[Morphologic and functional heterogeneous changes of the urinary bladder different parts at rats with infravesical obstruction of the urinary tracts].

Infravesical obstruction of the lower urinary tracts of 30 rats was carried out by the measured constriction of the urethral prevesical parts. Morphologic and functional changes of the urinary bladder different parts were studied in 1 week and in 3 months. Compensatory hypertrophy of the detrusor was accompanied increasing of hypertrophied, atrophic and native forms of leiomyocytes, as so their transformation into myofibroblasts with connective tissue formation between the muscle fibers mainly in the neck of urinary bladder Contractility of the detrusor decreased with their tonus increasing mainly in the neck of urinary bladder too. Weakening effect of adrenalin in 3 month after obstruction significantly decreased, while in the body and neck of urinary bladder it virtually disappeared. Blockade of alpha-adrenoreceptors after noradrenalin stimulation resulted in enchancement of the hypertrophic detrusor contraction when tonus of the urinary neck decreased. On the contrary, in the intact urinary bladder the similarly influence resulted in weakening of contraction.

[Biological aspects of choice of the intestinal segment for the cystoplasty].

Contractile activity of the iliac and sigmoid intestines versus detrusor activity, reabsorption and secretory activity of the iliac and sigmoid intestinal mucosa in contact with urine were studied in 30 rats. It was found that isolated segments of the iliac and sigmoid intestines have spontaneous contractile activity (stronger in the iliac intestine) while bladder segment contracted only in response to electric stimulation. A contraction-stimulating effect of acetylcholine and a relaxing effect of noradrenaline in experiments with the iliac intestine were close to their effects on the detrusor. The sigmoid intestine responded weaker to the above mediators. The iliac mucosa actively reabsorbed urinary urea, creatinin, glucose causing elevation of their concentrations in blood as well as K, Na, Ca, CI, P and secreted protein in urine leading to hypoproteinemia. The sigmoid mucosa showed weaker metabolic activity. The results of the study demonstrate importance of consideration of biological properties of different intestinal regions for choice of a cystoplasty method after cystectomy.

[Estimation of the contractile function of the upper urinary tract by multichannel impedance ureterography before and after endoureteropyelotomy].

We studied qualitative and quantitative characteristics of the upper urinary tract (UUT) contractile function examination with multichannel impedance ureterography (MIUG) in patients given roentgenoendoscopic treatment for stricture of the ureter and pelvoureteral segment (PUS) for prognosis of the disease outcome and decision on further therapy. UUT function was studied with MIUG in 12 patients with stricture of the upper third of the ureter and PUS during and 1-2 months after endoureteropyelotomy. UUT peristalsis was assessed qualitatively (direction of peristaltic wave, rhythm of peristalsis, wave shape) and quantitatively (amplitude of ureteral contractions, frequency of peristalsis, wall tonicity). Ureteral peristalsis disorders of different severity were found in the majority of patients. UUT contractile function improved after treatment in 83% patients. The improvement concerned wave shape, peristalsis amplitude, a relief of wall tonicity, frequency of contractions). MIUG can objectively assess UUT function in patients with ureteral and PUS stricture, predict efficacy of roentgenoendoscopic treatment early after surgery. MIUG is intended for diagnosis of UUT contractile disorders undetected by x-ray, for objective control over quality of therapy, for formulating indications to pathogenetic treatment.

[Tamsulosin in combind treatment of patients with urolithiasis].

In administration of tamsulosine (focusin, Zentiva, Czech Republic) in combined treatment of urolithiasis concrement evacuation after extracorporeal lithotripsy occurred in 83% cases in patients with the concrement stay in the ureter for less than one month. The size of the concrement after successful lithotripsy had no significant effect on subsequent stone-eliminating therapy but long-term stay of the concrement in one place promoted inflammatory and urodynamic disturbances in the ureter treated surgically. The comparative analysis of the contractile function of the distal ureteral comparment in patients given tamsulosin showed a less active (amplitude of the contractions) and passive (tonicity) resistance to urine flow than in patients given a standard therapy. These changes were accompanied with lower pressure in the renal pelvis and suppression of enzymuria. Thus, tamsulosin addition to combined treatment of urolithiasis has a positive effect on ureteral urodynamics, concrement evacuation and functional structures of the kidney by indirectly lowering intrapelvic pressure.

