The study was aimed to the evaluation of the effectiveness and results of ultrasound guided percutaneous nephrolithotripsy (PNL) for the treatment of patients with large stones in renal pelvis. The results of PNL in 138 patients who underwent surgery for kidney stones from 2011 to 2013 were analyzed. Seventy patients (Group 1) underwent surgery with combined ultrasound and radiological guidance, and 68 patients (Group 2)--only with ultrasound guidance. The study included patients with large renal pelvic stones larger than 2.2 cm, requiring the formation of a single laparoscopic approach. Using the comparative analysis, the timing of surgery, the number of intra- and postoperative complications, blood loss and length of stay were evaluated. Percutaneous access was successfully performed in all patients. Postoperative complications (exacerbation of chronic pyelonephritis, gross hematuria) were observed in 14.3% of patients in Group 1 and in 14.7% of patients in Group 2. Bleeding requiring blood transfusion, and injuries of adjacent organs were not registered. Efficacy of PNL in the Group 1 was 95.7%; 3 (4.3%) patients required additional interventions. In Group 2, the effectiveness of PNL was 94.1%, 4 (5.9%) patients additionally underwent extracorporeal lithotripsy. There were no significant differences in the effectiveness of PNL, the volume of blood loss and duration of hospitalization. Ultrasound guided PNL can be performed in large pelvic stones and sufficient expansion of renal cavities, thus reducing radiation exposure of patients and medical staff.
The treatment of patients with large calculi, formed on both ends of the long-standing stent, remains difficult problem of modern urology. We observed 6 patients with long-term (16 to 24 months) standing stents. Large calculi on both ends of the drain were detected in 5 patients, fragmentation of stent--in 1 patient. Indication for stenting was ureteral calculus in 4 patients, staghorn stone of the left kidney in one pregnant woman 26 years old, and the stent was installed during orthotopic cystoplasty in 1 patient. At the first stage, contact laser lithotripsy of calculus on cystic end of the stent was performed, and distal portion was removed with forceps. 2-3 weeks after, PCNL was performed and renal end of the stent was removed. Patient with fragmentation of stent underwent ureteroscopy, and parts of the drainage were removed. To remove the stent, on average 1.8 endourological intervention was required. Results of operations in all cases were successful. Endourological operations are an effective method for the treatment of patients with large calculi, formed at both ends of the "forgotten" stents.
This work is devoted to the vital topic of the influence of partial androgen deficiency of aging men (PADAM) on the development of cells with androgen receptors. The results obtained in this study suggest a conclusion that the production of testosterone by some tumors and tissues of the peritumorous zone, which is accompanied by increased proliferative activity and disturbance of the regulation of the cell cycle, is caused by PADAM. The given changes are directed at compensating for testicular deficiency (in particular at overcoming the androgen-dependent stage of development of androgen-sensitive cells). These changes are a partial manifestation of metabolic syndrome (X-syndrome). The atypical cells, which unavoidably develop during metabolic syndrome, are dealt with by means of the immune system, whose capabilities become less and less adequate in the given circumstances.
The article presents the description of the clinical observation of the 36 years old patient with testicular feminization syndrome: genetic (karyotype 46 XY) and gonadal male sex, female external genitalia and the absence of derivatives of Mullerian ducts (uterus, fallopian tubes, the upper third of the vagina). At the first stage, testes were removed; then, vaginoplasty using segment of the sigmoid colon for possible sexual intercourse was performed. There were no complications. Currently, the patient's condition is satisfactory; she lives a regular sex life.
Urgent surgical treatment was conducted in 3 patients admitted to hospital with neocystic rupture which occurred 6, 10 and 22 months after removal of the bladder with orthotopic cystoplasty. Two patients have undergone laparotomy, neocystic defect repair and drainage. In the third patient mobilization of the reservoir was accompanied with accidental cut of the ureters. Relaparotomy was made with bilateral ureterocutaneostomy. Intestinal plastic reconstruction of both ureters followed after stabilization of the patients' condition. Thus, all the patients with ileoneocystis rupture were successfully rehabilitated.
We performed subcutaneous bypass draining (SBD) of the upper urinary tract (UUT) in 12 patients (3 males, 9 females, mean age 64 years) in 2006-2008. Ureteral obstruction was caused by a tumor in 11 patients, one patient had extended obliteration of the left ureter after resection of the abdominal aorta aneurysm and two plastic operations on the UUT. All the patients with ureteral tumor obstruction had only one functional kidney. For SBD of the kidney we used Detoure stent in 2 cases, the nephrovesical bypass - in the rest cases. Surgery was made in the lateroposition of the patient which provided sumaltenous establishment of the renal and vesical ends of the stent. The kidney was also drained by the nephrostoma in 8 patients. The nephrostoma was removed after antegrade pyelography and pyelomanometry. Intraoperative complications were not registered. Suprapubic urine leak in 3 patients previously given radiotherapy was stopped by a long drain of the bladder. Obstruction of the distal stent part by a progressive tumor was diagnosed in 1 patient 3 months later. The bypass was removed and a nephrostomic drainage was made. The nephrovesical stent was changed in one case 5 months after SBD. Upon 6-32 month follow-up 3 patients died of cancer progression, the rest are still alive. Thus, SBD is indicated if stenting, ureteral endoprosthesis, constant nephrostomic drainage are impossible. In some cancer patients with ureteral obstruction in UUT drainage SBD is a method of choice with promising short- and long-term results.
The paper presents the results of 114 radical cystectomies made in 1996-2002. The age of 114 patients (103 males, 11 females) ranged from 37 to 78 years (mean age 57.5 years). Transient cell carcinoma was diagnosed in 81.5% patients. Supravesical urine derivation was conducted by means of ureterocutaneostomy and transureteroureteronephrostomy in 9 (7.9%) patients, ureterosygmoanastomosis--in 43 (37.7%) patients, artificial orthotopic urinary bladder was created in 7 (6.1%) patients of a gastric segment and in 55 (48.2%) patients of the ileum. Postoperative complications were observed in 28 (24.6%) patients, intestinal obstruction being a prevailing complication. Five patients died: 2 of pulmonary artery thromboembolism, 1 of acute cardiac failure, 1 of sepsis and 1 of gastric bleeding. Continent methods of urine derivation were preferred, such as ureterosygmoanastomosis by Mainz-Pouch II and creation of orthotopic urinary bladder of the stomach or of the ileum.
Percutaneous interventions for diseases of the kidneys and upper urinary tracts (UUT) were fulfilled in 1254 patients. In renal cysts puncture, evacuation of the content and sclerotherapy were fulfilled. Repeated punctures of the cyst were fulfilled in 20, laparoscopic excision of it was fulfilled in 16 patients. In 499 patients with cholelithiasis 427 percutaneous nephrolitholapaxy and 87 extractions of the stone without its fragmentation were fulfilled. Percutaneous treatment of cholelithiasis by monotherapy was effective in 89.8% of the patients, in 10% of the patients distant lithotripsy was performed for residual stones. Good results of endoscopic correction of UUT strictures were obtained in 85.9% of the patients, unsatisfactory results--in 14.1%. Percutaneous interventions for foreign bodies in UUT and tumors of the pelvis were successful in all observations.
The results of examination of serotonin content in blood of 35 patients with different stages of gastric cancer are reported. Patients with cancer of the stomach show a decreased blood serotonin level compared with analogous data, obtained in healthy individuals and in patients with ulcerous disease of the stomach and duodenum. Contrary to patients with ulcerous disease in patients with gastric cancer hyperserotoninemia would not be restored postoperatively.
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