[Roadmap of ultrasound-guided percutaneous access to the renal collecting system].

INTRODUCTION: The key point of successful PCNL is getting access to the renal collecting system. Ureteral catheterization and injection of contrast material provide an important advantage of visualizing and dilating the collecting system. However, catheterization increases the operation time, exposure to anesthesia, and requires additional reusable and disposable medical supplies. The purpose of the study was to develop a surgical algorithm for accessing the renal collecting system for mini-PCNL without catheterization. MATERIALS AND METHODS: We analyzed the treatment results of 82 patients with a single kidney stone, who underwent mini-PCNL without prior catheterization of the ureter. The percutaneous access was obtained according to the roadmap we had developed. The puncture was performed under X-ray control and US guidance. For a calyx stone, the puncture was performed "to the stone". For a pelvis stone, the targeted calyx was accessed using the following algorithm where each next step was performed if the puncture had been impossible at the previous one: 1. 30 min before the operation: infusion load of normal saline, 1000 ml. 2. Intraoperatively: intravenous furosemide, 60 mg. 3. Puncture "to the pelvic stone", injecting contrast material into the collecting system and correcting the access puncture through the required calyx. RESULTS: In all 82 cases, puncture access was performed without ureteral catheterization. In 20 patients with calyceal stones, puncture onto a stone was successfully performed in 100% of the cases. Of 62 patients with pelvic stones, preliminary infusion was enough to allow a successful puncture in 49 (79%), access after intravenous administration of furosemide was obtained in 13 (21%), and a primary puncture onto a pelvic stone had to be done in 6 (10%) patients. CONCLUSIONS: Our proposed algorithm for accessing the PCS of the kidney was successfully used in 100% of the cases. It makes possible to avoid routine ureteral catheterization and thus reduce the overall operation time and the risk of complications, as well as save medical supplies. Clearly, such results require that the surgeon should have significant experience with puncture interventions under ultrasound control.

[Transurethral resection and buccal mucosal graft for the treatment of refractory bladder neck contracture].

Bladder neck contracture after prostate surgery is a rare but feared complication. The treatment of choice is endoscopic incision or resection of fibrotic tissue. In case of ineffective transurethral correction, bladder neck reconstruction has to be done. In this report, we present a complicated case treated with combined transurethral and laparoscopic bladder neck reconstruction with buccal mucosal graft inlay. Using retrograde endoscopy fibrotic tissue in the bladder neck was resected to achieve a smooth and wide prostate cavity. After that the laparoscopy performed. The retropubic space is created and prostatic urethra opened via longitudinal prostatic-vesical incision. Buccal mucosal graft was fixed in place. Bladder and prostatic urethra were closed with resorbable suture. Two weeks after surgery the urethral catheter was removed and adequate voiding reestablished. After eleven months patient had no urination complaints and any sings of recurrence. Thus, the combined surgical approach for bladder neck reconstruction using buccal mucosa inlay may be a durable option for treatment of recalcitrant bladder neck contracture.

Primary myxoid leiomyosarcoma of renal pelvis: Case report and literature review.

Leiomyosarcoma arising from renal pelvis is a very rare disease. A patient was admitted to hospital with left renal colic due to nephrolithiasis, with a filling defect in renal pelvis that was considered to be a blood clot. Diagnosis of leiomyosarcoma was made after visual inspection and biopsy of the exophytic lesion. Laparoscopic radical nephrectomy was performed, histological and immunohistochemical investigation confirmed leiomyosarcoma with mixomatoid component. No adjuvant treatment was performed, the patient remains healthy 5 years after surgery without recurrence. Herein we provide literature review, discussion of the diagnosis and treatment scenario of the patient with renal pelvis leiomyosarcoma.

[Multicenter randomized study of bovhyalu-ronidase azoximer (Longidaza) in men after transuretral resection of the prostate].

