[Using energetic Doppler-angiography in combined diagnostics of prostatic abscess].

Diagnostic possibilities of conventional clinical-laboratory, physical methods, seroscale echography and energetic dopplerangiography (EDA) were compared in 32 patients with prostatic abscess (PA). Nonspecific symptoms hamper conventional PA diagnosis. PA is detected, as a rule, at transrectal ultrasonic investigation (TUI) which is effective in formed PA (sensitivity 100%) but is low effective in early PA (sensitivity 50%). Minimal size of PA detectable by TUI is 7 mm (mean 12 +/- 1.2 mm). EDA improves diagnostic potential of TUI in infiltrative PA (sensitivity 91.7%). In established PA, EDA confirms TUI findings. Transabdominal ultrasonography has insufficient resolution and must be used for PA screening.

[Doppler technologies in combined diagnosis of acute pyelonephritis].

We studied diagnostic potentialities of conventional clinical, device, x-ray and ultrasonic methods including current Doppler technology in differentiation of serous and purulent stages of acute pyelonephritis (AP) in 50 patients (mean age 25.5 +/- 5.5 years). Energetic dopplerangiography (EDA) showed the highest diagnostic significance. EDA was highly informative in renal carbuncle and total purulent destruction of the kidney and low informative in serous and apostematous AP, renal abscess. Conventional ultrasonic, x-ray, clinical and device investigations as well as impulse dopplerography and color Doppler mapping of blood flow are of secondary importance in AP.

[Use of proscar in preoperative preparation of patients with benign prostatic hyperplasia before transureteral resection]. / Primenenie proskara v kachestve predoperatsionnoi podgotovki bol'nykh s dobrokachesvennoi giperplaziei prostaty pered transuretral'noi rezektsiei.

Effects of proskar-MSD used before transurethral resection (TUR) of the prostate in patients with benign prostatic hyperplasia (BPH) were studied with specification of the drug action on hematuria during and after operation. Patients with histologically verified BPH received proskar for 3 and 6 months in a dose of 5 mg/day. Control patients did not receive preoperative proskar. Of patients who received proskar for 3 months, TUR with estimation of the intraoperative blood loss and changes in microcirculation and structure of prostatic tissue induced by proskar was made in 20 patients (mean age 68 years). A 3-month course of proskar reduced prostatic volume and its hyperplasia by 18-20 cm3, on the average. Mean blood loss was about 111 ml vs control 223 ml. Dopplerography revealed consolidation of adenomatous tissue and decline of volumic blood flow in the prostate after 3-month proskar course. Thus, preoperative proskar administration before TUR of prostatic adenoma results in sclerosing of prostatic tissue, decrease of microcirculation manifesting intraoperatively with diminished hematuria and less number of subsequent complications; promotes a favourable outcome of the operation; improves life quality.

[Minimally invasive method of the treatment of prostatic abscess]. / Maloinvazivnyi metod lecheniia abstsessa predstatel'noi zhelezy.

In discussion of advantages and shortcomings of different surgical procedures in the treatment of a prostatic abscess (PA) which rarely complicates acute prostatitis the authors focus on a thin needle transcutaneous puncture of PA under ultrasound control. This low invasive operation made under local anesthesia was performed in 15 PA patients. The abscess cavity was drained using a polyethylene catheter "pigtail". The manipulation was well tolerated by all the patients with no complications in the postoperative period. A mean time of the abscess cavity draining was 4 days. A follow-up for 1.5 years discovered recurrence in none of the patients. This low invasive method is proposed as an alternative to the existing traumatic methods of PA management.

[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 transurethral microwave thermotherapy of benign prostatic hyperplasia]. / Transuretral'naia mikrovolnovaia termoterapiia dobrakachestvennoi giperplazii predstatel'noi zhelezy.

