[Contemporary low-invasive, videoendoscopic and organ-sparing abdominal operations].

The paper presents the results of low-invasive, videosurgical, and organ-sparing operations, developed and performed by the authors. Original low-invasive techniques of external, external-and-internal and internal bile-duct drainage, and bile-duct endoprosthesis replacement have been performed in 25 patients with benign and malignant bile-duct strictures. Transcutaneous puncture drainage operations, including those combined with an original method of transdrainage sclerotherapy with nitric oxide, have been performed in 93 patients with postnecrotic pancreatic cysts. Endoscopic virsungotomy have been performed as part of the complex treatment of 43 patients with external pancreatic fistulas and 14 patients with polycystic head of pancreas. X-ray endovascular embolization has been performed in 7 patients with internal arterio-pancreatic fistulas. Program laparoscopic abdominal cavity sanation by an original method have been performed in 50 patients with diffuse peritonitis. The results of the study demonstrate high effectiveness of the methods, which in most cases can be applied as an alternative to conventional surgical interventions.

[Urinary tract occlusion: a principal cause of some complications of urolithiasis]. / Okkliuziia mochevyvodiashchikh putei -- osnovnaia prichina razvitiia riada oslozhnenii mochekamennoi bolezni.

Urinary tract occlusion in urolithiasis is a serious complication which provokes an attack of acute obstructive pyelonephritis. The infected urine aggravates this infectious-inflammatory process and endangers bacterial shock. Etiopathogenesis of this shock is outlined and modern approaches to its management are described.

[Gastrointestinal hemorrhage in urological diseases]. / Zheludochno-kishechnye krovotecheniia pri urologicheskikh zabolevaniiakh.

The authors analyse 28 cases of gastrointestinal hemorrhage (GIH) in urological diseases and after uronephrological operations, emphasize factors of uremic intoxication and relevant complications provoking DIC syndrome. Various factors leading to stress (acute blood loss, shock, sepsis) and development of immunodeficiency disturbed morphostructure of gastric and duodenal mucosa and provoked hemorrhage which was stopped most efficiently by fibrogastroduodenoscopy with coagulation of the bleeding vessel. If this operation failed, open surgery was performed. Conservative measures consisted in DIC syndrome management policy.

[Risks and complications of surgical treatment of urinary lithiasis of single kidney]. / Opasnosti i oslozhneniia operativnogo lecheniia bol'nykh mochekamennoi bolezn'iu edinstvennoi pochki.

163 patients with urolithiasis of the solitary kidney were treated surgically. Analysis of causes of postoperative complications (n = 70) and lethal outcomes (n = 11) demonstrate that lethal outcomes were in many cases related to exacerbation of renal failure, acute calculous pyelonephritis which had provoked sepsis and bacteriotoxic shock, acute hemorrhage with hemorrhagic shock followed by development of DIC-syndrome.

[Hyperbaric oxygenation in the treatment of patients with chronic congestive prostatitis and lower fertility]. / Giperbaricheskaia oksigenatsiia v lechenii bo'nykh khronicheskim kongestivnym prostatitom i snizheniem fertil'nosti.

Due to deteriorated demographic indices in the country, male infertility is a highly pressing problem. Chronic prostatitis is one of its causes. Hyperbaric oxygenation was used to affect male genital microcirculation, thus improving the spermatic morphological and functional characteristics. Positive effects of the method are ascribed not only to better microcirculation, but also to improved redox processes in spermatogenesis.

[Occlusive factor in development of urolithiasis complications]. / Okkliuziruiushchii faktor v razvitii oslozhnenii mochekamennoi bolezni.

Causes and mechanisms of complications in urolithiasis are analysed with a focus on the role of occlusion of the urinary tracts in the onset of pyoseptic complications. Most severe of them is bacteriotoxic shock which is hard to treat and dangerous for essential body functions. The priority of the treatment must be reestablishment of urine passage. Additional tools of the treatment include wide-spectrum antibiotics, efferent detoxication, electrochemical blood oxidation, hyperbaric oxygenation, UV blood radiation.

[The DIC syndrome as a complication of the surgical treatment of urolithiasis in urology patients]. / DVS-sindrom kak oslozhnenie khirurgicheskogo lecheniia mochekamennoi bolezni u urologicheskikh bol'nykh.

