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卷 11, 编号 3 (2021)
- 年: 2021
- 文章: 9
- URL: https://bakhtiniada.ru/uroved/issue/view/4149
- DOI: https://doi.org/10.17816/uroved.113
Original articles
女性持续性排尿困难：病因诊断和治疗
摘要
绪论。排尿困难-排尿疼痛，伴有尿频和/或排尿困难。
排尿困难见于许多泌尿系统疾病，是寻求泌尿系统护理的最常见原因之一。
该研究的目的是确定女性排尿困难的病因，并制定个性化的治疗方法。
材料与方法。对368名寻求医疗帮助并诊断为“慢性膀胱炎”的妇女进行了调查。该研究的纳入标准为排尿困难（疼痛和频繁排尿，每天超过8次，有或无困难），一年以上的尿失调症处方，以及18岁及以上的年龄。所有患者均接受了全面的泌尿学检查，以确定泌尿系统疾病的原因。
结果。在368名妇女中，只有78名（21.2%）被确诊为“细菌性膀胱炎”。在其余290名（78.8%）患者中，持续排尿困难的原因是其他疾病：膀胱白斑154例（41.8%），膀胱疼痛综合征/间质性膀胱炎38例（10.3%），病毒性膀胱炎34例（9.3%），尿道旁形成29例（7.9%）， 神经源性膀胱功能障碍25例（6.8%），尿道疼痛综合征5例（1.4%）人。排尿困难的原因还有放射后膀胱炎（2例），膀胱继发结石（2例），1例诊断为生殖器外子宫内膜异位症。
结论。女性持续性排尿困难的原因多种多样，需要对患者进行仔细检查。只有在准确确认诊断后才能进行治疗。
195-204
作为局限性前列腺癌患者预后标志物的前列腺特异性抗原密度
摘要
绪论。在改善前列腺癌患者治疗结果的领域中，最重要的任务是按风险组正确分层。现代分层系统不能为所有前列腺癌患者提供充分的风险评估。用于预测特定患者前列腺癌临床病程的算法的进一步开发可以积极影响疾病的病程和结果。
目的：前列腺特异性抗原（pPSA）密度在接受激素联合放射治疗的局限性前列腺癌患者中的临床和预后价值测定。
材料与方法。在1996年1月至2007年7月期间接受联合激素放射治疗的272例局限性前列腺癌患者中，评估了pPSA参数对肿瘤特异性生存率以及肿瘤过程的临床和形态学参数的影响。
结果。pPSA指标的高度临床意义已得到证实。PPSA的增加与血清PSA浓度的增加、PSA倍增时间的减少以及肿瘤分化的减少相关。pPSA的预后价值在接受联合激素放射治疗的局限性前列腺癌患者中得到证实。使用ROC分析，确定pPSA指数的阈值为—0.36 ng/（ml/cm3），超过该阈值与肿瘤特异性生存水平的统计学显著降低相关。曲线下面积为0.703（95% CI 0.236–0.434；p<0.001）。随着pPSA值的增加，肿瘤特异性死亡和复发的风险也会增加。
结论。pPSA参数是一种可靠的前列腺癌生物标志物，具有很高的临床和预后意义，其使用与引入昂贵且繁琐的实验室和仪器诊断方法无关。
205-212
下尿路异物取出术的特点
摘要
绪论。在临床实践中患者将异物引入膀胱和尿道的情况相对少见。因此，科学文献中关于从尿路取出异物方法的信息不足。
目的：确定从尿道和膀胱中取出异物的最佳方法。
材料与方法。21名患者中包括15名(71.4%)男性和6名(28.6%)女性，从下尿路取出异物。在7名 (33.3%)患者中异物在尿道中，14名(66.7%)在膀胱中。尿道和膀胱的异物通过内窥镜或在开放手 术中取出。
结果。9名患者在开腹手术中切除了泌尿道刺伤、切割和玻璃物体。12例患者在尿道膀胱镜下切除了边缘均匀的异物。同时，在两名患者中，凝结栓剂首先在膀胱腔内破碎，然后部分取出。1例患者在膀胱结石碎裂前用嵌有结石的栓剂行膀胱结石碎裂术。
结论。开放手术中，从下尿路取出边缘锋利或由玻璃制成的异物更安全。内窥镜可最佳去除表面光滑平整的异物。可以在膀胱腔内碎裂的又长又大的异物最好分部分去除。当异物结有大块结石时，应在内镜下取出异物前进行膀胱石研碎术。
213-218
Application of the complex Edelim in pathogenetic management of patients with erectile dysfunction
摘要
AIM: To assess the degree of changes in complaints, dynamics of biochemical parameters of lipid metabolism, penile hemodynamics in patients with ED during therapy with EDELIM in comparison with PDE-5 inhibitors. Assess the tolerability of the drug based on the analysis of reported adverse events.
