The potentials for the use of free buccal mucosa graft in reconstruction plastic surgery of extended uretral stricture are evaluated. From 2007 to 2013, 9 operations in 8 patients (mean age 54,5+/-7,2 years) were performed. The average length of cicatricial uretral stricture was 5,1+/-0,7 cm. 1 patient has lesion in the upper third of the ureter, 4 patients - in the middle portion, and 4 patients - at the bottom portion. The causes of extended uretral stricture were following: long standing calculi (n=3), ureteral injury after ureterolithotripsy (n=2) and after bringing down the calcuus using loop (n=1), radiotherapy (n=3, one patient had bilateral injury). All patients underwent plastic reconstruction of ureter using buccal mucosa graft by "on-lay" type. During the follow-up (median, 42 months, from 3 to 72 months), in 7 (88,9 %) of 8 patients (8 operations) ureteral strictures relapses were not observed. They all had satisfactory renal excretory function without the pronounced violations of passage of urine along the ureter. The excretory urography showed moderate expansion of the ureter at the site of operation in 6 of them. Due to the progression of secondary renal scarring, one patient underwent nephrectomy 1.5 year after reconstruction plastic surgery. In this patient, pronounced anatomical and functional changes in the kidney occurred before the operation. Application of the buccal mucosa graft in reconstruction plastic surgery in extended uretral stricture is high effective due to the relatively low level of early and late postoperative complications and low recurrence rate.

Stones located in the UPJ are accompanied by the most severe violation of the upper urinary tract urodynamics compared to other localizations of stones, which often leads to severe septic complications requiring emergency care. The study has evaluated the results of treatment of 147 patients with UPJ stones using various methods of treatment, and their efficacy in these patients. Extracorporeal shockwave lithotripsy (ESWL) was performed in 55 patients, contact ureterolithotripsy (CULT)--in 23 patients, percutaneous nephroureterolithotripsy and nephroureterolithoextraction (PCNLT and PCNLE)--in 43 patients, and open surgery (ureterolithotomy, pelviolithotomy)--in 26 patients. The best results in all parameters were obtained from patients with stone size up to 1 cm after ESWL, as well as in patients with stone size greater than 1 cm after PCNLT (PCNLE). In these groups, full discharge of stone at 3 months after treatment was achieved in 95 and 97.7% of patients, respectively. Complications in the ESWL group were recorded in 14.6% of patients, in the PCNLT (PCNLE) group--in 9.2% of patients.

The article presents the results of 42 retrograde nephrolithotripsy (RNLT) performed on 38 patients with staghorn nephrolithiasis. The staghorn cacculi SN-2 were most frequently indication for the intervention. 3 months after surgery, full exemption of the kidney from the fragments was observed in 85,6% of patients. RNLT is an effective and safe treatment for patients with staghorn stones with relatively low need for additional procedures. RNLT allows to reduce postoperative hospital stay and recovery period of patients.

Over the last two decades, marked increase in detection of incidental or asymptomatic renal cell carcinoma (RCC) in developed countries was observed. The study included 268 patients aged from 25 to 92 years with RCC, which underwent evaluation and treatment in urology clinic MRSRCI for the past 5 years. There were no significant differences in the frequency of histological types of RCC between incidental and symptomatic tumors. Among incidental neoplasms with clear- cell structure, tumor with small size--up to 4 cm (T1a stage) and moderate to high degree of differentiation (G 1-2 according Fuhrman) were predominant. Papillary variant of RCC was detected at a higher stage of the disease and characterized by a high degree of nuclear atypia, which indicates its high malignant potential. Chromophobe RCC was usually diagnosed at T3 stage. The average age of men and women with chromophobe RCC was 46.5 +/- 6.8 years; there were no age difference in patients with symptomatic and incidental RCC. Among the benign tumors of the kidneys, angiomyolipoma was most commonly diagnosed--in 13 (53.8%) cases. Thus, incidental tumors have a better prognosis than symptomatic tumors.

Transplantation of the kidney in patients with renal carcinoma is disputable. The article presents the results of kidney transplantation in different cancer lesions of the patient's kidneys. Seven case histories of patients with primary renal tumors are retrospectively analysed. A clinical case of development of the tumor of own kidney in a patient after transplantation is reported. A time factor of kidney transplantation after tumor removal in a recipient is discussed.