The authors discuss the causes of the DIC syndrome in urological patients operated on for urolithiasis. They enumerate the factors predisposing to the DIC syndrome and causing it. The predisposing factors are chronic renal insufficiency and metabolic disorders caused by azotemia, infectious inflammatory complications of urolithiasis, and intoxication. The causes of the disease are massive blood loss involving disorders of the hemodynamics and blood rheology, bacterial shock, and other stress conditions. A protocol for treating this complication and validation of pathogenetic therapy is offered.

[The disseminated intravascular coagulation syndrome in urological diseases]. / Sindrom disseminirovannogo vnutrisosudistogo svertyvaniia krovi pri urologicheskikh zabolevaniiakh.

The authors consider causes and mechanisms underlying DIC syndrome onset in complications of urological diseases. The syndrome may originate from azotemia-induced intoxication, injury to the kidneys and urinary tracts, complications of surgical interventions. Etiologically and pathogenetically validated approaches to DIC syndrome treatments, their regimens, combinations and dosages are presented.

[The current approach to assessing the degree of risk in performing urological operations]. / Sovremennyi podkhod k otsenke stepeni riska vypolneniia urologicheskikh operatsii.

Upon analysis of all the available classification of urological operative risk the authors conclude that classification proposed by the Moscow Anesthesiology Scientific Society meets current requirements as it allows for the opinion of the surgeon, anesthesiologist and functional diagnosis specialist.

[The detection of latent circulatory and respiratory failure in urologic patients at the prehospital stage]. / Vyiavlenie skrytoi nedostatochnosti krovoobrashcheniia i dykhaniia u urologicheskikh bol'nykh na dogospital'nom étape.

Elderly patients admitted to urological hospitals and departments with increasing frequency have the disease complicated with age-specific and associated circulatory and respiratory affections. Occasionally, these complications are not clinically evident, but may acquire unwanted decompensated course. Subclinical forms of circulatory and respiratory insufficiency can be managed using relatively simple methods of functional assessment applicable in outpatient setting. Recommendations are provided on operative preparations which can be made at home or in outpatient department thus reducing the cost of hospital stay.

[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.

[Bacterial toxic shock as a complication of calculous pyelonephritis]. / Bakteriotoksicheskii shok kak oslozhnenie kal'kuleznogo pielonefrita.

The causes of bacteriotoxic shock were examined in 33 patients (11 lethal outcomes). It has arisen as a complication of treatment given to 7830 patients for urolithiasis. Aggravation of chronic pyelonephritis, occlusion of the urinary tracts, urogenital mucosal and parenchymal injuries, low resistance to infection contribute to microbacteria and their toxins entering blood with resultant bacteriotoxic shock. Transcutaneous operative interventions, therapeutic and diagnostic procedures also produce high risk of blood infection with gram-negative microflora, especially in violation of asepsis and antisepsis rules. As shown by microflora tests, the dominating bacteria consisted of opportunistic agents which had acquired the resistance to antibacterial drugs. In view of rapid progression of bacteriotoxic shock therapeutic efforts should be concentrated on fast normalization of hemodynamics, recovery of urine passage, introduction of sorption detoxication, prevention of DIC syndrome. The schemes of combined antibiotic treatment adjusted to the kind of infectious agent are suggested.

[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 effect of psychoemotional stress on kidney function]. / Vliianie psikhoémotsional'nogo stressa na funktsiiu pochek.

Psychoemotional stress, like other kinds of emergency states, is accompanied by renal functional changes and accumulation of biologically active substances in the human body, among which middle molecular oligopeptides are classified. In inadequate or untimely premedication, an operative intervention of any scope occurs initially under unfavourable conditions due to accumulation of biologically active substances in blood and decrease in renal functions. The proposed method of preoperative measurement of the middle molecular oligopeptides and their correlations in plasma and urine may become an indirect indicator of premedication adequacy and a screening test of renal function.

[Epidural anesthesia in urology]. / Epidural'naia anesteziia v urologii.

Indications for epidural anesthesia have been analyzed on the basis of 1483 cases of its application. They include transvesical adenomectomy, transurethral electroresection of prostatic adenoma, distant renal and ureteral lithotripsy. It is emphasized that epidural anesthesia is an advantage in older and senile individuals with associated respiratory and circulatory diseases. Epidural anesthesia provides some protection against complications like a transurethral resection syndrome and coagulation disorders. The practical use of epidural anesthesia during urologic operations is safe when its level does not extend above the 9-10th dermatome. A range of measures is offered to prevent complications of epidural anesthesia by stabilizing the hemodynamics and improving blood rheology, coagulation, and humoral status.

[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.