[Diagnosis of urinary bladder function in patients with epicystostoma].

Functional tests performed in patients with urine retention and cystostomic drainage help in detection of individual defects in urinary bladder function. Knowledge of the mechanisms causing the above defects allows individual approach to preoperative preparation and postoperative management of the patients, to pathogenetic medication improving its results.

[Function of the urinary bladder detrusor after injection of botulinic toxin].

The effect of botulinic toxin of type A (BoNT) on urinary bladder (UB) function was studied during operation in situ in healthy rats using the method of infusion cystomanometry after a single injection of the toxin into the UB wall 3 to 30 days after the injection. Contractility of the muscular fragments in vitro was assessed in the isometric regimen in electric stimulation, depolarization of cellular membranes by ion [K+] excess, addition of noradrenalin (10(-5) M). In response to botulinic toxin injection 47-64% rats vs control animals (23%) operated on without toxin had no phasic UB contractions, detrusor pressure (Pdet) after the infusion was higher which indicated retension. In rats with intact UB contractility, contractions were stronger (Pdet 24-34 cm H2O), but rare (3-5/min) vs controls (19 cm H2O, 5/min, respectively). Contractility in vitro in response to electric stimulation regressed by 60-85% after toxin infusion. Contractility in solution [K+] regressed less (by 65, 36, 16% in 3, 10 and 30 days, respectively). No significant changes of noradrenalin-induced reactions were found. The results illustrate possible direct myogenic effect of the toxin on detrusor muscle.

[Determination of optimal length of extramural tunnels for their adequate anticurrent properties in intestinal urine derivation].

An acute experiment on adult dogs with conduction of manometry in outlets and inlets in reservoir filling and with Valsalva's test has established that reliable continent properties of the anti-current mechanisms are provided in creation of the tunnel with functional length 5 cm minimum leading to proportional rise in pressure in reservoir and in outlet. Pressure in the outlet was approximately 2 times higher than in the reservoir. In tunnel length 4 cm Valsalva's test registered leaking. The results obtained contributed to effective clinical use of the method.

[Urodynamics of the upper urinary tract in urolithiasis patients with chronic pyelonephritis].

Urodynamics was studied in patients with chronic pyelonephritis with a various level of upper urinary tract (UUT) obstruction. 90% patients with concrements of the low ureter had high intrapelvic pressure (IPP)--21.8 +/- 0.8/25.2 +/- 0.8 cm of water column (basal/peristaltic) and enhanced UUT contractility. IPP was elevated in 50% patients with proximal UUT obstruction (11.8 +/- 1.3/15.5 +/- 1.5 cm of water column) and it rose noticeably (by 110-184%) in changing body position (orthostatic test) but changed little in the respiratory test. High IPP persisted despite functioning nephrostomic drainages in 84-86% patients exposed to extracorporeal and/or contact lithotripsy at the average level 16.2 +/- 0.8/19.7 +/- 0.6 cm of water column. Different mechanisms may be involved in formation of high IPP in patients with chronic pyelonephritis and varying level of UUT obstruction. In view of damaging influence of high IPP on renal function the physician should control this index during the treatment and take additional measures to prevent elevation of IPP.

[Change of pressure in renal pelvis in acute and chronic course of pyelonephritis].