A total of 323 transcutaneous roentgenoendoscopic operations were made in 212 patients from January 2000 to December 2009 including 96 operations in 81 presenile and senile patients (87 and 9 operations, respectively). Transcutaneous nephrolithotripsy (TCNT) eliminated concrement from the kidney for one session in 59 (72.8%) patients. It proved to be the most sparing treatment in serious clinical situations and provided maximally complete evacuation of the concrement from the kidney. A total complication rate was 14.8%. All the complications were cured with conservative pharmacotherapy. TCNT has the same indications as open surgery, is a method of choice in presenile and senile patients with large, stag-horn and recurrent concrements of the kidney, impacted pelvicoureteral concrements, in impaired renal urodynamics and high bacteriuria. TCNT can be used as a second-line treatment in failure of extracorporeal shock-wave lithotripsy or in combination with it (sandwich-therapy) for complete concrement elimination.

The analysis of the results of examination and treatment of 510 urolithiasis patients with organic infravesical obstruction (IVO) treated in the urological clinic of M. F. Vladimirsky Moscow Regional Research Clinical Institute and in the urological department of Zhukovsky city hospital from 1995 to 2009 made it possible to arrive at the following conclusions: the above patients have obstruction symptoms in 100% cases, irritative symptoms--in more than 2/3 of the patients; combined use of low invasive, endoscopic and open methods reestablishes urodynamics of the lower urinary tract in more than 90% patients; the decision on the treatment policy and techniques depends on severity of clinical symptoms caused by IVO and urolithiasis as well as disturbance of upper and lower urinary tract urodynamics. In adequate choice of the patients and correct indications combined use of low invasive, endoscopic and open methods provides good treatment effect in patients with IVO and urolithiasis.

Retro- and prospective analyses of 802 case histories of patients with nephrostomic drainage (n=272), ureteral catheter (n=27) and ureteral stent (n=503) treated for urolithiasis in the urological department of M.F. Vladimirsky Moscow Region Research Clinical Institute and Zhukovsky city hospital hospitalized in 1995 to 2009 made it possible to develop algorithms of choice of upper urinary tract drainage depending on clinical and laboratory indices. Nephrostomic drainage is preferable in a single functioning kidney, acute obstructive pyelonephritis, anuria, hyperthermia above 38 degrees C, marked supravesical urodynamic disorder, in renal failure, serum creatinine over 200 mcmol/l, urea over 10 mmol/l, blood potassium over 5 mmol/l, uric acid over 380 mcmol/l and leukocytosis over 8 x 10(9) l. Draining with ureteral stent was used primarily in elective surgery--extracorporeal shock-wave lithotripsy and transurethral operations. Stenting was better tolerated and entailed less frequent complications. In the rest cases choice of drain method should be made by the urologist. In active inflammation, before getting antibioticogram, the drain should be followed by antibiotic treatment with fluoroquinolones, cephalosporines of the third or forth generation, aminoglycosides, carbapenems in standard doses.

