[Phytoprophylaxis of complications after extracorporeal lithotrips].

AIM: To evaluate the efficiency of the drug phytolysin (capsules) in the prevention of complications after extracorporeal lithotripsy. MATERIALS AND METHODS: A total of 15 patients diagnosed with urolithiasis and chronic pyelonephritis in the latent phase were treated. The predominant localization of radiopaque stones no larger than 20 mm in size was the collecting system. The piezoelectric lithotripsy (1-2 sessions) was performed, followed by the administration of the herbal drug Phytolysin in the dosage form of a capsule. The follow-up was carried out after 14- and 30-days using laboratory, ultrasound and x-ray methods. RESULTS: In the postoperative period, there were no cases of the pyelonephritis, which may result from a short-term disturbance of the upper urinary tract urodynamics due to the passage of stone fragments. The antibacterial, antispasmodic, diuretic and anti-inflammatory effects of Phytolysin ensured positive changes in laboratory and bacteriological tests, contributed to the prevention of postoperative complications after extracorporeal lithotripsy (renal colic, pyelonephritis), and contributed to maintaining renal blood flow within normal limits and significantly reduced the time to stone-free status. CONCLUSIONS: Our results justify the feasibility of using phytolysin in capsules in patients with urolithiasis after extracorporeal lithotripsy. The dosage form in capsules eliminates the undesirable effects associated with the specific smell and taste, that patients noted when using phytolysin in the form of a paste.

[Involvement of p2 receptors in the contractile activity of the bladder in patients with benign prostatic hyperplasia].

AIM: to study the role of P2 receptors in impaired bladder contractility in patients with lower urinary tract obstruction. MATERIALS AND METHODS: in pharmacological studies, tissue samples from the bladder wall of 30 patients were used, obtained during planned surgical interventions for benign prostatic hyperplasia (transvesical simple prostatectomy without placement of cystostomy tube). Based on these tissue, isolated smooth muscle specimens were prepared. Their mechanical activity and the efficiency of ligands of purine P2 and other receptors were evaluated. With this aim, the following P2-receptor agonists were used: adenosine triphosphoric acid (ATP), adenosine diphosphoric acid (ADP), uridine-5'-triphosphoric acid (UTP), alpha, beta-methylene-ATP, 2-methylthio-ADP, as well as antagonists of P2-disulfonate receptors acid (PPADS), suramin, NF023, MRS2500. In addition, the efficiency of ligands of other receptors, including carbacholine, epinephrine, histamine, serotonin, atropine was evaluated. RESULTS: the most effective agonist was alpha-beta-methylene-ATP, while ATP and 2-methylthio-ADP were significantly less active. In our experiments, ADP and UTP did not show an effect on human bladder. The influence of P2 receptor agonists was inhibited by P2 receptor antagonists PPADS and suramin, as well as MRS2500, although to a lesser extent. Carbacholine caused a strong concentration-dependent contractile response of the bladder, which was inhibited by atropine. Histamine resulted in mild bladder contractions only at high concentrations. Epinephrine and serotonin did not cause significant changes in the contractile activity of the bladder. CONCLUSION: The main subtype of P2 receptors involved in the contractile activity of the human bladder is P2X1 receptors. P2Y1 receptors also have some influence on the contraction, while other subtypes of P2 receptors are not detected by pharmacological methods.

[Improvement of oncologic results of transurethral resection in the treatment of non-muscle-invasive bladder cancer].