We studied urodynamics of the upper urinary tract in a different course of renal inflammation with consideration of the drainage method. Pressure in the renal pelvis was measured in 64 patients with acute obstructive and non-obstructive, and chronic pyelonephritis in different time of establishment of surgical or transcutaneous puncture nephrostomas and ureteral catheters. We assessed changes in intrapelvic pressure in respiratory (regular and forced respiration) and orthostatic (lying, sitting, standing positions) functional tests. The autonomic status of the body was evaluated by parameters of the spectral analysis of heart rate variability. We have found that intrapelvic pressure increases with progression of renal inflammation. Dynamics of the above indices in patients with acute non-obstructive and obstructive pyelonephritis versus patients with renal colic in the absence of evident inflammation allowed us to specify mechanisms of pressure formation in renal pelvis including inflammatory edema of the parenchyma and nervous-reflectory links of upper urinary tract regulation. Pressure in the renal pelvis may serve an important diagnostic criterion in choice of renal drainage method in pyelonephritis and criterion of inflammation course prognosis.

[A contractile function of various megaureter forms in infants and its pharmacological regulation].

A total of 43 infants under 3 years of age with organic, functional and reflux obstructive megaureter were studied. The function of the upper urinary tract was examined with dynamic pyeloureterosonography with diuretic load. Contractility of isolated fragments of megaureters and possibility of its pharmacological regulation were studied in patients after surgery in vitro. Different urodynamic variants of the response of refluxing and obstructive megaureters and those with functional obstruction on stimulation of diuresis were established at dynamic pyeloureterosonography with diuretic load. The differences concerned the strength and kind of the reaction, frequency, amplitude and performance of the megaureters (15-30-45 min). In vitro studies confirmed functional differences between the forms of megaureters. The data obtained show preservation of functional reserves of the wall of the refluxing megaureter in children, suppression contractions and reaction of the megaureters with organic obstruction in the ureterovesical anastomosis while functionally obstructive megaureters are able to contract slowly and have reactivity according to the state of the smooth muscle wall. Pharmacological impact on ureteral function by metabolic drugs (picamilone) is determined. A direct action of lasix on the smooth muscle (weakening of high toxic reaction) is proved.

[Role of the level of obstruction and urodynamics of the upper urinary tract in infectious-toxic complications in urolithiasis. (Clinical and experimental study). ]. / Rol' urovnia obstuktsii v narushenii urodinamiki verkhnikh mochevykh putei pri oslozhneniiakh mochekamennoi bolezni (Kliniko-éksperimenal'noe issledovanie)

Clinical studies have revealed that location of the occlusion in the kidney and upper third of the ureter raises the risk of severe infectious-toxic complications of urolithiasis. It is shown experimentally that mechanisms of compensation of impaired urinary transport along the upper urinary tracts differ in obstruction of the upper and lower third of the ureter.

[Urodynamics of the upper urinary tracts after ureteroplasty (experimental data)]. / Sostoianie urodinamiki verkhnikh mochevykh putei posle plasticheskikh operatsii na mochetochnike (éksperimental'noe issledovanie).

An experimental study on 12 mongrel dogs was made for assessment of urodynamics of the upper urinary tracts after reconstructive surgery. Ureterohydronephrosis was modelled by cryodestruction, confirmed by x-ray and radionuclide examinations. Urodynamics of the upper urinary tracts was studied by measurements of the intraluminal pressure and at multichannel impedance ureterography under thiopental anesthesia. It was found that reestablishment of normal urine passage after ureteroplasty is not accompanied by urodynamic recovery. Preoperative hyperfunction of the upper urinary tracts and their postoperative hypofunction appeared unfavourable prognostic signs for ureteroplasty outcomes.

[Usage of the novel synthetic material carbilan for urinary tract reconstruction in experiment]. / Ispol'zovanie novogo sinteticheskogo materiala "karbilan" pri porazhenii mochevykh putei (éksperimental'naia rabota).

