[Investigation of metabolic paramagnetic centers in the blood of patients with prostate adenocarcinoma prior to and after the plastic orchectomy].

Paramagnetic centers in the blood of patients with prostate adenocarcinoma have been studied prior to and after plastic orchectomy by EPR. It has been shown that significant alterations in blood paramagnetic centers occur after the surgery. These alterations point to an improvement of antioxidant properties of the blood. Specifically, the content of the Fe(3+)-transferrin complexes increased, and the number of inactivated adrenoreceptors, MetHb, and Mn(2+)-containing complexes decreased. It was found that, along with improvement of the antioxidant properties of the blood, a significant decrease in the intensity of lipid peroxidation in the blood of the patients occurs.

[Kidney protein complexes that inhibit gene expression in the nuclei of homotypic cells].

The comparative study of protein complexes (PCs) isolated by alcohol extraction from white rat and human nephrocytes (post-operational material) have been performed. It has been shown that PCs of white rat cells inhibit RNA synthesis in the nuclei of intact as well as nephrectomized (unilateral nephrectomy) animals. The same effect has been shown while studying the PCs of patients with hydronephrotic kidneys. At the same time the inhibition of transcription has not been detected in case of RCC kidney cancer cell PCs. The chromatography studies revealed that the active component of PCs (12 kDa protein factor) which had been detected earlier has not been shown up in cancer cells of human kidney.

[Some aspects of transurethral resection of large benign prostatic hyperplasia].

Benign prostatic hyperplasia (BPH) is a progressive disease that affects the quality rather than the quantity of life of men. There are two methods of surgical treatment of BPH: transurethral resection of the prostate (TURP) and open prostatectomy. In this study we investigated the safety and efficacy of TURP for large prostate glands. To analyze our clinical data we can conclude introduction of technological innovations, especially of "low pressure" TURP, have made it possible to perform TURP for large prostates so safely as for recommended volumes. Also our trial has demonstrated that complications after TURP were within admissible limits of standard TURP. Therefore, TURP can be considered as an effective and safe procedure for patients with large prostate glands.

[Assessment of long follow-up results after surgical treatment of stress urinary incontinence using tvt and pubovaginal short skin flap sling].

The aims of present study were to evaluate the quality of women's life (QoL) after surgical treatment of stress urinary incontinence (SUI) and to compare long follow-up results of two different procedures. Quality of life questionnaire represents a useful and cheap tool in the investigation of outcomes of the surgical treatment of stress incontinence. By providing an objective measure of the impact of results on women's lives, quality of life questionnaires allow more comprehensive understanding of disease severity and its effect on psychosocial function. In addition, they have an increasingly important role in clinical research, allow comparing two and more different methods of treatment. QoL of patients after TVT was significantly higher, then after pubovaginal sling using short skin flap (subjective cure 80% versus 66% after 48 months follow up). These benefits in QoL, coupled with the minimally invasive nature of the procedure, suggest that TVT could become a favored treatment option in women with SUI.

[Is sextant biopsy a valid method in diagnosis of prostatic cancer?].

We evaluated effectiveness of a laterally directed sextant biopsy on large prostates and analysed the results of this biopsy technique in a group of men with obstructive voiding symptoms and suspected prostatic cancer (PC). Biopsy was performed in 386 men because of elevated PSA and/or abnormality in digital rectal examinations (DRE). The mean prostate volume was 79.6 +/- 39.1 cm3, and in 72.3% of the cases the volume of the prostate was > or = 50 cm3. PC was diagnosed in 107 of 386 cases (27.7%). In groups of patients with < 50 cm3 (small), 50 to 79 cm3 (medium) and > or = 80 cm3 (large) prostate volume and normal DRE, PC was detected in 27.5, 19.4 and 9.5% of cases, respectively (p < 0.018). PC detection rate was statistically insignificant (SI) in the same groups of patients with abnormal findings at DRE, 49.2, 54.2 and 51.9%, respectively (SI). Repeat sextant biopsy revealed PC in 14.5% patients. After TURP prostatic cancer was found in 7.7% patients who had undergone biopsy two times before. Thus, our results show that laterally directed sextant biopsy is an effective method of PC detection among suspected patients (PSA > 4 ng/ml) with large volume prostates and abnormal findings at DRE. An extensive biopsy protocol should be considered as a more appropriate method for markedly enlarged prostates with normal DRE findings but also for repeat biopsies.