AIM: To evaluate the efficiency of additional methods of intraoperative control during transurethral resection (TUR) for the treatment of non-muscle invasive bladder cancer. MATERIAL AND METHODS: A total of 138 patients (92 men and 46 women) with non-muscle-invasive bladder cancer (Ta-T1N0M0) were treated in the urological clinic of Kazan State Medical University. The median age was 59 years. In 28 patients TUR was performed as monotherapy, in 28 patients TUR with photodynamic therapy (PDD) was done and other 26 patients undergone TUR under dynamic transurethral ultrasound control. In 29 patients, TUR was combined with a single intravesical instillation of a chemotherapy drug, and in 27 patients, TUR was combined with long-term intravesical chemotherapy. The frequency and type of relapses was evaluated depending on the treatment method during five-year follow-up period. Analysis of postoperative complications and their severity was performed according to the Clavien-Dindo classification. Statistical analysis was performed using the Statistica 7.0 and Microsoft Excel 2003 software package. Survival was assessed using the Kaplan-Meier method. Differences in survival between groups were determined using a log-rang test. RESULTS: The total 5-years recurrence rate in the group 1 was 60.71% (n=17). There were 6 recurrences in the resection area (21.43%) and 8 recurrences outside the resection area (28.57%). The progression rate was 10.71% (n=3). In the group 2, the overall recurrence rate was 25% (n=7), including 2 (7.14%) and 4 (14.29%) recurrences in and outside resection area, respectively. The progression rate was 3.57% (n=1). In the group 3, where TUR was performed in combination with transurethral ultrasound, 7 recurrences were diagnosed over a five-year period (26.92%), including 1 recurrence in the resection area (3.84%) and 6 recurrences in other parts of bladder (23.07%). There was no progression of bladder cancer. In the group of patients who received a single intravenous chemotherapy after TUR, there were no significant differences with the group of patients where TUR was performed as monotherapy. The total number of recurrences was 55.16% (n=16). There were 4 recurrences in the resection area (13.79%) and 9 recurrences in other parts of bladder (31.03%), as well as 3 case of disease progression (10.34%). At the same time, in the group of patients where prolonged course of adjuvant intravesical chemotherapy was performed, a significant decrease in the recurrences rate in the resection area (7.4%; n=2) and progression (3.7%, n=1) was found. The number of recurrences outside the resection area was comparable with the group 1 (22.22%; n=6). CONCLUSIONS: According to our data, we recommend to perform TUR in combination with PDD and transurethral ultrasound in order to improve the oncological results. Long-term intravesical chemotherapy is an effective alternative in case of inability to use additional intraoperative control and it should be included in the treatment scheme of patients with a high risk of recurrence.

[Method of complex therapy of chronic cystitis].

AIM: To assess the effectiveness of hydroxyethyldimethyldihydropyrimidine (trade name Xymedone) in the treatment of chronic recurrent cystitis in women. MATERIALS AND METHODS: The study included 30 patients (the main group) with a confirmed diagnosis of chronic cystitis (HC) with a recurrence rate of at least 3 times a year, the average age of the patients was 46.0+/-2.7 years. The control group consisted of 30 age-comparable patients with a similar diagnosis, who underwent standard treatment for this disease. The article presents the results on the effectiveness of the use of hydroxyethyldimethyldihydropyrimidine (Xymedone) in the treatment of HC after anti-inflammatory and local treatment with collargol instillations, and the terms for the regeneration of the bladder mucosa are determined. To patients of the main group Xymedone was prescribed in a dose of 500 mg 3 times a day for 30 days after the completion of local treatment. Control cystoscopy was performed 15 and 30 days after the start of the drug, 3 days after its withdrawal. RESULTS: The planned treatment was completed by all 30 patients of the main group. After 15 days from the date of administration of Xymedone most of patients had no low urinary tract symptoms (LUTS), in comparison with the control group. Cystoscopy performed at this time allowed to establish a positive trend while taking Xymedone in the process of restoring the bladder mucosa after influence of collargol. Hyperemia in the neck and triangle area persisted in most patients, and only in 8 (26.6%) it decreased. Treatment with Xymedone was continued. After 30 days of drug intake laboratory parameters were according to normal values, a significant increase in functional capacity of the bladder (189,5+/-19,8 ml) and volume of urination (147,9+/-26,7 ml.) was detected, the thickness of the bladder wall in a state of filling in the averages was 3.5+/- 0.3 mm, which corresponded to the norm. Cystoscopy, performed 3 days after canceling of the drug, showed a slight hyperemia in the bladder neck area only in one patient. Recurrence of HC in the control group occurred within 6 months after completion of treatment in 15 (51%) women. In the main group there were no relapses during two years of dynamic follow-up. CONCLUSIONS: Hydroxyethyldimethyldihydropyrimidine, included in the therapy of HC, accelerates the regeneration of the bladder mucosa after local treatment of recurrent cystitis and shortens the period of its recovery, significantly lengthens the period of persistent remission.

[Rationale of pharmacotherapy duration in patients with benign prostatic hyperplasia (a clinical-morphological study)].

AIM: To investigate the nature of morphological alterations in the urinary bladder wall in BPH patients receiving pharmacotherapy to establish treatment time limits. MATERIALS AND METHODS: The study comprised 120 BPH patients who underwent a transvesical adenomectomy. Prior to the surgery, 110 patients received pharmacotherapy (-blockers and 5-reductase inhibitors) lasting from 1-6 months to 5-10 years. Preoperative evaluation included a standard diagnostic algorithm. During the surgery, the urinary bladder wall specimens were taken for morphological examination. Histologic specimens were stained with hematoxylin-eosin and according to van Giesonn, and underwent immunohistochemical examination using desmin, vimentin, CD31, type IV collagen and pancitokeratin monoclonal antibodies. In patients who did not take medications or used them for less than 6 months, the bladder preserved the normal histological structure. Pharmacotherapy lasting 1 to 5 years resulted in microcirculatory alterations characterized by extensive hemorrhages, damage to the endothelium and vessel basal membranes, hypertrophy of the bladder muscle membrane. In patients taking the medications for 6 to 10 years, microcirculatory alterations resulted in the vascular wall sclerosis and thickening, narrowing of the vessel lumen, hypoplasia of the transitional epithelium and muscle layer atrophy. RESULTS: The study findings suggest that prolonged (over 1 year) pharmacotherapy can adversely affect the urinary bladder wall and worsen the results of radical adenomectomy.

