[The pathogenesis and prevention of urinary tract infection in women]. / Patogenez i profilaktika infektsii mochevogo trakta u zhenshchin.

Urinary tract infection (UTI) in females occurs significantly more frequently than in males because of specific anatomical and functional features of female urinary system, sequelae of pregnancy, delivery, gynecological diseases. Much controversy still exists as to pathogenesis of UTI and UTI-induced urinary inflammation. We have examined 233 females of different age with UTI and obtained evidence which shows participation of such factors as early and intensive sex, ignorance of sex hygiene, multiple pregnancies, deliveries, abortions, inflammatory gynecological diseases, anogenital infection in its pathogenesis. These factors were registered 2-4 times more frequently in UTI females than in controls without UTI. Bacteriological urinary and genital findings coincide in 80% of cases in terms of an infective agent. This suggests that it is essential to detect urogenital infection in girls and females as early as possible and to treat it adequately with antibacterial and other drugs. The leading role of an ascending urinogenic route in urinary tract infection from local sources in anogenital zone, sexual factor and the absence of relevant hygienic habits proved most contributing to UTI pathogenesis. This concept serves the basis for UTI prevention in females.

[The relationship of postoperative thrombotic-hemorrhagic complications to the local acute inflammatory process in patients with prostatic adenoma]. / O sviazi posleoperatsionnykh trombogemorragicheskikh oslozhnenii s mestnym ostrym vospalitel'nym protsessom u bol'nykh adenomoi predstatel'noi zhelezy.

Clinical, laboratory and pathomorphological investigations evidence for close relationships between acute infectious inflammatory conditions of the prostate and thrombohemorrhagic complications arising both locally and systemically. All these postoperative complications manifesting clinically as acute prostatitis, epididymo-orchitis, urosepsis, bacteriotoxic shock, bleeding, thrombosis and embolism, latent or marked DIC syndrome have underlying local infectious-inflammatory process (postoperative acute prostatitis). Preoperative detection of local infection (concomitant chronic prostatitis), monitoring of hemocoagulation, antibacterial and antiinflammatory therapy of chronic prostatitis and normalization of blood rheology improve surgical outcomes in prostatic adenoma and lead to less frequent occurrence of both acute inflammatory and thrombohemorrhagic complications.

[Vesicoureteropelvic reflux in pregnant animals and its role in the pathogenesis of acute gestational pyelonephritis (experimental research)]. / Puzyrno-mochetochnikovo-lokhanochnyi refliuks u beremennykh i ego rol' v patogeneze ostrogo gestatsionnogo pielonefrita (éksperimental'noe issledovanie).

The experiments on naturally pregnant rats have demonstrated that pregnancy contributes to much more frequent occurrence of vesicoureteropelvic reflux (VUPR) which, in its turn, is essential for pathogenesis of acute gestational pyelonephritis (AGP). Dynamic obstruction of the urine flow as a result of reduced function of leiomyocytes of urinary tract muscles, decreased urothelial glycocalyx and consequent adhesion of pathogenic agents comprise parts of this pathogenesis. The conclusion is made that VUPR pregnant females are at risk to develop AGP and should be placed by the urologist on ultrasonic monitoring lasting all pregnancy and postpartum periods.

[A method and the clinico-laboratory results of laser therapy for patients with chronic prostatitis]. / Metodika i kliniko-laboratornye rezul'taty lazernoi terapii bol'nykh khronicheskim prostatitom.

Local exposures to low-intensity laser radiation (LILR) in chronic prostatis (CP) patients diminish basic symptoms of the disease (pain, dysuria, sex disorders, objective picture). Clinical response was obtained in 93.2% of cases. LILR markedly improved prostatic function, promoted trends to normalization of quantitative and biochemical ejaculate composition. LILR may act as antiaggregator contributing to less ejaculate viscosity and stimulate spermatozoal activity and motility. The above results were seen in 72.4-80% of the exposed patients. CP laser therapy should be wider introduced in clinical practice because its resolving, antiedema, anti-inflammatory, analgetic and deaggregation effects potential.

[The preoperative anti-inflammatory and postoperative therapy of patients with calculous pyelonephritis and prostatic adenoma with chronic prostatitis under outpatient polyclinic conditions]. / Predoperatsionnaia protivovospalitel'naia i posleoperatsionnaia terapiia bol'nykh kal'kuleznym pielonefritom i adenomoi predstatel'noi zhelezy s khronicheskim prostatitom v ambulatorno-poliklinicheskikh usloviiakh.