The authors have treated benign prostatic hyperplasia (BPH) in 50 patients aged 54-89 years (mean age 67.5 years) including 10 patients with cystostoma. The patients were exposed to transurethral microwave thermotherapy (TUMT) performed on the prostcare unit. Only 1 session (60 min at 45 degrees C) was conducted. Inflammatory complications of TUMT occurred in 4(8%) patients. A 1.5-year follow-up covered 45 patients. A subjective response was obtained in 86% of patients. An objective response by urination rate and prostatic size 3 months after TUMT was reached in 80 and 90% of patients, respectively; 1.5 years after in 48, 34 and 47%, respectively. TUMT is recommended in uncomplicated BPH as an alternative to chemotherapy or surgical treatment (in patients with cystostoma and serious intercurrent diseases).

[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.

[Transcutaneous puncture drainage in suppurative destructive diseases of the perirenal cellular tissue]. / Chreskozhnoe punktsionnoe drenirovanie pri gnoino-destruktivnykh zabolevaniiakh okolopochechnoi kletchatki.

The authors introduce a new sparing therapy of pyodestructive lesions of the pararenal fat which comprises subcutaneous puncture drainage controlled by ultrasound with subsequent treatment of the purulent focus with a solution of a new antiseptic, sodium hypochlorite. The advantages of the above method over routine approaches include a 1.5-2-fold decrease in the treatment duration, minor traumatism, simplicity, effectiveness in severe conditions.

[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.

[The diagnosis and treatment of cystic diseases of the kidneys by using transcutaneous puncture methods under ultrasonic monitoring]. / Diagnostika i lechenie kistoznykh zabolevanii pochek s pomoshch'iu chreskozhnykh punktsionnykh metodov pod ul'trazvukovym kontrolem.

Presented in the paper are the methods of ultrasonic diagnosis and percutaneous paracentetic treatment of cystic kidneys under ultrasonic monitoring. Paracenteses were performed in 172 patients: 59 with polycystic and 113 with cystic kidneys. If the cysts located in the middle or lower segments of posterior, lateral or inferior drainage that was pushed through the guide into the cyst lumen. A thin-needle aspiration was used and the drainage avoided if the cyst located in the anterior part of middle or upper renal segments. Cystography and cystomanometry associated with the determination of the cyst tension index followed elimination of the aspirates for cyto- and bacteriological investigations. Paracentesis was accomplished under the ultrasonic monitoring of the position of a needle tip. The cavity of the cyst was sclerosed with 96% spirit in 84 patients; strong radiopaque agents were used in 8 and medicinal cyanacrylate glue in 13 patients. The drainage of the cysts with a long-term exposure to sclerosing agents (from 2 to 24 hrs) was employed in 32 patients. Postaspiration relapses were documented in all the patients with intrasinus cysts and cysts, whose major portion was surrounded by parenchyma. In the patients with other patterns of cyst location, the postaspiration relapses were noted in 94.4 per cent. A four-year follow-up of 13 patients who sustained the glue application registered 2 relapses which were successfully cured by a repeat application of the glue.(ABSTRACT TRUNCATED AT 250 WORDS)

[The role of outpatient ultrasonic study in the detection and differential diagnosis of benign kidney tumors]. / Rol' dispansernogo ul'trazvukovogo issledovaniia v vyiavlenii i differentsial'noi diagnostike dobrokachestvennykh opukholei pochek.

Investigation of 18,000 patients has demonstrated the value of ultrasonography for the detection and differential diagnosis of renal tumors. Benign renal tumors, detected by ultrasonography at a population screening, make up 21.4% of all detected tumors of the renal parenchyma. Typical echographic features of renal angiomyolipomas make ultrasonography effective even in cases of small formations, whereas computerized tomography was only valuable where the size of the tumor was more than 1.5 cm. There were diagnostic difficulties in one case of renal adenoma. There were no changes of size or structure of the formation in 23 patients with typical ultrasonic appearance of renal angiomyolipoma over 1 through 3 years of follow-up, so that active surgical intervention can be avoided here; where ultrasonic appearance is doubtful, additional combined investigation and surgery, where necessary, are required.