Vol 19, No 7 (2017)
Articles
The current state of the incontinence problem after radical prostatectomy
Abstract
A significant proportion of patients after performing radical prostatectomy face the problem of urinary incontinence (UI). Factors affecting the recovery of urine retention after radical prostatectomy can be conditionally divided into 3 groups: pre -, intra - and postoperative. The degree of their influence remains a subject for discussion. In the vast majority of cases, the continence is reached for some time after the operation, from several days to 1 year. The examination of a patient with UI should be comprehensive. The leading role among conservative measures of correction of incontinence is played by exercises for training the muscles of the pelvic floor. In the case of unsuccessful therapeutic measures, it is advisable to consider the question of surgical treatment. Patients suffering from UI light or in some cases of moderate severity can benefit from minimally invasive surgical correction methods, including sling operations. The modern "gold standard" in the treatment of patients suffering from a severe degree of UI remains an artificial urinary sphincter AMS 800. Indications for the implantation of slings and artificial urinary sphincter expand, which provides a cure for patients who have undergone a number of medical interventions. All this allows to provide an individual approach to each patient and optimize the quality of life.
Consilium Medicum. 2017;19(7):8-14
8-14
Precision of preoperative assessment of malignancy degree and prostate cancer stage
Abstract
Introduction. Despite the continuous improvement of preoperative examination methods, changes in the requirements for interpretation of the results of pathomorphological examination, the frequency of the difference in staging and evaluation of the degree of differentiation of prostate cancer before and after radical prostatectomy remains high. Materials and methods. A retrospective clinical study included 563 patients (mean age 61.3 years) with histologically verified localized and locally advanced prostate cancer. All patients underwent transrectal multifocal biopsy of the prostate under ultrasound guidance and then, during the period from January 2012 to March 2014, robot-assisted (n=490) or retropubic (n=73) radical prostatectomy in the urology clinic of A.I.Evdokimov Moscow State University. The percentage of tumor malignancy and disease stage difference before and after radical prostatectomy was calculated using a joint allocation table. Results. The frequency of Gleason scores before and after surgery was: for the sum of points (3+3) 6 - 55.0% (out of 285 only in 194 cases), (3+4) 7 - 39.6%, (4+3) 7 - 45.6%, 8 - 32.0%, 9 - 57.1%, respectively. The overall frequency of the Gleason score before the operation and the Gleason score after the operation was 48.7% (in 253 cases). Reduction in Gleason score was recorded in 12.9% of patients, increase in 38.2%. The stages of the disease - the T2c coincidence was less than 50%. In almost 40% of cases, a higher stage of the disease, pT3a, was diagnosed. In 1/4 of patients, the clinical stage of T3a was pT3b. The coincidence of the clinical and pathomorphological stage of the disease was recorded in only 1/4 of the patients participating in the study. Conclusions. The formation of the clinical stage of prostate cancer and the determination of the degree of malignancy of the disease in the preoperative period do not correspond to postoperative in about 50% of cases. It is necessary to take this fact into account when forming therapeutic tactics and to work on further improving the methods of preoperative examination of patients with prostate cancer.
Consilium Medicum. 2017;19(7):15-19
15-19
Long-term results of radical prostatectomy with locally advanced prostate cancer
Abstract
Radical prostatectomy for locally advanced prostate cancer is not a sufficiently effective method because of the frequent occurrence of early local tumor recurrences and metastases. In this regard, the evaluation of long-term results after radical treatment requires a long period of observation. Radical prostatectomy is limited by age and is performed in patients not older than 70-72 years, expected life expectancy of more than 5-10 years and minimal amount of concomitant diseases in the compensation stage. The level of prostate-specific antigen allows us to identify clinically significant and potentially curable forms of prostate cancer. The study of prognostic factors allowed isolating a group of patients in the stage of T3 with a favorable prognosis for a disease-free lifespan after radical prostatectomy.