Such wide-spread urological diseases as nephrolithiasis and prostatic adenoma requiring surgical management are often associated with chronic infection or inflammation (pyelonephritis, prostatitis, adenomitis). Relevant antiinflammatory treatment as a rule is conducted after the patient hospitalization which may induce unwanted emotional stress, occasional hospital infection, additional material expenditures. The authors have the experience of bactericidal and antiinflammatory treatment of the kidneys (143 patients with nephrolithiasis) and prostate (287 patients with adenoma) in the outpatient setting. Three-stage system of the patients' care is recommended: district outpatient clinic-consultative outpatient department of the Research Urological Center-Hospital of the above Center. Such an approach noticeably improved the treatment outcomes: the frequency of inflammatory postoperative complications reduced 2-fold, no more lethal outcomes occurred, the duration of the hospital stay decreased two-fold. The authors suggest to introduce the above three-stage system of pre- and posthospital outpatient antiinfectious and antiinflammatory treatment of nephrolithiasis-affected kidney and prostate in adenoma into the practice of all national, regional and local urological centers.

[The diagnosis of vesicopelvic reflux in pregnant women]. / Diagnostika puzyrno-lokhanochnogo refliuksa u beremennykh.

The diagnosis of vesicopelvic reflux (VPR) in pregnancy is not a simple task because of the requirements of noninvasiveness, safety, minimum radiation load, informative value. The authors suggest urinalysis and ultrasound (US) investigation as VPR screening tests in pregnancy. US VPR diagnosis meets the requirements of a screening method, has the advantages of a high VPR detection capacity, noninvasiveness, feasibility of further US monitoring, simultaneous study of the urological and obstetric status. High frequency of pre- and postnatal urinary reflux, the gape of the ureteral ostia as indirect signals of VPR in pregnant patients suggest that VPR may be characteristic of pregnancy, specific "pregnancy phenomenon". The authors provide US VPR classification the stages of which are usable in VPR and its complications prophylaxis.

[Acute experimental and clinical epididymitis]. / Ostryi épididimit v éksperimente i klinike.

In pathogenesis of acute epididymitis (AE) an important role belongs to retrograde infection of the epididymis. The infection with urethral or urinary flora occurs via reflux and adhesive mechanisms. Staging of the disease and differentiation of acute epididymitis with epididymo-orchitis are the essential aims in the diagnosis. For elderly patients with AE who comprise the majority of AE patients urgent epididymectomy is thought the best therapeutic approach.

[The characteristics of an acute infectious-inflammatory process in the single remaining kidney (experimental and clinical study)]. / Osobennosti ostrogo infektsionno-vospalitel'nogo protsessa v edinstvennoi ostavsheisia pochke (éksperimental'no-klinicheskoe issledovanie).

The paper is concerned with acute pyelonephritis pathogenesis in patients with a solitary kidney. Upon nephrectomy, the remaining kidney undergoes compensatory-adaptive processes giving rise to injury of the first barrier of the local nonspecific resistance. This results in more rapid and severe course of acute pyelonephritis, development of pyodestructive disease, protracted run. Active surgical policy in acute obturation pyelonephritis in patients with a single kidney, early recovery of adequate urine outflow can prevent progression to destructive pyelonephritis and advance treatment results.

[Bacterial toxic shock in urological diseases]. / Bakteriotoksicheskii shok pri urologicheskikh zabolevaniiakh.

It is a review of present-day and historical aspects of bacterial toxic shock arising in urological setting. It is noted that conditions of its onset are changing, therapeutic approaches undergo revision, critical care facilities are updated. Among the causes of this complication the authors single out endoscopic procedures, transurethral interventions in the presence of infectious process, hospital infection, long stay at hospital. Forty-eight cases of bacterial toxic shock are reviewed in relation to classification, causes of development, treatment, bacteriological evaluation.

[The prevention of infectious-inflammatory complications in operations on the kidney]. / Profilaktika infektsionnno-vospalitel'nykh oslozhnenii pri operatsiiakh na pochke.

The paper presented the experience in the prevention of infectious complications during the renal surgery developed both in the organ operated on (acute postsurgical pyelonephritis) and in the surgical wound later. The package of prophylactic measures was employed in 48 patients operated on for the diseases of kidneys and urinary tract (nephrolithiasis predominantly). It included aseptic, antiseptic techniques, antibacterial treatment and preventive treatment in the pre-, intra- and postoperative periods, as well as intraoperative irrigation of the wound with antiseptic solutions and postoperative local therapy. Antibacterial prophylaxis was started 3-5 days or at night before the indicated surgery. Antibiotics were administered only after a careful adjustment of the dosage. Their intravenous (mainly) injections were performed under the effect of preliminary anesthetics. Clinical materials for microbiological and pharmacokinetic monitoring were being taken during the operation. Sodium chloride solution was electrolyzed and the obtained sodium hypochloride was used for the sanation of pyogangrenous foci. Patients with pyodestructive renal lesions developed in the presence of active chronic or acute pyelonephritis and the drainage of the urinary tract underwent 5-7-day antibacterial therapy. The aforementioned preventive measures allowed the authors to gain a significant reduction in the incidence of postoperative pyelonephritis (from 94.2 to 31.2 per cent) and wound infection (from 19.2 to 8.3 per cent), as well as bacteremia (from 32.3 to 5.4). Postsurgical complications (acute pyelonephritis and wound infection), if appeared, ran a relatively favorable course and were cured 3-5 days later. Uroseptic conditions were not observed.