[Lantox treatment of neurogenic dysfunction of the bladder].

We studied correction of micturition disorders in 9 patients with neurogenic dysfunction of the bladder resistant to conservative treatment. Four patients had neurogenic detrusor hyperactivity and 5 patients had detrusor-sphincter dyssynergia. Injections of botulinic toxin preparation (lantox) were made in the wall of the bladder under endoscopic control in detrusor neurogenic hyperactivity. Women with detrusor-sphincter dyssynergia received transperineal injections of lantox in the region of external urethral sphincter. Men received botulinic toxin directly into the region of external urethral sphincter in urethroscopy. Positive results were achieved in all the cases confirming high efficacy of the method.

[Endoluminal ultrasonography in diagnosing and treating upper urinary tract diseases]. / Endoliuminal'naia ul'trasonografiia v diagnostike i lechenii zabolevanii verkhnikh mochevykh putei.

Endoluminal ultrasound scanning (EUS) of the upper urinary tracts (UUT) with intracavitary catheter sensor was performed in 15 patients (7 men and 8 women) aged 21 to 61 years. In 8 patients EUS was diagnostic (in one patient it was made twice, in 2 cases--in combination with ureteroscopy and biopsy), in 7 patients it was a diagnostic stage of the following surgical intervention, in 6--in combination with roentgenoendoscopic correction of strictures of the ureteropelvic segment (UPS) and in 1--in combination with transurethral pyelolithotripsy. A total of 16 procedures were made: 15 transurethral and 1--percutaneous. Endoluminal ultrasonography was conducted not only of the whole ureter but also of renal calycopelvic system (RAPS) which presented endosonographic semiotics of UUT. EUS has diagnosed urate concrement in 4 cases, "cross" vessels which narrowed UPS in 3 cases with late hydronephrotic transformation. In one patient EUS was carried out in combination with ureteroscopy and biopsy as a control examination 6 and 18 months after transurethral endoresection of ureteral tumor. In 6 patients with UPS strictures EUS was made for diagnosis of suspected cross vessels before endopyelotomy. No complications during EUS were encountered. Pilot experience with intracavitary ultrasonography of the UUT shows its high diagnostic potential and clinical value. This technique details inner structures of the ureter and RAPS with adjacent tissues due to minimal distance between the sensor and studied object.

[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.