Consilium Medicum. 2017;19(7):20-22
20-22
Evaluation of renal function after partial nephrectomy for cancer
Abstract
Introduction. Renal cancer is one of the leading urological cancers due to annually increasing morbidity and mortality rates for the last 10 years (29.39%), conceding in our country only prostate cancer. Aim of the study - to assess the functional results of nephron-sparing surgeries with a preventive hemostatic suture in patients with renal cell carcinoma using nephroscintigraphy and computed tomography. Material and methods. In 41 urological department of the S.P.Botkin City Clinical Hospital developed and implemented a new technique of partial nephrectomy with preventive hemostatic suture. Dynamic nephroscintigraphy was used to evaluate a renal function. Volume indexes was evaluated via contrast enhanced computed tomography (CT). Study included 150 patients with pT1a-pT2bN0M0 kidney cancers. Central tumor location was in 64 patients, 45 patients had upper segment tumors and 41 lower segment tumors. 74 patients had T1a tumor stage, T1b and T2a stage observed in 53 and 4 patients respectively. 19 tumors was cystic RCC’c. Results. All patients underwent nephron-sparing surgery. Mean operative time was 180±40 minutes, mean anesthesia time was 190.5±15 minutes. Mean blood loss was 250±70 ml. We didn’t used arteria clamping and warm ischemia and there was no conversions to nephrectomy during all partial nephrectomies. Perfusion index of the kidney before the surgery was 54.13±2%, after the surgery 46.23±3%, renal index was 53.24±4% and 46.82±2.39%, respectfully. In our opinion decreasing of renal indexes in early postoperative period is associated with loss of kidney parenchyma due to the surgery. Mean kidney volume was 140±30 cm3 with 120±20 cm3 functional parenchyma volume and mean tumor volume 40±20 cm3. Functional parenchyma volume after surgery insignificantly decreased to 115±20 cm3. Conclusion: preventive hemostatic sutures during partial nephrectomy allows to remove the tumor in almost any part of the kidney, At the same time, its vessels are not worn out, which makes it possible to protect the renal parenchyma from ischemic damage, thereby maximally preserving its function, as confirmed by nephroscintigraphy and CT.
Consilium Medicum. 2017;19(7):23-27
23-27
Correlation of antiviral antibodies and morphological changes in bladder cancer patients
Abstract
Currently, the task of searching for prognostic criteria of disease progression and recurrence of bladder cancer is extremely important. Objective. To evaluate the correlation of the level of antiviral antibodies and morphological changes in bladder cancer. Materials and methods. The examination and treatment of 100 patients (72 men and 28 women), aged from 38 to 90 years (mean age 65±10) with referral diagnosis of bladder cancer. Additionally performed: a blood test for IgG, M to herpes (HSV) type 1 and 2, cytomegalovirus (CMV), the virus Epstein-Barr (EBV). The tumor tissue and urine of patients taken for PCR diagnosis of viruses HSV 1 and 2 types, high-risk types of HPV, CMV, EBV. Results. Levels of antiherpetic antibodies are set for morphological changes in the form of koilocytosis, degradation of the surface of the tumor cells, perivascular lymphoid infiltration, the presence of lymphocytes in tumors as prognostic factors of tumor processwhich only start to appear. Specified levels of antiviral antibodies, according to which it is possible to predict the recurrent nature of the tumor and polyvocality lesions of the bladder wall. Conclusions. The correlation of the level of antiviral antibodies and morphological changes that allow with high probability to predict the course of neoplastic process.
Consilium Medicum. 2017;19(7):28-34
28-34
Prostate-specific antigen as a marker for prostate diseases and a target for drug therapy (literature review)
Abstract
Prostate-specific antigen (PSA) not only is the factor of prostate diseases diagnosis but regulation of its activity also influences the state of such diseases as benign prostatic hypertrophy (BPH) and chronic pelvic pain syndrome (CPPS). Functions of PSA are not limited by its key biological role - decrease in the semen rheological properties, PSA is involved in various cascade reactions including pathological ones. The medication Afalaza containing affinity purified antibodies to PSA and endothelial NO-synthase (eNOS) in released-active forms modulates PSA and eNOS activity providing antiproliferative, anti-inflammatory and endothelium-protective effects that result in the improvement of urodynamic parameters and increase of life quality of patients with BPH and CPPS.
