Ultrasonic transabdominal and transrectal investigations, computed tomography, endoscopic photodynamic studies, polyfocal biopsy of the urinary bladder were used in examination of 1238 patients which were diagnosed to have urinary bladder cancer. 894 patients underwent transurethral resection of the bladder. Morphologically, cancer of the urinary bladder has an inductory effect on intact parts of the bladder mucosa. This means that even most radical resection does not eliminate grounds for a new tumor growth. Radical cystectomy was performed in diffuse papillomatosis, multiple stage T2 tumors of high-grade malignancy, tumors at stage T3, T4, Nx, MO, in rapid recurrent tumors after conservative or operative treatment.
Whereas 25-57% of patients diagnosed with renal cell carcinoma (RCC) present with metastatic disease, about 50% of (RCC) patients develop metastases after potentially curative radical nephrectomy. Five-year survival at following surgical removal of solitary metastases is approximately 35-50%. Our experience demonstrate that a small cohort of patients benefit from aggressive surgical therapy for consequtively arising solitary distant metastases with long-term palliation.
Basing on original experience (2150 cases) and literature data, the authors review in detail current status of EL: indications and contraindications, complications, pediatric applications, use in anomalous and single kidneys, in single, multiple and coral concrements. Prospects for the future are outlined.
Citrate therapy was tried in 483 patients with urate nephrolithiasis. A good response was obtained both in monotherapy or in combination of urates with invasive or remote treatment. The authors advocate the drug blemaren (ESPARMA, Germany) as most beneficial among citrate drugs.
32 patients with chronic lymphoid leukemia (CLL) were examined to specify reasons of renal damage. Measurements were made of blood urea, creatinine, total protein, electrolytes, uric acid. Also, urinary sediment, diurnal loss of protein and creatinine with urine, glomerular filtration rate, concentration ability of the kidneys were studied. Urinary system was assessed by ultrasound. Most CLL patients studied had renal affection characteristic for chronic pyelonephritis with chronic renal insufficiency. The ultrasonic investigation stated reduced size of the kidneys, thinning of the cortex, extension of the renal pelvis and calyces, concrements. The kidneys and ureters were pressed and displaced by enlarged spleen, liver, lymph nodes. The plan of CLL patients' examination must include ultrasonic investigation of the abdominal organs for early detection of renal lesions.
Whereas 25-57% of patients diagnosed with renal cell carcinoma (RCC) present with metastatic disease, about 50% of (RCC) patients develop metastases after potentially curative radical nephrectomy. Five-year survival at following surgical removal of solitary metastases is approximately 35-50%. Our experience demonstrate that a small cohort of patients benefit from aggressive surgical therapy for consequtively arising solitary distant metastases with long-term palliation.
Reproductive function and treatment results have been analysed for 59 patients aged 17 to 32 years after herniotomy. 28 and 31 of them underwent standard and endosurgical interventions, respectively. The control group consisted of 30 healthy males matched for age. As shown by 6-month follow-up, the endosurgical herniotomy was not associated with such complications as hydroscheocele, hydrocele, testicular atrophy, diminution of blood flow along the testicular arteries. Ejaculate, levels of sex hormones in the blood, cremasteric reflex remained intact. After routine herniotomy there appeared defects in scrotal and testicular microcirculation with partial testicular atrophy in 25% of cases, testicular circulation fell 2.2-2.5-fold, deterioration of spermogram and cremasteric reflex parameters, reduction of serum testosterone were observed.
The authors analyze the results of ESWL (URAT-P unit) for urolithiasis performed in 106 patients (49 females and 57 males) aged 16-67 years with anomalous kidneys and upper urinary tracts. 28, 1, 11, 14, 24, 4, 22 and 2 patients had horseshoe, L-shape, solitary, lumbar distopic, double, sponge, cystic kidneys, congenital megacallicosis, respectively. The stones ranged in size from 7 to 30 mm. Bilateral urolithiasis was in 7 patients. The number of impulses averaged 1745 +/- 168.4 per the procedure. The average number of ESWL procedures per stone was 1.4 (1-4). The stones were completely eliminated after one ESWL session in 78(73.6) patients, after two sessions in 23(21.7%) patients, after three sessions in 4, after for in 1 patient. Complications developed in 18 patients: urinary tract obstruction and attack of acute pyelonephritis (15 and 3 patients, respectively). Within 2-10-year follow-up recurrences arose in 12 patients who were retreated. Thus, ESWL is a method of choice in the treatment of urolithiasis patients with malformations of the kidneys and upper urinary tracts. Good results of ESWL are achieved in strict adherence to principles of the patients' selection, preoperative preparation technique, individual approach to patients in postoperative period, follow-up to detect complications and recurrences.