Carbilan was tried as a new synthetic suturing material and ureteral prosthesis in reconstruction surgery on the urinary tracts. In experiments on 24 dogs carbilan suturing threads were used for establishment of ureteral-ureteral and vesicoureteral anastomoses, suturing of the ureter, bladder or urethra. In a comparative group of 36 dogs such operations were made using chrome-plated catgut. Complications occurred in 3.8 and 17.6% of the dogs from the carbilan and catgut groups, respectively. Replacement of the part of the ureter in the middle or in the lower third 3-5 cm in length for a carbilan transplant was conducted in 8 dogs. In 6 cases of the suture leaking, the prosthesis underwent deformation and compression by commissures which formed around the flap within 3 months after the implantation. In 2 experiments the prosthesis was sealed with fibrin (a short-term implantation into the artery). This provided normal function of the prosthesis for 9-13 months. Later, the urinary tracts were also obstructed. No occlusions of the prosthesis with urinary salts or detritus were observed. Histologically, both suturing threads and ureteral prosthesis made of carbilan showed good biocompatibility. Massive commissures around the prosthesis arose because of its leaking and contact of the urine with the surrounding tissues.

[Effects of impaired urodynamics and contractile function of the upper urinary tract on elimination of stone fragments after extracorporeal lithotripsy]. / Vliianie narushenii urodinamiki i sokratitel'noi funktsii verkhnikh mochevyvodiashchikh putei na otkhozhdenie fragmentov kamnei posle distantsionnoi litotripsii.

The authors analyze effects of amplitude, tone and frequency of ureteral contractions on elimination of stones fragmented after extracorporeal shock-wave lithotripsy (ECSWL) in 30 patients with concrements in the kidneys and ureters. Before ECSWL the patients had indications for renal pelvis cathetarization. The measurements were made with multichannel impedance ureterography. According to initial dilatation of the upper urinary tracts (UUT), the patients were divided into 3 groups. It is shown that urodynamic UUT disorders determine effectiveness of ECSWL in urolithiasis patients: the greater is the dilatation the more probable are unsatisfactory results of ECSWL. Ureteral contractile activity is essential for rehabilitation in early postoperative period after ECSWL in patients with unrevealed UUT dilation: high amplitude of ureteral contractions in low tone is good for the fragments elimination, while high tone may result to the fragments ejection into the kidney. Low contractility may contribute to development of stone path. In patients with pronounced UUT dilation ureteral contractility is less important for ECSWL effectiveness than the wall tone and retrograde ureteral peristaltic movements. ECSWL results are better in patients with low tone of UUT wall. High UUT tone, especially in combination with retrograde peristaltic ureteral contractions registered prior to ECSWL indicates high probability of residual stones and additional fragmentation procedures irrespective of initial UUT dilation.

[Functional state of upper urinary tract in urgent extracorporeal lithotripsy]. / Funktsional'noe sostoianie verkhnikh mochevyvodiashchikh putei pri neotlozhnoi distantsionnoi litotripsii.

Seven patients have undergone urgent extracorporeal lithotripsy (UEL) for renal colics. 3 patients were cured. Before UEL they had insignificant defects of urodynamics and ureteral contraction. 3 patients with initial dilation of the upper urinary tracts > 2 cm and reflux ureteral motility, residual concrements eliminated spontaneously or after additional UEL procedures or combined treatment. One female with initial pelvic and uretral dilation and disturbed motility of the upper urinary tracts was treated for 6 months. 1-2.5-year follow-up detected neither concrements nor marked dilation of the calyceropelvic system. Patients with renal colics have more pronounced local defects of contraction rhythm and activity, peristaltic direction. Peristaltic disorders in the upper urinary tracts in patients with renal colics are local and may be related to acute occlusion and neuroreflex effects. This explains why UEL produces good results in renal colics, especially in patients with minimal defects of urodynamics. Complicated course after UEL early after the operation occurred in patients with dilated upper urinary tracts, high contraction amplitude registered by high tonicity of the ureteral wall and the presence of retrograde peristaltic waves.

[Internal prosthetic appliance of ureter (experimental study)]. / Vnutrennee protezirovanie mochetochnika (éksperimental'noe issledovanie).

