[The results of prostatic adenomectomy in patients with severe concomitant diseases]. / Rezul'taty adenoméktomii predstatel'noi zhelezy u bol'nykh s tiazhelymi soputstvuiushchimi zabolevaniiami.

Immediate and long-term results of prostate adenomectomy were studied in 1549 patients, 322 of whom being of old age. In 1499 (96.8%) patients concomitant diseases were revealed: ischemic heart disease (934 patients), cardiosclerosis after 1-3 myocardial infarction (185), hemiparesis after acute cerebrovascular disturbances (74), diabetes mellitus (88), chronic lymphoid leukemia (5), cirrhosis of the liver (15), cancer (22) and true diverticula (15) of the urine bladder, drug-related polyallergy (16). 628 patients were radically operated in conditions of circulatory insufficiency of stage I-II. In 631 (40.7%) patients surgical intervention was carried out as urgent because of acute dysuria (hampering of urination) or to bleeding from tumor. Transvesical adenomectomy was carried out with hemostasis by 2 semipouch string removable sutures. In 89.5% of patients uncomplicated course of postoperative period was observed. Postoperative lethality in patients with concomitant diseases made up 3.2%. Causes of death were postinfarction cardiosclerosis (6.5%), after-effect of cerebrovascular stroke (5.4%), diabetes mellitus (5.7%), cirrhosis of the liver (6.7%). 6 months to 11 years after the operation 91.2% of the patients achieved good follow-up functional results of surgical treatment, in majority of the patients medical and social rehabilitation was observed.

[Sexual readaptation after the surgical treatment of benign prostatic hyperplasia]. / Seksual'naia readaptatsiia posle operativnogo lecheniia dobrokachestvennoi giperplazii prostaty.

Sexual function was studied in 818 patients with benign prostatic hyperplasia (BPH) before and after surgical treatment of this disease. Before surgery, sexual activity was absent in 276 examinees. After surgery 4.3% of them retained erection, 95.7% remained impotent. 542 patients before operations were sexually active. Surgical treatment of BPH (transurethral resection, transvesical adenomectomy) creates grounds for deterioration of sexual function and risk of erection loss. Thus, 77 operated patients had no erection, 176 had weak libido, 159--insufficient erection, 244 retrograde ejaculation, 188 painful orgasm. Transurethral resection led to a complete loss of copulative function in 5.3% of patients, transvesical adenomectomy--in 9.9%. Sexual readaptation after transurethral resection and transvesical adenomectomy has been improved due to a special complex developed by the authors. This complex consists of 14 therapeutic and prophylactic procedures.

[The effect of meteorological factors on the incidence of acute urinary retention]. / Vliianie meteorologicheskikh faktorov na chastotu ostroi zaderzhki mocheispuskaniia.

The implication of meteorological factors in the incidence of acute urinary retention (AUR) were studied in prostatic adenoma patients. The trial was performed in the city of Perm (population 1.1 million) situated in the temperate zone with continental climate. The only center for emergency urological aid registered all AUR cases observed in the city throughout 1980-1990. All 1504 episodes of AUR were recorded with reference to meteorological conditions on the day of admission (temperature, atmospheric pressure, etc.). The original data obtained after mathematical processing of the material indicate that AUR frequency goes up in day-to-day temperature fluctuations (5 degrees C and more), changes in atmospheric pressure (9 GPa and more) and in humidity (20% or more); in moderate and strong winds, cloudy wet weather, thunder storms. A complex of general and pharmacological measures is proposed to prevent AUR episodes in patients with prostatic adenoma.

[Cyproterone acetate (Androcur-depo) in the treatment of inoperable prostatic cancer]. / Atsetat tsiproterona (Androkur-depo) v lechenii neoperabel'nogo raka predstatel'noi zhelezy.

The authors consider fundamentals of hormone therapy in prostate cancer, mechanism of long-term androgenic stimulation, detail mechanism of action of antiandrogen (ciproteron acetate-androcur) on the basis of discovered key role of cellular receptor in endocrine regulation of physiological functions in metabolism. Monotherapy with androcur-depo (300 mg once a week) was given to 24 patients with prostatic cancer stage T2-T4. Eight patients had metastases to the bones. The age of the patients ranged from 58 to 80 years. Alleviation of pain, reduction of the prostate size and density, positive uroflowmetric changes (maximal urination rate increased from 2-5 to 10-15 ml/s), residual urine fall occurred as early as treatment week 5-7. There was also a decrease in the activity of acid phosphotase from 5-10 to 0.3-0.8 units according to Bodansky. Serum level of prostate-specific antigen (PSA) dropped from 388-23 to 116-4 ng/ml. Androcur-depo monotherapy demonstrated high efficacy in the treatment of local prostatic cancer.