[Extended lymphadenectomy in radical cystectomy: margins, scope, methodology].

Radical cystectomy with pelvic lymphadenectomy is a gold standard for treatment of muscle-invasive urinary bladder cancer. However, therapeutic and prognostic value of pelvic lymphadenectomy is still controversial. Recent studies have demonstrated a better prognosis after extended lymphadenectomy. A multicenter study was made to standardize an extended lymphadenectomy procedure. We examined prospectively the total number of lymph nodes removed from various sites, number and location of positive nodes and its relation to location of primary tumors in the urinary bladder. Thirty five radical cystectomies with extended lymphadenectomy were performed for the treatment of invasive bladder cancer in National Urology Center in 1999-2004. The margins of extended lymphadenectomy were: cranial level of a.mesenterica inferior; lateral--n.n. genitofemoralis; caudal-fossa obturatoria. A total amount of removed lymph nodes comprised 1081, mean 34.2 +/- 8.1 lymph node per patient (range from 10 to 58). Fourteen patients (40.0%) were node positive (69 nodes). According to N category: N1--6 patients; N2--7 patients. Six patients had lymph node metastases up to the aortic bifurcation. In 6 cases a positive node was found on the contralateral side. Thus, we recommend extended radical lymphadenectomy for all patients undergoing radical cystectomy for bladder cancer.

[Local recurrence of renal cell carcinoma after radical nephrectomy].

Radical nephrectomy was made in 483 patients with renal cell carcinoma (RCC) without metastases admitted to National Urology Center in 1989-2004. Isolated local recurrence was observed in 10 (2.07%) patients who were divided into two groups. The recurrent tumor was removed in 6 patients of group 1, four patients of group 2 received conservative treatment. Statistic processing was made with Kolmogorov-Smirnov test and unmatched t-test. Survival was estimated according to Kaplan-Meyer, significance of the differences--by log rank test. Three patients of group 1 died of progression of basic disease. Only 1 patient from group 2 was alive 22 months after detection of the recurrence. Mean survival in group 1 was 27.5 +/- 14.9 months, in group 2--10 +/- 8.5 months (p = 0.045). A mean size of the recurrent tumor in survivors was 5.4 +/- 2.1 cm, while in dead patients--10.05 +/- 2.76 cm (p = 0.02). Radicalism of the recurrent tumor removal influenced survival of the patients (p = 0.019). In survivors local recurrence developed 35.7 +/- 28.1 months after radical nephrectomy; in the deceased the recurrence arose 23.3 +/- 25.5 months after nephrectomy (p = 0.46). Thus, early detection of isolated local recurrence of a relatively small size allows complete recovery in some surgically treated patients.

[Long-term results of nephron-sparing surgery for small renal tumors with elective indications].

The widespread use of modern radiological techniques substantially changed clinical presentation of renal cell carcinoma (RCC) in the recent decades. Currently, more than one half of all patients with surgically resectable renal tumors are detected incidentally. In this due interest in nephron sparing surgery (NSS) for the treatment of small localized tumors has increased. The amount of healthy parenchyma that should be removed together with the tumor to minimize the risk of local recurrence is an important and controversial issue. In the present study we retrospectively studied 44 cases of NSS performed for elective indications. A total of 44 patients underwent elective NSS from 1994 to 2001. According to the operative techniques the patients were distributed in two groups. Group I consisted of 17 patients who underwent "enucleoresection" with a small part of normal parenchyma around the excised tumors. The rest 27 patients (Group II) underwent NSS by means of enucleation. Mean follow-up was 88.36+/-24.75 months (range: 49-146 months). The mean tumor size was 37,04+/-4,65 cc (range: 25 to 45). There was no perioperative mortality. Hemorrhage was observed in 1 patient (5,9%) from Group I. Urinary leakage was observed in 3 (6,8%) cases in both groups: two (11,7%) in group I and one (3,7%) in group II. No local recurrence was observed during the follow-up period. One patient (2, 8%) developed distant metastases and died at 81 month postoperatively. 5-year cancer specific survival was 97,6 %. Simple tumor enucleation is a safe and acceptable approach for elective NSS. It provides excellent long-term progression-free and cancer specific survival rates, and is not associated with an increased risk of local recurrence compared with partial nephrectomy.

