie invazivnogo raka mochevogo puzyria.

We have conducted a retrospective analysis of radical cystectomy in 53 patients (45 males and 8 females, 85 and 15%, respectively) with invasive bladder cancer (BC) treated in the Research Institute of Urology in 1997-2002. Stages T2N0M0, pT3aN0M0, T3bN0M0, pT4aN0M0, pT4aN1-2M0 were in 4 (7.5%), 13 (25%), 21 (40%), 7 (12.5%), 8 (15%) cases, respectively. Well differentiated transitional cell BC (G1) was detected in 1 (2%) patient, moderately differentiated (G2) in 16 (30%) cases, poorly differentiated (G3) in 36 (68%) patients. The following methods of urine derivation were used: orthotopic plastic surgery (n = 3, 6%), ureterocutaneostomy (n = 4, 8%), Mainz pouch II operation (n = 16, 30%), Hassan operation (n = 5, 9%), Bricker procedure (n = 22, 44%), transureteroanastomosis (n = 3, 6%). In the postoperative period there was one lethal outcome, early complications in 5 (9%) patients, late complications in 9 (17%) patients. Distant metastases to the lungs, bones and iliac lymph nodes after treatment were detected in 3, 2 and 3 patients, respectively. One patient had a local pelvic recurrence. For 53 patients 2-year corrected survival was 68 +/- 12.0%. We have come to the conclusion that the only radical surgical treatment of invasive BC is cystectomy, limitations to which are connected only with complexity of subsequent urine derivation.

[Monitoring in hepatology]. / Monitoring v gepatologii.

A program has been worked out of dynamic observation on patients with chronic diffuse liver diseases (CDLD) and 4 kinds of monitoring--metabolic, immunological, regulatory and structural were singled out. Monitor tests were determined by means of mathematic analysis of the results of examination of 167 patients with CDLD. The possibility has been shown of using dispensarization schemes for creation of a therapy program and evaluation of its efficacy.