[Renal function after surgical treatment of stag-horned nephrolithiasis].

Renal function in patients with stag-horn nephrolithiasis was assessed after two surgical treatments--percutaneous nephrolitholapaxy (PCN L) and pyelonephrolithotomy. The function of the operated and contralateral kidneys was studied early and late after operation by parameters of blood biochemistry, Doppler investigation of renal parenchyma, dynamic nephroscintigraphy. Stabilization or improvement of blood biochemical indices was observed in 58 (70%) patients. A secretory renal function late after surgery (from 6 months to 2 years) evidenced for improvement or stabilization of renal function (according to radionuclide test) in 71 (85.5%) patients. Integral parameters of renal blood flow were physiological or improved versus preoperative ones. PCNL was made in patients with deficient secretion less than 70%, 35 (87.5%) patients were diagnosed to have stabilization or functional improvement. After open intervention functional improvement took place in 11 (25.6%) patients, stabilization of renal function occurred in 25 (58.1%) patients. Tubular secretion deterioration was seen much more frequently in patients after open intervention. PCNL is less invasive surgical intervention than pyelonephrolithotomy as this technique produces milder surgical trauma and does not result in intraoperative renal ischemia. PCNL is the most effective surgical modality in stag-horn concrements of the kidneys and significantly expands potential of low-invasive treatment of such patients.

[Reproductive function in chronic abacterial prostatitis patients].

The results of examination of 325 patients with chronic abacterial prostatitis, varicocele showed marked changes in ejaculate parameters of these patients. Prostatitis of different duration in the same degree causes pathozoospermia, reduces ejaculate fertility. Such condition of spermatogenesis indicates involvement of other sex organs suggested by the literature data and previous experience. This necessitates extended diagnostic examination of patients with chronic prostatitis.

[Varicocele in children and adolescents]. / Varikotsele u detei i podroskov.

We made examinations (physical, clinical and laboratory) of 301 senior children and adolescents with varicocele admitted to Research Institute of Urology for the last 5 years. Spermatogenesis was assessed by WHO criteria for healthy men. 78% of the patients were operated by Ivanissevich, 22% received sclerotherapy. Sperm motility and morphological parameters were found subnormal. Taking into consideration relative subfertility of the patients, surgical results were positive. We continue follow-up of the patients and plan further studies of spermatogenesis.

[Percutaneous intrarenal ultrasonography]. / Perkutannaia intrarenal'naia ul'trasonografiia.

In vivo and in vitro experiments were made to study percutaneous intrarenal ultrasonography (PIU). The transurethral ultrasonic probe (5.5 MHz, 1850 "Bruel&Kjer, Denmark) was inserted through the nephrostomic fistula in the dilated pelvis with the tubus of the nephroscope K. Storz 27093B. Scanning of the cavitary renal system and ureteropelvic zone was conducted by moving the probe in the longitudinal and transverse directions. The experiment on 21 removed kidneys investigated potentialities of PIU in hydronephrotic transformation caused by ureteropelvic stricture (4 kidneys), urolithiasis (7 kidneys), carcinoma of renal parenchyma (5 kidneys), pelvic cancer (1 kidney), combined renal cell and epithelial renal carcinoma (1 kidney); in pyonephrosis (1 kidney) and contracted kidney (2 kidneys). 43 patients (19 males and 24 females aged 7 to 63 years) have undergone PIU in the course of percutaneous nephrolithotripsy (n = 23), percutaneous endopyelotomy (n = 15) and percutaneous endoresection of solitary renal cyst (n = 5). PIU accurately localizes residual and x-ray-negative concrement fragments raising the effectiveness of percutaneous nephrolithotripsy, precisely differentiates internal renal structures, visualizes pelvic wall, vessels and tissues of the renal sinus, provides additional information about ureteropelvic zone and its changes. PIU can find wide application in intraoperative diagnosis of different renal and upper urinary tract diseases.

[Treatment of solitary renal cysts in children]. / Lechenie prostykh kist pochek u detei.

The authors formulate therapeutic policy basing on clinical, ultrasound and parenchymal morphological studies in 34 children with solitary renal cysts. Operative intervention is indicated in renal function decline manifesting with enlargement of the cyst and reduction of the cystic-renal coefficient. The kind of the operation is decided by location of the cyst and its characteristics obtained at radiodiagnosis. In slow growth of the cyst and no further decline in its function the patients should be followed up as a risk group.

[The diagnosis of vesicopelvic reflux in pregnant women]. / Diagnostika puzyrno-lokhanochnogo refliuksa u beremennykh.

The diagnosis of vesicopelvic reflux (VPR) in pregnancy is not a simple task because of the requirements of noninvasiveness, safety, minimum radiation load, informative value. The authors suggest urinalysis and ultrasound (US) investigation as VPR screening tests in pregnancy. US VPR diagnosis meets the requirements of a screening method, has the advantages of a high VPR detection capacity, noninvasiveness, feasibility of further US monitoring, simultaneous study of the urological and obstetric status. High frequency of pre- and postnatal urinary reflux, the gape of the ureteral ostia as indirect signals of VPR in pregnant patients suggest that VPR may be characteristic of pregnancy, specific "pregnancy phenomenon". The authors provide US VPR classification the stages of which are usable in VPR and its complications prophylaxis.