INTRODUCTION: Transurethral resection of the prostate (TURP) is the gold standard of BPH surgical treatment. It is of current interest to search for medications that can reduce the incidence of complications after TURP. AIM: To evaluate the efficiency of Longidaza (rectal suppositories of 3000 IU) as part of combined therapy in order to prevent complications after TURP. MATERIALS AND METHODS: The study included 202 patients who underwent TURP in 3 hospitals. The patients were divided into 2 groups: main group - 96 men taking standard postoperative therapy with Longidaza rectal suppositories N 20; control group - 106 men - taking standard postoperative therapy (tamsulosin 30 days; fluoroquinolone 5 days). Follow-up included IPSS, urinalysis, urine culture, ultrasound examination of the prostate volume (PV), post void residual urine, uroflowmetry at 1,2,3,6 months after surgery. Average preoperative indices: IPSS 27 [23; 30], Qol 5 [4; 6], prostate volume (PV) 71+/-19cc (30-272 c), Qmax 7.5+/-2.5ml/s (1,3-18,7 ml/s). RESULTS: There was a significant improvement in IPSS, QoL, Qmax, PV, post void residual urine (PVR) compared to preoperative values during the entire observation period. There was no statistical difference between the main and control groups for these indexes in 6 months. In the main group had statistically lower incidence of bacteriuria at 3 (11% vs 17%) and 6 months (7% vs 17%), and leukocyturia at 3 (31% vs 46%) and 6 months of follow-up (20% vs 44%). Overall incidence of infectious complications and additional antibacterial drugs prescription was lower in the Longidaza group compared to the control group (17,7% vs 20,7%). Urethral strictures developed in 7 men in the main group, and 8 in the control group. CONCLUSION: Our results show that prescription of Longidaza significantly reduces the incidence of leukocyturia and bacteriuria postoperatively, decreasing the rate of infectious complications in men after TURP.

[Ultrasound indicators of the prostate, urinary bladder and uroflowmetry parameters in the diagnosis of infravesical obstruction in men with benign prostatic hyperplasia].

RELEVANCE: Benign prostatic hyperplasia (BPH) is one of the most common urologic diseases of males. In patients who failed drug therapy of lower urinary tract symptoms (LUTS) caused by BPH, the most important indication for surgery is the presence of infravesical obstruction (IVO). IVO is detected by pressure-flow studies and is characterized by high detrusor pressure with decreased urinary flow rate. The invasiveness and high cost of this investigation has stimulated a search for non-invasive techniques that could reliably characterize the presence of IVO secondary to BPH. AIM: To determine the value of ultrasound indicators of the prostate, urinary bladder and uroflowmetry parameters in the diagnosis of IVO in men with BPH. MATERIALS AND METHODS: Seventy-six men with moderate and severe LUTS secondary to BPH underwent a comprehensive urological examination, including a clinical history, digital rectal examination, International Prostate Symptom Score (I-PSS), serum prostate-specific antigen (PSA), various ultrasound indicators of the prostate and urinary bladder, uroflowmetry and a pressure/flow study. RESULTS: Infravesical obstruction (IVO) was detected in 73.1% of men with BPH. IVO was found to have the strongest correlation with ultrasound signs of the intravesical prostatic protrusion (IPP, r = 0,667, p <0,05) compared with the prostate volume, prostate transition zone volume, prostate transition zone index, prostatic urethral angle, urethral length of the transition zone, estimated prostate circumference, prostate peripheral zone thickness, residual urine volume, weight of urinary bladder, the thickness of the detrusor, maximum and average urine flow rates and I-PSS score. The incidence of IVO increased in parallel with the increase of IPP. We established a cut-off value for IPP of 10 mm for the diagnosis of IVO with a sensitivity of 68.2%, a specificity of 100%, a positive predictive value of 100%, and a negative predictive value of 53.3%. CONCLUSION: The ultrasound findings of IPP measuring more than 10 mm strongly correlates with the IVO in men with LUTS and BPH as compared with other ultrasound parameters of the prostate, urinary bladder and urinary flow rates. The IPP is anatomical parameter that do not require urination, and is easily detected by both transabdominal and transrectal ultrasound. However, at the PPI values less than 10 mm, the main method for detecting IVO remains the pressure/ flow study.