Tumors arising in human embryo from embryonic laying of an organ can be considered anomalies. Such tumors are renal adenomyosarcoma (Wilms' tumor), mesenchymoma and sarcoma botryoides of the prostatic gland, embryonal cancer of the testis, leydigocellular tumors of the testis and teratomas. Such anomaly as testicular teratoma occurs not rarely. However, testicular teratoma containing brain tissue is a rare finding. A case of teratoma of the left testis is reported in an 11-month-old infant. The tumor contained skin, appendages of the skin, cartilage, bone tissue, brain tissue, hair, fat.
The authors report a case of massive hemorrhage from the vessels of the renal peduncle in a 68-year-old male patient with nephroureterolithiasis after one session of ESWL. Urgent nephrectomy was made. Histologically, there were sclerotic-distrophic changes of the vascular peduncle of the left kidney induced by long-term obstruction of the ureter with the calculus and extravasation of the urine into the renal sinus. This ESWL complication may take place in elderly patients with long-term ureteral obstruction with the stone. In such cases ESWL should be carried out only in hospital.
Three different approaches to treatment of non-seminomal germinogenic testicular tumors (NSGTT) of stage I after orchidofuniculectomy: preventive retroperitoneal lymphadenectomy, preventive chemotherapy, expectant treatment. Recurrences, 5-year recurrence-free and overall survivals reached 17.4, 81.8 and 95.4%; 6.3, 93.8 and 100%; 33.3, 66.4 and 83.5%, respectively. Progression occurred more frequently in patients having invasion of tumor cells in lymphatic and blood vessels in the primary tumor. The authors conclude on preferable use of preventive chemotherapy after removal of the primary tumor.
The authors report a case of a male patient with urate nephrolithiasis aggravated with postrenal anuria due to total obturation of the single kidney's ureter with multiple calculi located as a path. The outcome was satisfactory.
Central hemodynamics was investigated in 23 children aged 3-12 years operated on the upper urinary tracts. By anesthetic management the patients were divided into two groups: those operated under combined neuroleptanalgesia (group 1, n = 14) and under combined epidural anesthesia (group 2, n = 9). The latter anesthesia provided more reliable defense of the child's organism against surgical stress.
Replacement of the gall bladder with an isolated ileal segment was made to evaluate function of the urinary tracts depending on configuration of the created urine reservoir early and late after the operation in dogs. Intestinoplasty of the gall bladder changes parameters of ureteral function. Upper urinary tract urodynamics after ileocystoplasty is characterized by lowering of intraureteral pressure, decreased amplitude of the contractions, high tonicity and motility. The intestinal bladder has the same mean basal pressure at rest but less when full than the control animals. Reflex urination after the bladder reconstruction in subtotal resection was intact. Detubulized urinary reservoir had low intravesical pressure and no spontaneous contraction activity.
1-19-year follow-up results of plastic surgery for fused kidney hydronephrosis (FKH) in 12 children aged 3-14.5 years (a total of 15 hydronephroses, 3 cases of bilateral disease) were estimated as good. Correction of FKH is performed by resection of the affected ureteropelvic segment with bypass plastic reconstruction according to Andersen-Hynes-Kucera, compulsory total resection of the renal isthmus. Isthmotomy can be conducted only in the presence of connective tissue bridge between the renal poles. Often, renal isthmus consisting of parenchyma is to be removed together with resection of the renal pole (in joint circulation). In addition, for good outcome it is necessary to reconstruct pelvis and (or) perform nephropexy with muscular graft. The operated patients need long-term follow-up, control examinations of the kidney, updated treatment following elimination of the obstruction.
The trends in male urinary and genital cancer morbidity and mortality are specified. Statistics on separate malignant urological diseases are provided. In 1996 the number of patients with cancer of male urinary and sex organs reached 31.700. A growth in morbidity was due rather to a higher risk to develop the disease than because of changes in the population age. Urological cancer reduces mean life span of Russian population by 2 months, and the patients' life terminates 10-19 years earlier. Financial losses due to deaths of urological cancer stand as high as 197 million roubles as estimated in 1990 prices.
Laparoscopic dissection of common renal cysts was made in 27 patients who complained of low back pains and hypertension. The diagnosis and indications for operation rested on ultrasonic investigation and dynamic nephroscintigraphy. All the surgical interventions were performed under endotracheal anesthesia after creation of pneumoperitoneum with the use of three trochars. The procedure comprised maximal dissection of the free cystic wall, electrocoagulation of the residual part's margins and retroperitoneal drainage. Postoperative period was uneventful in 92.6% of the cases. Control examination 3 and 6 months after the operation indicated good results: pain relief, stabilization of arterial pressure and improvement of renal function.