[In vitro effects of cAMP- and cGMP-stimulating drugs on the relaxation of the prostate smooth muscle tissue contraction induced by endothelin-1].

Results from experimental studies suggested a significance of the nitric oxide (NO)-cGMP- and cAMP-pathways in the control of the function of the smooth musculature of the human prostate. In addition, it has also been assumed that the vasoconstrictory peptide endothelin-1(ET-1) may play a role in the dynamic component of benign prostatic hyperplasia (BPH) and the so-called lower urinary tract symptomatology (LUTS). Nevertheless, up till now, little is known as to potential interactions between the contraction of prostatic smooth muscle mediated by ET-1 and the relaxation induced by NO and cGMP. Thus, it was the aim of the study to elucidate the effects of drugs interfering with the cGMP-pathway on the tension induced by ET-1 of isolated human prostate tissue, as well as contractile responses of isolated strip preparations to ET-1 and angiotensin-II (AT-II). Macroscopically normal human prostate tissue from the transition zone was obtained from male patients who had undergone surgery for localized cancer of the prostate or urinary bladder. Using the organ bath technique, the ability of ET-1 and AT-II to contract isolated prostate strips was evaluated. In another set-up, the effects of the NO-donor S-nitrosogluthatione (GSNO) and C-type natriuretic peptide(CNP), known as an endogenous ligand of the membrane bound guanylyl cyclase, (1 nM-1/10 microM) on the tension induced by 0.1 microM ET-1 of human prostate strips were investigated. The adenylyl cyclase stimulating agents forskolin and NO-donor natrium nitroprusside (NNP) were used as reference compounds. While AT-II failed to contract the prostate tissue, ET-1 induced stable and reproducible contractions of the tissue strips. The tension induced by 0.1 microM ET-1 was dose-dependently reversed by the drugs. The rank order of efficacy was forskolin >NNP>CNP(1 microM)>GSNO. R(max) values ranged from 55% (forskolin) to 35% (GSNO). Forskolin was the only compound which reached an EC50 value. Our results demonstrate that drugs in terfering with the cGMP- and cAMP-pathways can reverse the tension induced by ET-1. These findings are in support of the hypothesis that both cGMP and cAMP contribute to the control of the prostate smooth muscle tension and may provide new strategies for the future pharmacotherapy of LUTS und BPH.

[Comparative study of the influence of renal endogenic factors on the proliferation activity of epithelial cells].

The proliferation activity of monolayer culture of Madin Darby Canine Kidney (MDSK) cells is suppressed by a thermostable protein factor of renal tissue of white rats and of humans. Under the influence of renal factors (RF), a decrease in cell number, and suppression of DNA synthesis and mitotic activity in MDCK cells occur. The inhibition of proliferative activity of cultured cells under the influence of RF was substantiated also by MTT assay. It was established that the inhibitory influence of RF is stipulated by suppression of RNA synthesis. It follows that RF may inhibit division of MDCK cells via suppression of gene expression in G1-phase. Similar factors were obtained from renal cells of different systematic groups of organisms (snail, frog, fish, pigeon, guinea pig, swine).

[Model of screening for prostatic cancer among patients with prostate specific antigen concentration of 4-10 ng/ml in blood]. / Model' skrininga raka predstatel'noi zhelezy u muzhchin s umerenno povyshennoi kontsentratsiei prostatspetsificheskogo antigena (4-10 ng/ml) v krovi.

