[Continent heterotopic derivation of urine in a partially isolated segment of the sigmoid intestine after cystprostatectomy].

From 1992 to 2006 cystprostatectomy with continent heterotopic urine derivation in a partially isolated segment of the sigmoid intestine was made in 37 males aged 39-78 years. The patients had the following tumor stages: 2 patients with T2NXM0, 20 patients with T3NXM0, 6 patients with T3N1M0, 9 patients with T3-4N1MX. Thirty patients (81%) had no complications in an early postoperative period, 7 (19%) had complications: purulent pyelonephritis (n = 2), wound suppuration (n = 3), intestinal eventration (n = 1), interintestinal abscess (n = 1). There were two lethal outcomes early after operation: one patient died of bilateral purulent pyelonephritis and the other one--of acute cardiac failure. For 3 years 27 (77%) of 35 patients had satisfactory quality of life. Thus, urine derivation by simple methods one of which is creation of a partially isolated reservoir from a sigmoid segment with transanal urine derivation is indicated after cystprostatectomy for elderly males with a high risk of postoperative complications and lethality (stage T2-T3NXMX) and unclear distant metastases.

[Choice of surgery in the treatment of recurrent varicocele].

The article presents the results of examination and surgical treatment of 48 patients with varicocele recurrence after Ivanisevich operations. Ultrasound dopplerography revealed principal causes of the recurrences: unperformed ligation of vein-satellites, undetected renospermatic reflux with hypertension in the renal vein, undetected ileospermatic or mixed reflux. Depending on the detected hemodynamic disorders, we made microsurgical ligation of veins-satellites, created proximal vein-veinous testiculosafic or distal testiculosafic anastomoses with good clinical results and correction of pathospermia. Ultrasound dopplerographic control of anastomoses after 1 year of their creation showed satisfactory function of anastomoses in 80.1% cases. Thus, choice of surgical method in varicocele recurrence must be based on assessment of hemodynamic disorders in the territory of genital veins.

[Sildenafil citrate in diagnosis of erectile dysfunction].

We examined 86 patients: 24 with functional and 62 with organic erectile dysfunction (EDF). In functional EDF, sildenafil citrate (SC) in a dose 25-50 mg or intracavernous injection of 2% solution of papaverin always resulted in satisfactory erection. In EDF, SC, papaverin injection and LOD test results were compared. Morphological examinations of cavernous tissue and tunical albuginea of the penis. Correlations were found between clinical findings, results of SC and intracavernous papaverin solution administration, LOD-test, morphological evidence. This provides objective data for classification of EDF into three stages (I, II and III). Stages I and II were defined as compensated, stage III--as a decompensated stage of organic erectile dysfunction. SC has some advantages over other tests, therefore it is recommended as a monomethod for diagnosis of functional forms, indirect staging of organic EDF.

[Choice of surgical method in the treatment of varicocele]. / Vybor metoda operativnogo lecheniia varikotsele.

The data are presented on 788 patients with varicocele and impairment of spermatogenesis. All the patients were divided into two groups. Group 1 consisted of 240 patients not examined with ultrasound dopplerography who had undergone Ivanissevich operation with estimation of spermatogenesis before and 12 months after the operation. Improvement on the spermatograms was observed in 167 of 227 (73%) patients. Group 2 consisted of 548 patients. Hemodynamic alterations were examined in 342 (62.4%). After this examination they were operated by Ivanissevich. Improvement of spertmatogenesis was achieved in 285 (90.4%) patients. Sapheno-testicular intervenous anastomoses were established in 183 patients. 168 (92%) of them improved spermatogenesis. Recurrences were detected in 19 (8%) and 10 (5.4%) patients of groups 1 and 2, respectively. The above treatment policy promoted recovery of sperm fertility in operated patients and makes recurrences less frequent.

[Operative treatment of complications caused by intracavernous administration of "Interfal" gel]. / Operativnoe lechenie oslzhnenii, vyzvannykh intrakavernoznym vvedeniem gelia "interfal".

The authors have operated 5 men for complications after introduction of gel "interfal" into cavernous bodies of the penis. The removal of the gel was accompanied with incomplete intracavernous prosthesis of the penis by M. N. Zilberman. A satisfactory functional result was achieved in 3 patients. Postoperative purulent cavernitis required removal of the prostheses in 2 men. Individual approaches to the treatment are recommended. The use of gel "interfal" must not be permitted for treatment of erectile dysfunction.

[Doppler ultrasonography of penile vessels in combination with various methods of erectile stimulation in diagnosis of erectile dysfunction]. / Ul'trazvukovaia dopplerografiia sosudov polovogo chlena v sochetanii s razlichnymi sposobami stimuliatsii érektsii v diagnostike érektil'noi disfunktsii.

Ultrasonic dopplerographic investigation (Ultramark-9, USA) was made in 227 males. 50 males with normal erection served controls. Stimulation of erection with an individual LOD-device is a low-invasive, convenient to standardize technique in ultrasonic dopplerographic examination of penile vessels for diagnosis of erectile dysfunction. Erection stimulation by different methods in the same patient during penile vessel dopplerography raises diagnostic value of this method.

[Surgical treatment of erectile dysfunction in Peyronie's disease]. / Operativnoe lechenie érektil'noi disfunktsii pri bolezni Peironi.

Methods of surgical treatment of fibroplastic induration of the penis are briefly reviewed. Supplements to classification of Peyronie's disease are proposed regarding the degree of erectile dysfunction and the angle of the penis deformity in erection. The authors analyse the results of operations performed from 1987 to 2000: Nesbit's operation (n = 13), intracavernous penis prosthesis (n = 48), dissection of the fibrous plaque, the defect repair with preserved dura mater followed by intracavernous prosthesis (n = 10). Indications for various surgical procedures in Peyronie's disease are described.

[The indications for operations on the penile veins in venogenic erectile impotence]. / O pokazaniiakh k operatsiiam na venakh polovogo chelna pri venozno-obuslovlennoi érektil'noi impotentsii.

Unsatisfactory results of surgical management of venous erectile failure are attributed to difficult selection of relevant patients. The operation is to be performed in patients with isolated distal venous outflow. The diagnosis of occult proximal or mixed outflow may be made at dynamic cavernosography with loading test on the device for stimulation of erection. After obtaining the erection and removal of the constriction ring, distal venous outflow is blocked, thus creating the conditions for detection of occult proximal venous outflow. Surgical treatment (ligation of the dorsal vein or its insertion under tunica albuginea) is indicated only for patients free of mixed venous outflow.

[A device for stimulating erection in the combined treatment of erectile insufficiency]. / Ustroistvo dlia stimuliatsii érektsii v kompleksnom lechenii érektil'noi nedostatochnosti.

A device operating by the principle of local negative pressure has been developed and patented in Russia. Its trial in 122 patients with erectile insufficiency in combination with conservative treatment showed that positive effect may be reached in patients subjected to partial intracavernous restorative surgery of the penis with unsatisfactory outcome.