Consilium Medicum. 2017;19(7):35-40
35-40
Perioperative indicators of quality of life in patients with localized kidney cancer
Abstract
Introduction. Standartized morbidity rate of kidney cancer has increased on 60.4% over the last ten year and was 9.02 per 100 thousand people. There is persist high mortality rate 4,4 per 100 thousand people (RF 3.4) and one-year mortality 19.3% (RF 18.0%). 3524 patients with kidney cancer were registrated in the period from 1999 to 2013, part of them, namely 2230 (63.3%) patients were operated and only 341 (15.3%) patients had organ-saving operations. The quality of life (QoL) remains a poorly understood issue. Purpose. Conduct a comparative analysis of the QoL of patients with localized kidney cancer in the perioperative period. Materials and methods. This study included 35 adult patients with kidney cancer (T1-2N0M0) underwent open partial and radical nephrectomy. To compare their peritoperative quality of life, the patients filled in questionnaire EORTC QLQ-C30 (version 3). Results. The baselines of global health status, role and social functions, fatigue, loss of appetite, insomnia were higher in the group of partial nephrectomy. The global health status, physical and emotion status were significantly better in group after partial nephrectomy. The using of open access reduced QoL in both groups according to functional scales due to comparable severity of pain syndrome and decreased social functions. The wide introduction of endoscopic partial nephrectomy can improve QoL and rapid rehabilitation of patients with kidney cancer. Conclusion. High physical and emotional functions, general health status are characteristic of organ-saving operation with advantages in laparoscopic access.
Consilium Medicum. 2017;19(7):41-44
41-44
On appointment of M-cholinolytics after synthetic sling operation in women
Abstract
A group of patients (123 women, mean age 54 years) with urinary incontinence under tension, who had undergone surgery of a trocar synthetic sling earlier after the examination and conservative preparatory treatment, was under observation. In the postoperative period, a subgroup of women (28 patients, 24% of the total number of operated patients) was allocated, who underwent conservative treatment in connection with the onset of the syndrome of a hyperactive bladder. For therapy, a combination of drugs with the appointment of M-cholinolytics trospii chloridum (Spasmex®) and α1-adrenoblocker was chosen. As a result, correction of urinary disorders occurred. According to the neurophysiological model, the appointment of M-cholinolytics for a long period is completely justified and safe provided there is no infravesical obstruction.
Consilium Medicum. 2017;19(7):45-49
45-49
Hemorrhagic cystitis in women: epidemiology, etiology, pathogenesis, diagnosis
Abstract
Hemorrhagic cystitis (HC) in the structure of inflammatory diseases of the lower urinary tract occupies from 5 to 10%, and recently there has been a tendency to increase the number of patients with this disease. HC may be a complication of antitumor chemo - or radiation therapy in patients with malignant tumors of the pelvic organs. However, the most common HC occurs in women with chronic herpes-viral infection. Given the variety of etiological factors leading to the onset of HC, various pathophysiological mechanisms of the disease development take place, which requires an individual approach, the development of examination algorithms and the management of these patients. The article includes a review of foreign and domestic scientific publications on the epidemiology, etiology, pathogenesis and diagnosis of HC.
Consilium Medicum. 2017;19(7):50-55
50-55
Radon therapy in complex treatment and rehabilitation of patients with chronic cystitis
Abstract
The problem of chronic cystitis therapy remains one of the most difficult tasks of urology. Sanatorium treatment in many ways makes it possible to solve this problem, but it is not always possible to completely stop the symptoms of the disease. The use of herbal preparations can improve the results of therapy. We conducted a study aimed at identifying the most effective treatment for patients with chronic cystitis at a sanatorium-resort stage. As a result of this work, we came to the conclusion that a combination of spa treatment with the use of radon waters and herbal medicine Canephron® N allows to achieve the greatest clinical effect in the management of patients with this pathology.