[Phytoperfusion of the bladder after adenomectomy]. / Fitoperfuziia mochevogo puzyria posle adenoméktomii.

For continuous irrigation of the bladder after prostatic adenomectomy herb infusion (Urtica dioica L. 12-15 g/l, Hypericum perforatum L. 8-12 g/l. Marticaria recutita L. 8-10 g/l, folia Plantaginis majoris 7-10 g/l, Herba Millefolii 4-6 g/l, folia Betula 3-5 g/l. Artemisia vulgaris L. 1-2 g/l, folia Fragaria vesca 3-4 g/l, water 11 maximum) was dripped through a thin suprapubic and urethral drainages. Such phytoperfusion of the urinary bladder used in 22 patients reduced postoperative blood loss, bacteriuria, prevented hemorrhagic and purulent inflammation following adenomectomy. Side systemic effects were not reported.

[Prostatic adenomectomy in patients with a history of myocardial infarct, acute cerebral circulatory disorder and pulmonary thromboembolism]. / Adenoméktomiia predstatel'noi zhelezy u bol'nykh, perenesshikh infarkt miokarda, ostroe narushenie mozgovogo krovoobrashcheniia i tromboémboliiu legochnoi arterii.

Immediate and long-term outcomes of adenomectomy have been analyzed for patients with prostatic adenoma with a history of 1-3 myocardial infarctions (185 subjects), 1-2 episodes of cerebral circulation disorder (74 cases) on pulmonary artery thromboembolism (3 cases). The surgery was urgent because of acute urine retention for 88 patients, while it was scheduled in 174 patients. The postoperative developments were uneventful in 84.9%, 87.8%, 100% of postinfarction, postapoplectic and post-thromboembolism patients, respectively. Postoperative lethal outcomes occurred in 6.5% of patients with postinfarction cardiosclerosis, 5.4% of those with postapoplectic complications. As shown by long-term follow-up available for 225 patients, 19 of them died (8.4%), 296 survived 1-11 years after the surgery. One more myocardial infarction developed in 17, apoplexy in 3 patients. Long-term functional results of adenomectomy can be considered good in most of the patients in absence of a significant progression of cardiovascular disease. The authors think adenomectomy not contraindicated and promising in terms of short- and long-term outcomes if made in above kind of patients 4, 6 and 9-12 months after myocardial infarction, pulmonary artery thromboembolism and disturbance of cerebral circulation, respectively.

[The indications and contraindications for emergency adenomectomy in patients with severe concomitant diseases]. / Pokazaniia i protivopokazaniia k neotlozhnoi adenoméktomii u bol'nykh s tiazhelymi soputstvuiushchimi zabolevaniiami.

The authors have performed 631 urgent suprapubic transvesical adenomectomies in patients with prostate adenoma complicated by acute urine retention or hemorrhage. Prearranged and urgent interventions had, by the authors' experience, virtually the same rate of postoperative complications and lethal outcomes. The risk in urgent adenomectomy performed in 294 patients was attributed to their concurrent affections: postinfarction cardiosclerosis, myocardial ischemia or hypertensive crisis, hemiparesis after brain apoplexy, bronchial asthma, diabetes mellitus, hepatic cirrhosis, chronic lymphoid leukemia, drug polyallergy, multiple tumors of the urinary bladder, stomach, etc., in stage T1-3NOMO. 80 patients had intermittent chronic renal failure. In compensation of severe concurrent diseases and satisfactory condition of the patients urgent adenomectomy was conducted within 24 hours since hospitalization. Longer interval (within 24-72 hours) was necessary in subcompensation of the concurrent diseases, intermittent chronic renal failure which were intensively treated. The authors achieved uneventful postoperative course for 272 (92.5%) high-risk patients. Postoperative lethality made up 3.06%. According to 1-11-year follow-up 7 patients died, for the most part of blood and respiratory diseases. Functional long-term outcomes were good in 83.5% of the patients. Basing on their experience, the authors specify indications to urgent adenomectomy and optimal time of its conduction. Contraindications to urgent adenomectomy were revised and narrowed.

[Control over prostatic functional activity]. / Kontrol' za funktsional'noi aktivnost'iu predstatel'noi zhelezy.

The investigation of the tendency in the development of benign hyperplasia of the prostate is a crucial point in decision on the treatment initiation, schedule and policy. In view of this, the knowledge of the intensity of cellular proliferation and secretion, i.e. prostatic functional activity, in line with detrusor assessment is held essential. Optimal criteria of this value can be obtained by histological examination of prostatic biopsies, investigation of androgen and estrogen receptors in distant adenomatous nodes, by comparison of various biochemical ingredients in prostatic secretion. Twelve biochemical ingredients of prostatic secretion were studied in patients of the control group, in those with prostatic stones, adenoma, chronic prostatitis. The treatment included either androgenic, or antiandrogenic, or estrogenic therapy. Prostatic secretion biochemistry analyzed mathematically showed fluctuations in zinc ions concentration which appeared most significant. It is inferred that zinc ion concentration in prostatic secretion must be considered a significant means of overall evaluation of prostatic function able to represent the capacity of glandular epithelium for response to androgenic stimulation or estrogenic (antiandrogenic) inhibition of secretory and proliferative processes.