In experiment, endoprosthetic appliances were placed in the intact ureters of 5 dogs, in previously created stricture also in 5 dogs. Three types of endoprostheses were used: nitinol thermo-extensible spiral prosthesis (Russia), reticular extensible vascular endoprosthesis Wallstent (Schneider, Switzerland) and tough teflon biliary prosthesis (Olympus, Japan). The dogs were followed up 1-36 months. Regardless of the prosthesis type, in good patency, in all the cases excretory urography and dynamic nephroscintigraphy demonstrated moderate dilatation of the upper urinary tracts, slowing down of urine evacuation. Urodynamic investigations detected arise in intraureteral basal and peristaltic pressure, transient more frequent contractions above the prosthesis and persistent less frequent contractions of the distal ureter, increased amplitude of the contractions. The contractions became arrhythmic, retrograde waves arose. Later, some dogs had chaotic contractions. It is concluded that endoprostheses reestablish patency of the urinary tracts but hinder contractions in part of the ureter thus affecting negatively urodynamics.

[Contractile function of ureter in its anomalies in children]. / Sokratitel'naia funktsiia mochetochnika u detei pri nekotorykh ego anomaliiakh.

A study on the testing unit was made of a contractile function of ureteral fragments removed at reconstructive operations for vesicoureteral reflux (VUR), neuromuscular dysplasia (NMD) and pelvoureteral segment stricture (PUSS). The study parameters (wall rigidity, amplitude of the contractions, potassium depolarization contracture, responses to adrenoreactive drugs) in patients with VUR were close to normal, whereas in those with NMD or PUSS changed significantly, especially in PUSS patients. Ureteral contractility impairment was heterogenic in all the groups, varying from intact to lost and did not correlate either with age or the disease stage. The value of functional studies of the ureter in reconstructive surgery for specifying the disease pathogenesis, mechanisms of functional decline and individual prognosis of functional efficiency of the operative intervention is discussed.

[Urodynamics of upper urinary tracts after intestinal plastic surgery on urinary bladder (experimental study)]. / Urodinamika verkhnikh mochevykh putei posle kishechnoi plastiki mochevogo puzyria (Eksperimental'noe issledovanie).

In dog experiments, the urinary bladder was replaced for an isolated intestinal segment to test upper urinary tract function as regards configuration of the established urine reservoir early and late after the surgery. Intestinal plastic surgery of the bladder changes parameters of ureteral function in unchanged potential reserve of ureteral contraction. Postileocystoplasty urodynamics of the upper urinary tracts is characterized by lowering of intraureteral pressure, decreased amplitude of ureteral contractions, enhanced tonicity and motility. Plastic replacement of the bladder with isolated intestinal segment is not contraindicated in the solitary kidney.

[Upper urinary tract hypertrophy of the solitary kidney]. / Gipertrofiia verkhnikh mochevykh putei edinstvennoi pochki.

17 dogs were examined 1 and 3 months, 1-1.5 years after unilateral nephrectomy. It was found that compensatory hypertrophy develops not only in the parenchyma of the remaining kidney but in the upper urinary tracts as well. 1 month after the nephrectomy ureteral activity for urine evacuation enhanced as compared to its preoperative activity. 3 months and 1-1.5 years after the nephrectomy ureteral performance remained elevated. High performance was supported due to increased amplitude of the contractions and their prolongation. Frequency of the contractions reduced. Basal and peristaltic pressure in the ureter, as a rule, rose. Diuretic lazix load 3 months after nephrectomy and more led to higher elevation of the intraureteral pressure. Ureteral wall lock in contraction promoting active urinary transport was observed whereas this locking mechanism before nephrectomy was decompensated even in lower intraureteral pressure. Ureteral hypertrophy was followed by negative effects such as defective generation and conduction of excitation through the ureter, higher incidence of endogenous infection in the urinary tracts.