We studied efficacy of transcutaneous nephrolithotripsy (TNLT) in patients with urolithiasis and anomalous upper urinary tract. For two years we performed TNLT in 148 patients with complicated forms of urolithiasis and anomalous kidneys (age 18-86, 76 females and 72 males). The examination for urolithiasis has found different anomalies of the urinary tract in these patients: double pelvis and ureter (9 cases--6.1%), lumbar dystopy of the kideney (59 cases--39.9%), horseshoe kidney (12 cases--8.1%), solitary cyst of the kidney (43 cases--29.0%), parapelvic cysts (25 cases--16.9%). Extracorporeal shock-wave lithotripsy (ESWL) was conducted as first-line treatment in the other 139 patients with nephroliths under 1.5-2 cm in size who had the following anomalies of the urinary system: a solitary kidney (n=14), double pelvis and ureter (n=26), anomalous position of the kidney (n=46), anomalous shape of the kidney (n=20), simple and parapelvic cysts (n=33). A total of 154 TNLT were performed in 148 patients. Transcutaneous interventions were most frequent in the treatment of coral (31.3%) and pelvoureteral (14.6%) concrements, one-stage operation was made in 143 patients. Transcutaneous puncture nephrostomy as the first stage was made in 5 patients. The concrements were removed by one operative intervention in 132 (89.2%) out of 148 patients. Exacerbation of pyelonephritis as a postoperative complication was treated conservatively in 12.5% patients. Residual fragments were diagnosed in 16 patients. Of them, 11 patients had multiple and 5 patients had coral concrements. Residual fragments were removed in 14 patients either by renephroscopy or by ESWL. Treatment of 139 patients with concrements less than 1.5-3 cm in size consisted in 197 ESWL sessions. In combination of anomaly and urolithiasis the number of lithotripsy sessions per one patient was 1.8 +/- 0.2. The least number of ESWL sessions per one patient was conducted in patients with lumbar dystopy of the kidney (1.3 +/- 0.45), the greatest number in horseshoe kidney (3.8 +/- 0.8). Evacuation of the concrements after ESWL depended on the type of anomaly and concrement location. It was 61-69% in patients with anomaly of the shape and position of the kidney, in cystic anomalies is was 89-91%. Open surgery was indicated in 7 patients who needed plastic surgery of hydronephrosis (4) and obstructive megaureter (3). Thus, low-invasive operations provide high efficacy of urolith removal in patients with anomalies of the urinary tract and can replace traumatic open operations.

The examination and surgical treatment were performed in 34 kidney recipients (22 males and 12 females aged 16-65 years) with different urological diseases admitted to the urological clinic of M. F. Vladimirsky Moscow Region Research Clinical Institute in 1992-2007 3 weeks to 15 years after kidney transplantation. Most of the patients had urolithiasis, prostatic adenoma, some patients had renal cyst, implanted kidney tumor, tumor of the arteriosclerotic kidneys, posterior urethra stricture, posterior urethra valve. The recipients with such urological diseases as chronic pyelonephritis, vesicoureteral reflux, chronic prostatitis, chronic cystitis received conservative treatment outpatiently. Extracorporeal lithotripsy (ELT) was made in 12 patients (each patient, except one, was exposed to 2 sessions, one patient--3)--a total of 27 sessions. After the first ELT session fragments of the concrements (mean size 2-5 mm in diameter) evacuated spontaneously. Transurethral (retrograde) x-ray-endoscopic operations for removal of the transplanted kidney uroliths were not conducted as the newly created ostium in the upper part of the urinary bladder made it impossible to use a retrograde approach for elimination of the concrements. Kidney recipients with prostatic adenoma (2 and 5 years after transplantation) in 3 cases were subjected to scheduled TUR because of manifest obstructive symptoms. Four patients with AUR undergoing TUR showed intraoperative tissue hemorrhage as the operation was conducted during anticoagulant and anti-platelet therapy used early (3 months to 2 months after the transplantation. In view of this, TUR lasted longer as adequate hemostasis was needed. Urethral nitinol stenting was made in one patient with AUR and prostatic size over 60 cm3, TUR was made 4 months later. Thus, low invasive surgical interventions in kidney recipients with urological diseases have changed routive approaches to treatment of such patients consisting in open surgery which was often cancelled because of contraindications. ELT is a basic method of treatment of the transplant's uroliths, in other cases different endourologic interventions are used. Prostatic adenoma is treated, as a rule, surgically (TUR of the prostate).