[State of the reproductive system of men who participated in the cleaning-up of aftereffects of the Chernobyl AES accident]. / Sostoianie zhelez reproduktivnoi sistemy u muzhchin, uchastvovavshikh v likvidatsii posledstvii avarii na Chernobyl'skoi AES.

A total of 164 males aged from 22 to 50, who had taken part in liquidating the consequences of Chernobyl power station accident, was examined. According to the military cards irradiation dose did not exceed 25 cGy. Semen of 125 examinees was studied. One third of examinees showed sexual dysfunction, which did not appear to depend on the irradiation dose. Analyses revealed pathologic changes in semen and ultrasound demonstrated alterations in prostate and seminal vesicles similar to chronic prostatitis and vesiculitis. No typical radiation-induced lesions were discovered. The author suggest assigning infertility and impotence to the list of entitles, which occurred and exacerbated due to liquidating the consequences of Chernobyl power station accident.

[Ultrasonic study of the parathyroid glands in patients with coralliform nephrolithiasis]. / Ul'trazvukovoe issledovanie okoloshchitovidnykh zhelez u bol'nykh s korallovidnym nefrolitiazom.

Functional activity of the parathyroid glands (PTG) is important for the choice of proper therapeutic policy in patients with dendritic nephrolithiasis. The location of the hyperfunctioning gland (usually adenomatously or hyperplastically changed) is a complicated problem as the dimensions of the gland are extremely small. Ultrasonic investigation of the parathyroid gland area for detection of the enlarged gland is used at the Research Institute of Urology, the RSFSR Ministry of Health. Linear (7.5 mHz) and sector (5 mHz) transducers have been used through the water medium and by the immediate contact with the surface of the patient's neck. A total of 24 subjects were enrolled in the study (13 females and 11 males aged 23-64 years). Enlarged parathyroid glands situated in the lower thyroid lobe (low parathyroid glands) or in the upper medial third of the thyroid lobe (upper parathyroid glands) were recorded in 9 patients and confirmed in the course of surgeries. In one case, the enlarged parathyroid gland was found in the thyroid tissue. Its length varied from 0.6 to 1.5 cm and its thickness, from 0.4 to 0.9 cm. All the glands were echographically evidenced as oval formations with a low-rate echogeneity and clear-cut smooth contours. In 3 cases the site of the gland was confirmed by a selective testing of the neck venous blood for parathyroid hormone. Histological examination of the removed glands revealed that hyperplastic changes were more common than the adenomatous ones.

[Ultrasonic examination in the diagnosis of closed trauma to the kidney]. / Ul'trazvukovoe issledovanie v diagnostike zakrytoi travmy pochki.

Ultrasonic investigations (USI) were used in the diagnosis of closed renal injuries in 59 patients (51 males and 8 females) aged from 17 to 65 years. The lesion of the right kidney was diagnosed in 35 (59.3 per cent) patients, the left kidney was affected in 24 (40.7 per cent) of examinees. In 2 persons the injury of the kidney was combined with the lesion of the urinary bladder. According to USI results, the patients with suspected closed trauma were enrolled in 4 groups: persons with an intact renal parenchyma, fibrous capsula and pelvicaliceal renal system (the contusion of the kidney); persons with normal ultrasonic picture of the kidney and the presence of intermuscular hematoma; those with subcapsular hepatoma; and those with pararenal hematoma. USI technique turned to be high-informative in the diagnosis of the occult renal injuries and permitted evaluating the structure of the kidney, the character and degree of the lesion and following up the status of the compromised organ during the conservative treatment.

[Local vibrotherapy of patients following telelithotripsy]. / Lokal'naia vibroterapiia u bol'nykh posle distantsionnoi litotripsii.

Trying to solve an actual problem of enhancing the spontaneous passage of fragments, "calculous trails" and gravel in the patients who underwent remote lithotripsy the authors used the technique of local vibrotherapy in 54 postoperative patients. The technique employed two unique vibrators; lumbar and manual, and the frequencies close to the resonance frequency of the upper urinary tracts. Spontaneous passage of the fragments and "calculous trails" within 30 days was recorded in 48 (89 per cent) of the patients and in 4 (19 per cent) patients out of 21 controls. Postponed local vibrotherapy, the size of the fragments exceeding 1 cm, pelvic dilatation of a compromised kidney exceeding 2 cm were prognostically unfavourable conditions. Therefore, the authors came to the conclusion that in patients with fragments sized more than 1 cm, fragment-induced ureteral obstruction of more than 0.8 cm resulting in pelvic dilatation of more than 2 cm, as well as in those whose "calculous trails" consisted of large (0.8 cm) fragments causing ureterohydronephrosis, a repeat remote lithotripsy was indicated. The use of local vibrotherapy in combination with phytotherapeutic agent, nierone in particular, was found to be the most beneficial treatment. Advantage of local vibrotherapy versus the general one was emphasized as was the possibility of its employment both on inpatient and outpatient bases and, in perspective, at home. A favourable combination of local vibrotherapy with other techniques of nephroureterolithiasis conservative treatment advocates for the advisability of its wider implementation into the urological practice.