[Intravesical prostatic protrusion in diagnosing infravesical obstruction in men with benign prostatic hyperplasia].

Infravesical obstruction (IVO) is an important characteristic of the functional state of male lower urinary tract. It is believed that IVO confirmed by pressure-flow study findings warrants switching from a medical to surgical management of lower urinary tract symptoms (LUTS). Intravesical prostatic protrusion (IPP) is a new indicator for detecting IVO secondary to benign prostatic hyperplasia (BPH). This indicator has several advantages over other non-invasive methods for evaluating IVO. The initial findings on the relationship between IPP and IVO suggest the feasibility of its clinical use as a screening tool in men with obstructive voiding symptoms.

[Transabdominal and transrectal ultrasound assessment of intravesical prostatic protrusion].

RELEVANCE: Benign prostatic hyperplasia (BPH) is one of the most common urological diseases among men. Despite the noticeable positive effects of pharmacotherapy on the quality of urination in BPH, the presence of an intravesical obstruction (IVO) leads to discontinuation of conservative treatment in favor of surgical interventions. One of the features of prostate enlargement is the degree of its intravesical growth (intravascular prostatic protrusion, IPP). According to some studies, IPP value of 10 mm or more is indicative of IVO in virtually all men. AIM: To compare transabdominal and transrectal ultrasound measurement of IPP in men with BPH. MATERIALS AND METHODS: The study comprised 108 men aged 69+/-10 years (43 to 93 years) with lower urinary tract symptoms and BPH. Patients underwent a standard urological examination. The shape of the prostate, prostate volume and the measurements of the IPP were assessed using transabdominal and transrectal ultrasound. RESULTS: The IPP measurements obtained using transabdominal and transrectal ultrasound were 9.8+/-5.7 mm (1.1 to 28 mm) and 9.3+/-5.3 mm (0.5 to 26 mm), respectively. The IPP measurements evaluated by transabdominal and transrectal ultrasound were found comparable regardless of the prostate volume. CONCLUSION: Similar results in assessing PPI by both ultrasound modalities allow them to be used equally effectively.

Effect of Preliminary Injection of Bone Marrow Cell Total RNA on Erythropoiesis Recovery Dynamics in Rats Exposed to an Acute γ-Irradiation.

Total RNA from the bone marrow of healthy donor rats was injected to experimental rats 6 h, 2 h, or 30 min prior to a single γ-irradiation in the sublethal dose of 6 Gy. Injection total RNA 30 min prior to the exposure most effectively restored erythropoiesis in experimental animals. In 5 days, reticulocyte count in these animals 30-fold surpassed the control (injection of 0.9% NaCl). In 12 days, the content of new erythroblastic islands in the bone marrow in rats injected with the total RNA 2 h or 30 min prior to irradiation increased significantly and erythropoiesis recovery activation was observed.

Dynamics of Erythropoiesis in Erythroblastic Islands in the Bone Marrow in Experimental Benzene-Induced Anemia.

In 14 days after triple subcutaneous injection of benzene to rats in a dose of 0.05 ml/100 g body weight, the number of erythroblastic islands in the bone marrow 2-fold decreased, de novo erythropoiesis ceased, de repeto erythropoiesis slowed down, and the number of lymphoid cells contacting with erythroblastic islands decreased. By day 56 of the experiment, proliferation of erythroid cells in the bone marrow start to recover due to erythropoiesis reconstitution, but the number of reticulocytes in the blood remained low. Analysis of phagocytic ability of macrophages in the erythroblastic islands showed that the intensity of phagocytosis of latex particles in mature islands decreased, which could affect denucleation of oxyphilic erythroblasts.

