[Classification of hydroureteronephrosis by ultrasonography findings].

A complex examination including blood and urine biochemistry, pyelomanometry, x-ray-radionuclide and endoscopic investigations of the urinary tract as well as ultrasonography with estimation of morphometric and functional parameters of different parts of the urinary tract was conducted in 525 patients with various diseases of the pelvic ureter and urinary bladder complicated by hydroureteronephrosis (HUN) and 50 healthy controls. The findings made it possible to distinguish four stages of HUN: hyperkinetic, dyskinetic, hypokinetic and akinetic. This gradation rests on the results of sonographic assessment of morphofunctional condition of the urinary tract which were compared with findings of the other methods of urological examination. The proposed 4-stage HUN classification based finally only on ultrasonography data describes not only severity of anatomic changes but, indirectly, functional reserves of the upper urinary tract. Sonography is an available, non-invasive, cost-effective method without contraindications. This allows recommendation of this HUN classification for wide application. According to the stage of urodynamic disorder, therapeutic policy is proposed.

[Radical nephrouretercystectomy].

The results of radical nephrouretercystectomy (NUCE) are presented for 13 patients (9 males and 4 females, age 44-70 years, mean age 58 +/- 1.7 years). One-stage NUCE was made in 11 patients, two- or three-stage--in 2 patients. Indications for NUCE were the following: urothelial cancer, urogenital tuberculosis, microcystis, neurogenic dysfunction of the urinary bladder complicated by definite renal dysfunction. Postoperative complications arose in 3 patients. Lethal outcomes were absent. The results presented say in favour of extended surgery in involvement of the kidney, ureter, urinary bladder, prostate, urethra. Radical NUCE is primarily indicated in cancer of the renal pelvis, ureter with muscular invasion into the bladder wall, non-functional kidney due to ureteral obstruction with a tumor or scar.

[The results of orthotopic plastic reconstruction of the urinary bladder with gastric and iliac graft].

To compare the results of postoperative plastic reconstruction of the urinary bladder (PRUB) with gastric and iliac graft, we studied 205 patients (150 males, 73.2%; 55 females, 26.8% aged 23-72 years, mean age 62.1 +/- 0.5 years) who had undergone orthotopic PRUB. Artificial bladder was created in 26 (12.7%) patients of a stomach pedicle segment, in 174 (84.9%)--of a detubulated iliac segment, in 5 (2.4%)--of a sigmoid segment. Early and late postoperative complications in using small intestinal segment reached 14.0 and 10.4%, respectively, lethality being 2.6%; in using gastric segment made up 3.9 and 8.7%, respectively, lethal outcomes were absent. Patients after PRUB had neither disorders of acid-base balance nor defects in electrolytic balance of blood. Urodynamic parameters were close to physiological ones. Thus, satisfactory clinical and functional results of urinary bladder orthotopic reconstruction even in long-term follow-up confirm advantages of orthotopic reconstruction of the lower urinary tracts in diseases of the urinary bladder.

[The frequency and diagnostic value of microscopic signs of minimal prostate adenocarcinoma].

Prostate biopsy specimens from 64 patients were studied. In most cases with minimal prostate adenocarcinoma, the tumor was limited by the organ and of moderate malignancy.

[Fluorescent cystoscopy and transurethral electroresection in diagnosis and treatment of patients with invasive cancer of the urinary bladder]. / Vozmozhnosti fliuorestsentnoi tsitoskopii i transuretal'noi élektrorezektsii v diagnostike i lechenii bol'nykh invazivnym rakom mochevogo puzyria.

From 1996 to 2002 we examined and treated 224 patients with invasive cancer of the urinary bladder (ICUB). The examination complex included clinical, laboratory, radiation tests, endoscopic and morphological investigations of the surgical material. The patients received four types of treatment: transurethral resection (TUR) of the bladder wall (n = 102) alone; TUR+MVAC chemotherapy (n = 56); open resection of the urinary bladder only (n = 38); open resection+MVAC chemotherapy (n = 28). In diagnosis of papillary lesions sensitivity of cystoscopy (CS) was 66.6%, fluorescent CS (FCS)--95.2%. Sensitivity in diagnosis of squamous tumors was 33.3 and 91.6%, respectively. The best results were achieved in patients with pT2A tumor invasion depth, G1 differentiation of tumor cells after TUR with adjuvant polychemotherapy (PCT) recurrences in these patients arose by 41.2% less frequently than in patients after TUR only, 5-year survival in patients after TUR+PCT was 83.3%. Thus, FCS improves diagnosis of urinary bladder tumors (sensitivity of CS was 70.0% vs that of FCS--95.0%). In cancer of the urinary bladder the organ can be saved only at stage pT2G1. A method of choice is TUR of the bladder wall with adjuvant PCT.