[The use of NefroDoz in patients with urolithiasis who underwent extracorporeal shock wave lithotripsy].

The article presents the results of the multicenter clinical comparative open-label trial in three parallel groups, which was aimed to the evaluation of the efficacy and safety ofbiologically active food supplement NefroDoz after extracorporeal shock wave lithotripsy (ESWL) in patients with urolithiasis. NefroDoz was prescribed for the lithokinetic purpose. The study involved 114 patients from different regions of the Russian Federation aged from 18 to 75 years (mean age 45.56 +/- 12.49 years) with a diagnosis of urolithiasis who underwent ESWL. Patients were divided into 3 groups according to the type oftreatment. Evaluation of the effectiveness was performed using data from a blood test, urine analysis, and biochemical blood assay, ultrasound and KUB X-ray. The results showed that NefroDoz has diuretic, anti-inflammatory, and lithokinetic effects, and is effective and safe drug for the patients with urolithiasis who underwent ESWL.

[Therapy of rapid ejaculation using dietary supplement "NeyroDoz": results of a multicenter non-randomized clinical study].

The main aim of the study was to determine the effectiveness of a multicomponent dietary supplement NeyroDoz in patients with rapid ejaculation. We examined 50 patients with rapid ejaculation (premature ejaculation), who were recruited in 9 clinical centers in different regions of Russia. These patients received NeyroDoz, 2 capsules twice a day for one month, followed by a control observation for 1 month. In study group of patients, symptomatic improvement was achieved in 45 (90%) of 50 patients at 4-week observation target date. In assessing the impact of NeyroDoz on different groups of symptoms, it was found that it significantly increases the average time of sexual intercourse by 2 times, increases the orgasm brightness, reduces the severity of psychosomatic component and has a positive effect on all components of the copulative cycle. In assessing the afterimpression, this effect was maintained throughout the period of follow-up.

[Efficiency of tolterodine in the treatment of patients with overactive bladder].

The article presents the results of the examination and treatment of 30 patients with overactive bladder receiving M-anticholinergic drug tolterodine at a dose of 2 mg twice a day for 1 month. Evaluating the effectiveness of the drug was performed on the basis of the data on voiding diary, urodynamic changes, and results of ultrasound examination. The analysis showed that treatment with tolterodine within 15 days has a positive trend: normalization of urination was observed in 96.6% of patients, 76.6% of patients have reported decrease of the frequency of urgency urination, and episodes of imperative urinary incontinence decreased in 83.3% of patients. The therapy promoted the increase the duration and volume of urination, reduction of maximum uroflow rate, indicating that the effectiveness of treatment. On the 30th day of treatment, the vast majority (80%) of the patients reported improvement of their wellbeing.

[The use of ProstaDoz in patients with chronic prostatitis. Results ofa multicenter nonrandomized clinical study].

The main purpose of the study was to determine the effectiveness of a multicomponent dietary supplement ProstaDoz in patients with chronic prostatitis. The study included 50 men with clinical symptoms of a chronic prostatitis, which were observed in 9 clinical centers in different regions of Russia. All patients have received 2 capsules of ProstaDoz twice a day for 1 month, followed by dynamic observation for 4 weeks. Symptomatic improvement was achieved in 46 (92%) patients. Evaluation of effects of ProstaDoz on various groups of symptoms has revealed that it reduces pain, promotes urination normalization and improvement of quality of life. These effects were maintained during all follow-up period.

[Efficacy of vitaprost forte in the treatment of prostatic adenoma].

Thirty patients with a documented diagnosis of prostatic adenoma were treated with vitaprost forte (100 mg rectal suppositoria) for 60 days. Treatment efficacy was assessed after therapy and for two months with a 30-day interval. It is shown that the drug can be used as monotherapy. Its efficacy was proved by improved urodynamics of the lower urinary tract, reduction of prostatic size. A therapeutic effect after the drug discontinuation points to a complex organotropic action of the drug. Side effects were not registered. Vitaprost forte is recommended for treatment of patients suffering from prostatic adenoma with mild and moderate symptoms.

