[The function of the closure apparatus of the bladder in retrograde ejaculation in diabetics]. / Sostoianie zamykatel'nogo apparata mochevogo puzyria pri retrogradnoi éiakuliatsii u bol'nykh sakharnym diabetom.

The impairment of sympathetic innervation of the urinary bladder neck was supposed to be a cause of the syndrome of diabetic retrograde ejaculation (DRE). The performance of the sphincter system had not been studied in this category of patients. The liquid profilometric technique was used to examine 3 groups of males: 8 patients with the DRE syndrome; 5 patients with diabetes mellitus (DM) without ejaculation disorders; and 7 apparently healthy subjects. All the examinees showed no organic changes in the prostate and urethra. The groups were matched by age, type, duration and severity of DM. The DRE syndrome patients had no elevation of intraureteral pressure in the area the inner sphincter of the urinary bladder, which evidenced its atony. In health the elevation of vesical pressure is usually accompanied by an increase in ureteral resistance (r = 0.96; p less than 0.001), thus maintaining the stability of the positive pressure gradient and preventing the escape of urine. Correlation analysis revealed alterations of interrelations between intravesical and sphincter pressures in diabetes mellitus patients. This phenomenon evidenced the disorders of somatic innervation of the outer ureteral sphincter more pronounced in patients with the DRE syndrome. No significant differences were revealed in the length of the anatomical and functional ureter as well as in the length of the posterior ureter of all the patients involved in the study.(ABSTRACT TRUNCATED AT 250 WORDS)

[The use of the M-cholinomimetic test in predicting treatment efficacy in neurogenic bladder dysfunctions]. / Primenenie M-kholinomimeticheskogo testa v prognozirovanii éffektivnosti lecheniia neirogennykh disfunktsii mochevogo puzyria.

Presented are the first-hand correlations between therapeutic responses and hyper-response of the bladder of M-cholinomimetic drugs made by the authors on the basis of a follow-up of 98 children with hyper-reflex dysfunctions of the urinary bladder. The study revealed a definite relationship: the more pronounced hyper-response was, the more difficult it was to get a persistent effect of recovered function of the bladder. Out of 63 M-cholinomimetic-positive patients, the effective response was noted in 61.9 per cent, recovery, in 31.7 and improvement in 30.2. All of 35 cholinoceptive-negative patients (100 per cent) responded to the treatment: 77.1 per cent recovered, 22.9 per cent improved. Higher treatment response observed in cholinomimetic-negative patients could be explained by the fact that in the absence of hypersensitivity, i.e. in case of minimal "immaturity" of neuromuscular structures, it was much easier to recover the function of the bladder. And on the contrary, it was difficult to make the final prognosis for those with pronounced cholinoceptive hypersensitivity (positive tests) because of high possibility of therapeutically resistant patterns of disease. Thus, the efficacy on the treatment in children with hyper-reflex dysfunction of the urinary bladder was in inverse proportion to cholinoceptive hypersensitivity. Taking into account the currently absent methods of prognosis for therapeutic response of neurogenic dysfunctions of the urinary bladder the authors advised to use the M-cholinomimetic test for these purposes.

[Value of alpha adrenergic blocking agents in the complex treatment of hydronephrosis in children]. / Znachenie al' fa-adrenoblokatorov v kompleksnom lechenii gidronefroza u detei.

Results of a pharmacotest with phentolamine show that in hydronephrosis patients the amplitude of contractions of the ureter became 3 times greater, the tonometrical index was 2 times greater, the basic pressure became 2 times less. The including of adrenoblocking agents into the complex treatment of patients with functional obstruction of the ureteropelvic system facilitated considerable dilatation of the calyceal-pelvic system. Plastic operations were performed in 21 patients.

[Characteristics of the hydrodynamic situation in the urinary tract in vesico-ureteral reflux based on an analysis of a general type of equation of the linear transport model]. / Kharakteristika gidrodinamicheskoi situatsii v mochevykh putiakh pri puzyrno-mochetochnikovom refliukse na osnovanii analiza uravneniia obshchego vida lineinoi transportnoi modeli.

Upper urinary tract urodynamics are described through a linear deterministic chamber model. An analysis of possible urodynamic variants in vesico-ureteral reflux (VUR), using a mathematical model, has suggested that hydrodynamic situation in the refluxing ureter will be dependent on vesical and ureteral activity where ureterovesical incompetence and VUR are of similar grades. Where ureteral anatomy and function remain fairly intact, urinary regurgitation under high pressure shall be accompanied by the development of a considerable intraureteral hypertension. Besides, VUR-associated urodynamic disorder must have an obstructive component whose markedness will depend on the extent of arterial motor impairment, intravesical hypertension or a combination of the two. Urodynamic and radioisotopic studies have completely confirmed the theoretical postulations. In second- or third-degree VUR, for example, the highest intraureteral pressure developed in children with uninhibited bladder, while in fourth-degree VUR the bladder showed no response to gradual intravesical pressure rise. Urodynamic disturbance was already shown to have a functional/obstructive component in those cases of second-degree VUR where the bladder was uninhibited and be free of it in cases of normal bladder reflex and third-degree VUR.

[Immediate and late results of anti-reflux surgery in children]. / Blizhaishie i otdalennye rezul'taty antirefliuksnykh operatsii u detei.

Nearest and long-term results of 114 antireflux operations performed on 78 children were studied. Choice of the method of operative intervention, degree of ureterectasia on excretory urograms and functional state of the urinary bladder were shown to have an influence on results of antireflux operations. Best results were obtained following operations after Politano--Leadbetter and Kohen. Unsatisfactory results were mainly observed in III-IV degree ureterectasia and continuing dysfunction of the urinary bladder. Their amount was found to increase with longer terms of observations.

[Bilateral obstructive diseases of the upper urinary tract in children]. / Dvukhstoronnie obstruktivnye zabolevaniia verkhnikh mochevykh putei u detei.

The authors examined 371 children aged 4 days to 15 years with obstructive diseases of the urinary tract. In 51 out of them there was bilateral hydronephrosis and 54 had bilateral obstructive megaureter. A new uretero-pelvic anastomosis was made in 47 children with bilateral hydronephrosis, in 31 out of them it was created successively. Resection of the pelvis was performed in 5 cases. Principles of the stepwise operative treatment are described as well as indications to a plasty without drainage in hydronephrosis. Operations were performed on 46 patients (92 ureters) with obstructive megaureter, 8 patients were treated conservatively. The conservative treatment is thought by the authors to be expedient in patients with compensated disturbance of urodynamics of the upper urinary tracts in obstructive megaureter and the every year rentgen-urodynamic control. Ureterocystoneostomy is indicated only in a progressing course of the disease.