[The etiology and pathogenesis of penile oleogranulomas]. / Etiologiia i patogenez oleogranulem polovogo chlena.

The paper reports the experience with surgical treatment of 25 males with penile paraffinomas. A detailed pathomorphological examination of the removed tissues allowed the authors to propose an original idea on the process dynamics upon subcutaneous administration of oily substances. A pathogenetic relationship was established between various stages of chronic inflammation in paraffinoma up to development of rapidly progressing fibrous process the malignancy of which increases in joining infection. The authors advocate early operative interventions instead of long-term conservative therapy in penile paraffinomas complicated by infection.

[An experimental validation of organ-preserving operations in traumatic lesions of the parenchymatous organs]. / Eksperimental'noe obosnovanie organosokhraniaiushchikh operatsii pri travmaticheskikh povrezhdeniiakh parenkhimatoznykh organov.

Resulting from the experiment performed on 32 dogs, the authors have established that the use of technology of tissue bioinhibition and cryogenic influence led to local cryopreservation, hypercoagulation and change in the physical properties of the damaged parenchyma. This contributes to successful performance of the organ preserving operations and prevents the development of early and long-term postoperative complications.

[The role of a sanatorium-health resort factor in the complex treatment of patients with chronic prostatitis]. / Rol' sanatorno-kurortnogo faktora v kompleksnom lechenii bol'nykh khronicheskim prostatitom.

The results of two-step treatment of 62 patients with chronic prostatitis are presented. The first-step treatment was given at the clinic of the Urologic Research Institute of the RSFSR Ministry of Health, and the second step was completed at the Zheleznovodsk Urologic Clinic of the Pyatigorsk Research Institute of Health Resort Treatment and Physiotherapy. In addition to its medical aspect, treatment for chronic prostatitis has significant social implications, as chronic prostatitis mostly affects males of young or middle age, with the inflammation persisting for long periods of time and leading to sexual and reproductive disorders as well as psychoneuroses. Since chronic prostatitis is regarded as an inflammatory disease of infectious-immunologic etiology, with both parenchymal and interstitial tissues of the prostatic gland affected, the patients underwent antibacterial treatment, adjusted to the causative agent's sensitivity to antibacterial drugs, and the availability of physiotherapeutic procedures in hospital as the first stage of treatment. Those to whom further rehabilitation was indicated were referred to the Zheleznovodsc Urologic Clinic where they were given a treatment course making use of the natural factors: oral and external administration of mineral waters of the Smirnovsky and Slavyanovsky springs, mud treatments and physiotherapy where indicated. Treatment was designed to improve microcirculation in prostatic tissues, and used natural factors, capable of normalizing and activating systemic protective potentials. There were good results (considerably improved general condition, both subjectively felt and objectively documented) in 78%.(ABSTRACT TRUNCATED AT 250 WORDS)

[Transient obstructive aspermia and transient obstructive oligospermia]. / Tranzitornaia obturatsionnaia aspermiia, tranzitornaia obturatsionnaia oligospermiia.

The article is a continuation of a series of papers dealing with changes of ejaculatory ducts associated with various diseases of the prostatic gland and posterior urethra. Clinical description of patients, earlier treated for aspermia or oligospermia is presented. In some of the patients with such clinical manifestations, complete or partial compression of the ejaculatory ducts by the inflamed prostate or seminal bulb may be the cause and the disorder may be transitory rather than continuous. Twenty-six cases of transitory aspermia are reported, with special reference to laboratory and instrumental findings and treatment results. A group of patients (43) with transitory oligospermia is also described, and the results of investigation and treatment are presented.

[Intratesticular stimulation of spermatogenesis]. / Intratestikularno stimulirane na spermatogenezata.

The possibility to exert local effect on suppressed spermatogenesis in patients with different forms of secretory sterility is presented. To this end, the authors created an experimental model of 10-minute acute ischemia in mouse testis. Destructive changes in the testicular parenchyma after the 3., 9., 22. and 30 day were observed and described. Testosterone concentration in the tissues of the ischemic and the contralateral testis was determined by highly effective liquid chromatography. It is concluded that saturation of the interstitium with androgens may avert irreversible postischemic sequelae in the testis. At first chorion gonadotropin and testosterone, but later on Sustanon-250 with prolonged action, were used as protectors. This experimental study is a contribution both to the investigation of spermatogenesis physiology and disturbances and to the refinement of the treatment of secretory forms of male sterility.