A total of 1100 sessions of extracorporeal shock wave lithotripsy (ESWL) were made in 720 patients with urolithiasis in the last decade with application of LGK-Compact lithotripter which generates shock waves electrodynamically and has no focusing lens. Such lithotriptor allows ESWL in patients with a high anesthesiological risk. Fitting the LGK-Compact lithotriptor with an endourological complex ENDO-MIT tooled for low-invasive interventions under X-ray control enabled treatment of 467 patients with urolithiasis aged 30-80 years. Most of the patients (66.04%) were at the productive age of 18-50 years. ESWL on the LGK-Compact lithotriptor was made in 182 patients (mean number of sessions was 2.1). Six and 12 month follow-up examinations registered complete elimination of the fragments in 169 patients. Thirty-four patients with concrements of the intramural ureter were exposed to 1 to 3 sessions. The fragments eliminated for 1-14 days after the session in 25 patients. Three patients developed stone path which evacuated spontaneously in two cases. For 3 years transcutaneous nephrolithotripsy was conducted in 214 patients. The concrements were removed during one operation in 156 (72.9%) patients, 58 (26.1%) patients had residual fragments. Reoperation was made in 34 patients 7-12 days after the first intervention. In the rest 24 cases (11.2%) residual fragments were removed by means of ESWL on LGK-Compact. Thus, ESWL is a leading technique in management of uncomplicated uroliths maximum 2 cm in size. When indications to ESWL are limited or this method is not effective, the role of roentgenoendoscopic interventions, such as transcutaneous nephrolithotripsy and transurethral contact ureterolithotripsy, takes on special significance. Such clinical innovation as endourological complex ENDO-MIT with lithotripter LGK-Compact made in Russia opens new perspectives of the treatment of urolithiasis and other urological diseases due to introduction of novel highly effective domestic technologies leading to a significant reduction in the number of postoperative complications and time of treatment, to 1.5-2 fold reduction in costs of equipment compared to foreign analogues.

The aim of our study was assessment of clinical efficacy and safety of a new alpha-adrenoblocker kamiren XL in patients with prostatic adenoma (PA) with or without acute retention of urine (ARU). Seventy PA patients were divided into two groups. Group 1 (n = 35) patients had no ARU. They received kamiren XL in a dose 4 mg/day for 1 month. Group 2 (n = 35) patients received the same doses of kamiren XL in addition to urethral catheterization for 3-7 days. In group 1 efficacy of the pharmacotherapy reached 91.4%. Overall symptoms score fell by 45.2% (from 18.5 +/- 6.9 to 10.2 +/- 5.9), quality of life--by 36.5% (from 3.7 +/- 1.5 to 2.4 +/- 1.4), volume of residual urine diminished by 54.9% (from 35.2 +/- 42.1 to 15.9 +/- 24.4 ml), Qmax rose by 37.7% (from 9.6 +/- 2.7 to 13.3 +/- 4.6 ml/s). Side effects (weakness--11.4%, vertigo--8.6%, sleepiness--5.7%) were registered in 5 (14.3%) patients. The drug produced significant changes neither in systolic, diastolic blood pressure nor heart rate. In group 2 urination resumed in 25 (71.4%) patients. Of them, 45.7% patients considered their voiding satisfactory, control ultrasound investigation detected that their residual urine was less than 50 ml while Qmax was over 5 ml/s. Difficulties in urination were experienced by 25.7% patients who demonstrated residual urine in the range 10-210 ml and Qmax under 5 ml/s. Side effects were seen in 14.3% patients. Thus, alpha-adrenoblocker kamiren XL (doxasozine retard) is a highly effective and safe drug for treatment of PA patients including those with ARU.

A case is reported of a 58 year old patient with a diagnosis: double giant ureterocele, secondary multiple calculi of the right ureterocele, calculus of the inferior calyx of the right kidney, calculus of the terminal part of the left ureter, double ureterohydronephrosis, chronic pyelonephritis, multiple calcifying myoma of the uterus. A combined single-stage operation (panhysterectomy, deletion of multiple calculi of the right ureterocele, deletion of the calculus of the left ureterocele, crosscut right ureterectomy with excision of ureterocele, right ureterocystoneostomy by Leadbetter-Politano, installation of the double J-stent into the right kidney, crosscut and longitudinal left ureterectomy with excision of ureterocele, left ureterocystoneostomy by Leadbetter-Politano, installation of intubating drainage into the left ureter, cystostomy) followed by extracorporeal shock-wave lithotripsy were performed in this adult patient with combined pathology of the urinary system.

Application of radical methods of prostate cancer treatment isn't always possible which is, first of all, associated with the fact that the majority of the disease cases covers somatically aggravated elderly patients. Development and improvement of alternative, high-technology methods of the prostate cancer treatment is an urgent problem of the uptoday urology. One of such methods is an ultrasound ablation that is virtually a high-intensity focused ultrasound (HIFU) waves (3 mHz) influence on the prostate tissue. Our observations are indicative of the fact that HIFU is an effective, miniinvasive, and a rather safe, mini-complicated method of treatment which allows to use it in the somatically-aggravated patients with prostate cancer.