[INFLUENCE OF TOTAL RNA SPLENIC LYMPHOID CELLS ON ERYTHROPOIESIS IN EXPERIMENTAL POLYCYTHEMIA].

Total RNA, isolated from rat spleen's lymphoid cells during the period of hematopoietic tissue's reparative regeneration, has a remarkable activating effect on the processes of erythroblastic islet formation in vivo and in vitro. Total RNA, isolated from normal rat spleen's lymphoid cells, restores depressed erythropoiesis in erythroblastic islets up to physiological level.

[THE MODERN PROSPECT FOR CITRATE MIXTURES IN THE TREATMENT OF UROLITHIASIS].

The authors present a review of literature on the use of litholytic citrate medications for conservative management of urolithiasis. Urate urolithiasis is the most common clinical condition encountered by urologists. Citrate agents, in particular Blemaren, not only may be employed in a conservative therapy of uric acid stones, but can also be successfully used in the treatment of the calcium urolithiasis, i.e. mixed composition stones, which is supported by current international urology guidelines.

[Stating the need of surgical treatment of the infiltrative lung tuberculosis].

To reveal predictors of demand formation in phthisiosurgical care during standard treatment of infiltrative pulmonary tuberculosis. Clinical, radiological, laboratory and psychological examination of 103 patients with new-onset infiltrative pulmonary tuberculosis in exsolved phase (ICD-10 A15. and A16.) before standard therapy were done. All patients were divided into two groups (with indications to phthisiosurgical treatment and without indications to transthoracic operation) based on prospective 12-months follow-up results. Predictors of demand formation in phthisiosurgical care were revealed based on results of intergroup comparison and stepwise logistic regression. It was established that demand formation in phthisiosurgical care during conservative treatment of infiltrative pulmonary tuberculosis linked with M. tuberculosis presence in sputum and relative increasing sizes of tuberculous infiltrates, content of erythrocytes in blood, thymol test, atherogenic index and circulating ceruleoplasmin concentration at a time when depressive soreness and asthenia relatively decreased. Integrate algorithm of demand in phthisiosurgical care prognosis was formed by dint of stepwise logistic regression. This algorithm is based on consideration of integrated index of clinical symptoms severity, hidrosis, number of destruction in tuberculous infiltrate and its sizes, HDL concentration, total protein and serum beta-globuline percentage. Algorithm formed with logistic regression offers the possibility to make a prognosis of demand in phthisiosurgical care with 72,7% responsiveness and 80% specificity.

[Predictors of the closure of tuberculosis infiltrate decay cavities during the conservative treatment of infiltrative tuberculosis].

We studied predictors of the closure of tuberculosis infiltrate decay cavities (DC) in the affected regions in patients with infiltrative lung tuberculosis (ILT) by clinical examination. X-ray laboratory and psychological methods 103 patients were under observation for 12 months and received standard therapy. The closure was achieved during the first 4 months in 74 patients but did not occur in 29 ones. Logistic regression analysis showed that the probability of DC closure in the first 4 months decreases in parallel to the initial character of complaints of "chest pain", the size of tuberculosis infiltrates determined in X-ray study, results of thymol test, content of lipid peroxides in expirates, depressive "fatigue" and "suicidal thoughts". The probability of DC cavity during 4 months increased with the initial "number of destructions" in the infiltrate (by X-ray) and depressive "loss of working ability". Results of regression analysis permit to predict the closure of DC during the first 4 months with sensitivity 98.3% and specificity 82.4%.

[Predictors of the inefficiency of combination treatment in patients with infiltrative pulmonary tuberculosis].