Screening based on the measurement of prostate specific antigen (PSA) in the blood is the basic method for early detection of prostatic cancer. However the specificity of this method even in combination with the digital rectal examination (DRE) or with PSA derivatives remains disputable in cases when PSA concentrations in the blood vary between 4 and 10 ng/ml. We evaluated the efficiency of different diagnostic methods in order to create an effective diagnostic method in patients with PSA concentrations of 4-10 ng/ml. The study was carried out in 176 patients divided into 2 groups. Group 1 consisted of 120 patients. The efficiency of DRE, PSA density, PSA transition zone density (PSAT), free to total PSA ratio, and repeated PSA (measured after antibiotic therapy in patients with prostatic inflammations) were assessed. Diagnostic methods with the highest predictive values were identified. Positive predictive values of PSAT (cut-point 0.25 ng/ml/cc), nodule and induration (revealed by DRE) were estimated as 100, 100, and 75%, respectively. Negative predictive value of repeated PSA measurement (after antibiotic therapy) was 100% with the threshold value of 4 ng/ml. Using these diagnostic methods, a model of prostatic cancer screening was created. Group 2 consisted of 56 cases. A screening model representing a combination of the above diagnostic methods with the highest predictive value was clinically tried in this group. The sensitivity of the model was 80%, specificity 94%, positive predictive value 89%, and negative predictive value 89%. Use of this model makes biopsies unnecessary in 64% cases, with the risk of undetected cancer cases no higher than 20%. Hence, the screening model based on the use of diagnostic methods with the highest predictive value effectively detects prostatic cancer among patients with PSA concentrations of 4-10 ng/ml.

[Retrograde nephrostomy in the treatment of kidney stones]. / Retrogradnaia nefrostomiia v lechenii kamnei pochek.

Transcutaneous nephrolithotomy is widely used in management of nephrolithiasis. The outcome of the intervention is largely due to successful establishment of nephrostoma. For this purpose retrograde nephrostomy was employed in 7 nephrolithiasis patients. Relevant technique is described for primary and recurrent disease. Its indications involve absence of calyceal-pelvic dilation, obesity, pararenal cicatrices. The manipulation appeared beneficial in all the cases. Retrograde nephrostomy is considered an alternative to antegrade nephrostomy in the treatment of nephrolithiasis.

[Hemodynamics in transurethral operations under peridural anesthesia]. / Gemodinamika pri transuretral'nykh operatsiiakh v usloviiakh peridural'noi anestezii.

Three types of cardiovascular system response were revealed in course of transurethral surgery. In the first 10-20 min after peridural anesthesia there was a decrease in total peripheral vascular resistance in all patients. This provided a positive effect in 84% of them as evidenced by normalized blood pressure, heart rate and cardiac output. In 8% of the operated on, lower total peripheral vascular resistance caused dangerous hypotension due to their weak compensatory mechanisms. 8% had a two-phase blood pressure decrease: firstly its decrease to subnormal levels was associated with lower total peripheral vascular resistance, but a repeated decrease (30-40 min later) in blood pressure to a critical level was initiated by a reduction in cardiac output and depletion of compensatory mechanisms, perhaps, due to a surgical hemorrhage. The both types of hemodynamic destabilization were easily corrected by an alpha-adrenomimetic drug (mezaton) infusions and graded intravenous administration. In case of a proper hemodynamic correction, the peridural anesthesia secured an optimal regime for the function of cardiovascular, respiratory and central nervous systems.

[The transurethral resection of prostatic adenoma]. / Transuretral'naia rezektsiia adenomy predstatel'noi zhelezy.

The paper presents the analysis of 255 patients aged 39-89 yrs who sustained transurethral resection of prostatic adenoma between 1985 and 1988. The choice of the surgery technique depended on the direction of adenoma growth the weight of its tissue and the presence of associated diseases of the lower urinary tract. At present, the allowable weight of the removed tumor is increased from 30 to 60 g while the mean operation time is decreased from 50 +/- 10 to 35 +/- 5 minutes. The authors arrived at the conclusion that the aforementioned technique was of high performance and low-rate traumatism, thus widening the limits of the disease surgical treatment, decreasing the incidence of early (13.7 per cent) and late (2.7 per cent) complications and death rates (1.9 per cent). Besides, the duration of postsurgical hospital stay decreased (5 +/- 1.5 days in noncomplicated cases and 12 +/- 3 days in complicated ones).