Consilium Medicum. 2017;19(7):56-59
56-59
Bladder capacity and detrusor fibrosis as factors predicting the clinical course of the painful bladder/interstitial cystitis syndrome
Abstract
Painful bladder syndrome / interstitial cystitis is a progressive disease of the bladder, leading to loss of its capacity and severe pelvic pain. Etiology remains unclear, one of the reasons is the violation of the integrity and permeability of the glycosaminoglycan layer of the urothelium due to circulatory disorders. Treatment remains empirical and multidomain. In connection with the development of detrusor fibrosis in complex therapy in the early stages of the disease should include drugs with antifibrotic action, for example, Longidaze.
Consilium Medicum. 2017;19(7):60-64
60-64
Diagnostics of men's infertility: current state of the problem. Clinical lecture
Abstract
Male infertility is one of the key problems of urology. In Russia, as throughout the world, the violation of the reproductive function of men who are infertile marriage has acquired a special medical and social significance. The lecture at the modern level highlights the classification of male infertility, the influence of lifestyle, various external factors, congenital and acquired diseases, methods of clinical, laboratory and instrumental diagnostics.
Consilium Medicum. 2017;19(7):65-69
65-69
Causes of disorders and prospects for improving reproductive health in Russia. Clinical lecture
Abstract
In the article in the form of a clinical lecture, the demographic problems of Russia in the last quarter of a century are analyzed in detail with the analysis of fertility, mortality, and population growth. The cause of these processes is in many respects the problems of infertility in a married couple, the leading factor is often the male factor. At the heart of the decline in male fertility, in addition to social and economic factors, there are unfavorable environmental conditions, occupational hazards, sexually transmitted diseases, early onset of sexual activity in adolescence in young men and women, casual and promiscuous sexual intercourse, alcohol, drugs, etc. A special place Paid attention to the role of emotional and oxidative stress, the deficit of antioxidants and microelements necessary for the normal function of the reproductive system. As an example, the successful use of Selzinc Plus, containing zinc, selenium, vitamins C, E, β-carotene in the required adequate dosage is considered. Ways of improving the prevention of violations of male reproductive function and overcoming male infertility are outlined.
Consilium Medicum. 2017;19(7):70-75
70-75
76-82
The prediction of outcomes of the testicular biopsy in patients with azoospermia using clinical, endocrine and genetic factors
Abstract
Introduction. The prevalence of azoospermia in the population of all men is 1%, and among infertile men - 10-15%. The cause of azoospermia can be various clinical, endocrine, genetic and other factors. The purpose of the study: the identification of clinical, endocrine and genetic factors affecting the detection rate of spermatozoa with open testicular biopsy in patients with azoospermia. Patients and methods. 44 men with non-obstructive azoospermia aged from 20 to 55 years were examined. All patients had a wide range of instrumental, laboratory and physical methods of research before performing a testicular biopsy. In the blood plasma, the level of luteinizing (LH) and follicle-stimulating hormones (FSH), prolactin, total and free testosterone, estradiol, globulin, binding sex hormones was determined. Genetic tests included the study of the karyotype and the determination of the azoospermia factor. Results. In factor analysis, three factors were identified, that is, three sets of hormonal and clinical indicators that affect the outcome of an open testicular biopsy. It turned out that the explained variance reached 85%, and the individual significance of the third factor was highly informative. "Artificial neural network" allowed to reveal the factors influencing the frequency of detection of spermatozoa with open testicular biopsy. Conclusions. The outcome of testicular biopsy in patients with azoospermia is influenced by three groups of factors: the first - FSH and LH, the second - prolactin and age, the third - the age and total testosterone. The artificial neural network revealed the predictors of testicular sperm extraction (TESE) outcomes, which are a combination of clinical (the presence of an operation for varicocele in the past, the age of a patient older than 30 years), endocrine (high FSH), and genetic factors (Klinefelter syndrome, AZFc microdeletions).
Consilium Medicum. 2017;19(7):83-85
83-85
86-88