AIM: To reveal the predictors of inefficiency of combination treatment in patients with infiltrative pulmonary tuberculosis (IPT). SUBJECTS AND METHODS: One hundred and three patients with new-onset IPT underwent a complex clinical, radiological, laboratory and psychological examination before treatment. The findings were compared with the results of combination treatment for IPT within a year after the initiation of therapy. RESULTS: The standard treatment regimens was ascertained to cause no clinical recovery in 6.8% of the patients who were characterized by the baseline excretion of M. tuberculosis and sputum in 100% of cases, by the highest X-ray and clinical manifestations of IPT with simultaneously evolving leukocytosis, increased erythrocyte sedimentation rate (ESR), elevated serum ceruloplasmin and enzyme markers of cholestasis, depressive fatigability, weight loss, and a worsening quality of life because of pain. Discriminant analysis yielded an algorithm for predicting the inefficiency of standard treatment for IPT, which was based on the integrative evaluation of thoracic pain, ESR, circulating ceruloplasmin levels, gamma-glutamyl transpeptidase and alkaline phosphatase activities in the serum. CONCLUSION: It has been demonstrated that the inefficiency of IPT therapy may be predicted from the data of a complex clinical, hematological, and biochemical examination of patients before therapy.

[Compliance predictors of patients with pulmonary tuberculosis needing phthisiological treatment].

The factors predicting initial readiness of patients with infiltrative pulmonary tuberculosis to give their consent to transthoracic interventions were investigated. It was shown that initial readiness of patients to give their consent to phthisiological treatment directly depended on the indices of "social functioning" and lymphocyte percentage in leukogram. The total prognosis algorithm with 94.1% sensitivity and 75% specificity is presented as discriminative function estimated by "social functioning" data, lymphocyte percentage in leukogram and ordinal evaluation of complaints to sweating.

[Prediction of infiltrative pulmonary tuberculosis outcomes depending on the procedure of its detection and on the manifestation of clinical and x-ray symptoms].

The possibility of predicting the outcomes of infiltrative pulmonary tuberculosis (IPT) depending on the procedure of its detection and on the manifestations of clinical and X-ray symptoms has been assessed. The severity of clinical symptoms of IPT is shown to be much higher in patients who actively seek medical aid than that in patients identified at planned fluorographic study. Actively seeking medical aid and the high baseline degree of clinical and X-ray manifestations have been found to be significant predictors of a good response to combined drug therapy for IPT with the clinical recovery being achieved in patients, the minor residual (posttuberculosis) changes developed in the lung, and the decreased need for surgical treatment for IPT.

[Predictors of bacterial excretion in patients with infiltrative pulmonary tuberculosis].

An association of bacterial excretion with the magnitude of the X-ray and clinical symptoms of infiltrative pulmonary tuberculosis, with the intensity of concomitant anxiety-depression disorders and the results of complex laboratory peripheral blood tests was studied in 100 patients with this condition. The fact that M. tuberculosis was present in the sputum was shown to be linked to the significant increase in the size of tuberculous infiltrates, the extent of decay in the latter, their connection with the root of the lung, the spread of excretion foci, and the intensity of cough and bloody expectoration. The similar trend was demonstrated in the degree of situational anxiety, depressive indecision, and pessimism, as well as in the values of leukocytosis and erythrocyte sedimentation rate. The predictive informative value of a set of findings is illustrated by the discriminant function equation that allows the correct prediction of bacterial excretion in 76.8% of cases.

[The values of the lipid peroxidation-antioxidative defense system as predictors of the poor course of infiltrative pulmonary tuberculosis].

The authors have studied whether an indirect clinical-and-laboratory assessment of the extent of a destructive process in the tuberculous infiltrates and that of concomitant pleural affection can be made from the values of the lipid peroxidation-antioxidative defense (PLO-AOD) system in the blood of patients with infiltrative pulmonary tuberculosis (IPT). Regression analysis has indicated that PLO-AOD values significantly reflect the extent of X-ray verified destructions in the tuberculous infiltrates, concomitant pleural involvements, the specific features of immunity of patients with IPT. The neural network technology used to analyze the baseline PLO-AOD values has been ascertained to permit a reliable prognosis of decay cavity closure 4 months after the initiation of medical treatment and of a need for surgical treatment for IPT.