[Prevention and treatment of complications in patients after cystectomy with enterocystoplasty].

Surgical outcomes have been analysed for 211 patients with urinary bladder tumors. The operation consisted in cystectomy with one- or multistage creation of intestinal neocystis. Causes of early and late postoperative complications were studied. Original surgical techniques with creation of orthotopic intestinal bladder preventing complications of cystectomy are proposed.

[Efficacy of a plant complex Prolit after extracorporeal lithotripsy in patients with urolithiasis].

A study of an additive prolit efficacy was made in the urological clinic of Kazan State Medical University. All the examinees were divided into two groups: 20 patients of group 1 were exposed to extracorporeal lithotripsy (EL) followed by conventional postoperative conservative therapy, 22 patients of group 2 received EL plus prolit. The latter was able to reduce twice the time of concrement elimination from the urinary tract after EL, to lower leukocyturia from 86.4 to 18% and bacteriuria from 50 to 13.6%, renal colic rate and risk of stone path after EL, to improve renal blood flow and to reduce the risk of traumatic parenchymal damage due to the shock wave impact in EL.

[Choice of a method of surgical treatment of urinary bladder neoplasms]. / Vybor metoda operativnoogo lecheniia novoobrazovanii mochevogo puzyria.

The results of treatment of 850 patients with urinary bladder cancer (UBC) are analysed. Precise staging of the tumor should be made in the following order: suprapubic ultrasonic investigation (USI), cystoscopy and microcystoscopy, transrectal, transurethral USI. Indications for different treatments are outlined: typical and atypical papillary fibroepithelioma, papillary cancer in stage T1 should be managed with TUR after previous electrocoagulation; cancer in stage T2-3--with urinary bladder resection and uni- or bilateral pelvic lymphadenectomy; total papillomatosis, multiple lesions in stage T3, in cases of recurrent cancer--with cystectomy including one-stage or multistage replacement of the urinary bladder by intestinal transplant. The only physiologically sound method of treating patients after cystectomy with ureterocutaneostomy and ureterocolostomy is creation of intraperitoneal intestinal urinary bladder with reestablishment of transurethral urination. Arguments against creation of artificial urinary bladder made of detubularized segments consist in the absence of advantages.

[The formation of an artificial bladder from the intestines]. / Formirovanie artifitsial'nogo kishechnogo mochevogo puzyria.

Basing on the long-term experience in radical surgery of 252 patients with invasive bladder cancer, the authors come to the conclusion that the establishment of intestinal bladder with postcystectomy recovery of physiological uresis is the most proper therapeutic approach. Extra- or intraperitoneal position of the transplant was decided upon regarding the type and stage of cystectomy and prior methods of derivation. The techniques of one- and multistage operations are presented. Clinical practice evidences that more rapid recovery of urethral uresis can be obtained with application of primary continuous suture of artificial intestinal bladder (ideal enterocystoplasty) at the end of the surgery. Urodynamic low urinary tract findings are provided. The technique developed by the authors offers new surgical opportunity for bladder cancer patients following cystectomy.

[Patient rehabilitation following cystectomy for cancer]. / Reabilitatsiia bol'nykh posle tsistéktomii po povodu raka.

In 171 out of 251 cancer patients subjected to cystectomy, the bladder was replaced for isolated intestinal segment followed by recovery of transurethral urination. This recovery produced a favorable effect on physical, psychological and social, occupational status of the patients. Two-stage technique of establishing reservoir for the urine with renewal of transurethral urination is detailed. Normalization of the function of the kidneys and upper urinary tracts, prevention or early treatment of complications, natural transurethral urination should be considered criteria for rehabilitation of postcystectomy cancer patients.

[Iatrogenesis in urology]. / Iatrogeniia v urologii.

The proportion of misdiagnosis and errors in the treatment of urological diseases holds high, this being particularly true for iatrogenic pathology of the ureter and urinary bladder. The disturbances used to arise in response to traumatic gynecological and proctological surgical interventions and often remained undetected. The traumas are mainly induced by inaccurate use of the instruments and defects in surgical techniques. One of the serious iatrogenic complications is microcystic involvement of the urinary bladder as a result of radiotherapy for cancer. The method proposed by the authors for medical and social rehabilitation of such patients implies the replacement of the affected urinary bladder with isolated intestinal segment providing the recovery of natural uresis. Systemic endotoxinemia, another variant of urologic iatrogenesis, is associated with massive-dose antibiotics and extensive intracavitary operations. Early diagnosis and management of the conditions are supposed an effective protection against endotoxin shock.