MATERIALS AND METHODS: The study was prospective comparative observational cohort. The study included 60 patients over 18 years old with complaints of persistent, at least 1 month, erectile dysfunction. The patients were divided into 2 groups: group 1 – patients with ED received Edelim on a regular basis, one capsule 2 times daily for 3 months; group 2 – patients with ED received generic tadalafil 5 mg daily for 1 month, then 1 month break, then 5 mg per day for 1 month.
RESULTS: The mean age of the patients was 38.4 ± 9.2 years. In group 1, significant differences were noted in the all hemodynamic and biochemical indicators, except for HDL levels (2.2 ± 0.4 vs. 2.3 ± 0.4 mmol/L; p = 0.067). In group 2, significant differences were noted in the dynamics of the IIEF-5 scale, the level of HDL, and the blood flow velocity in the right and left cavernous arteries. There were no significant differences in blood flow in the left and right dorsal arteries, levels of total cholesterol, LDL, triglycerides, glucose, HbA1c, systolic blood pressure. In the 1st group of patients, there were no adverse events, in the 2nd group, in 3 patients – mild side effects.
CONCLUSIONS: The improvement in the quality of erection in the group of patients taking Edelim is associated with decrease in the lipid profile, glucose, glycated hemoglobin, which can be regarded as a variant of pathogenetic conservative treatment of ED.
219-225
Hemodynamics and functional state of the contralateral kidney in the early postoperative period after surgical treatment of kidney cancer
摘要
AIM: To study the hemodynamics and functional state of the renal tissue of the contralateral kidney in the early postoperative period after surgical treatment of kidney cancer.
MATERIALS AND METHODS: The prospective study included 58 patients with renal cell carcinoma, 36 (62.1%) of whom underwent radical nephrectomy, and 22 (37.9%) underwent partial nephrectomy. Tumor sizes ranged from 1.0 to 12.0 cm. All patients before surgery and in the early postoperative period underwent ultrasound examination of the structure and size of the kidneys, Doppler ultrasonography of the renal vessels, biomicroscopy of the bulbar conjunctiva, measured peripheral blood pressure, determined the glomerular filtration rate (GFR) and performed a coagulogram. The control group included 16 healthy adults.
RESULTS: In 83.3% of patients after radical nephrectomy and in 13.6% of patients after partial nephrectomy a tendency towards an increase in blood pressure compared with the initial values was noted by the 2-4th day after the operation. By the 5th day after surgery, the volume of the only kidney remaining after radical nephrectomy increased by an average of 4% (from 126.1 ± 1.4 to 131.2 ± 2.1 cm3, p < 0.05), while after partial nephrectomy has not changed reliably. After surgery, a decrease in GFR was detected in 34 (58.6%; p < 0.05) patients, including after radical nephrectomy (n = 28) – up to 73.4 ± 8.2 ml / min / 1.73 m2, after partial nephrectomy (n = 6) – up to 98.2 ± 3.4 ml / min / 1.73 m2. Doppler ultrasonography of the vessels of a single kidney in patients after radical nephrectomy showed a moderate increase in linear blood flow, an increase in the resistance index in the main trunk of the renal artery, and a decrease in the pulsation index in the segmental and arc arteries. In patients after partial nephrectomy in the contralateral kidney these changes were not observed. When performing biomicroscopy of the bulbar conjunctiva in 83.3% of patients after radical nephrectomy and in 13.6% of patients after partial nephrectomy, changes in the microvasculature were revealed: narrowing of arterioles, expansion of venules, slowing of venular and capillary blood flow. Before the operation and in the early postoperative period, the content of fibrinogen and soluble fibrin-monomer complex in the blood of patients with renal cell carcinoma was significantly higher than in the control group.
CONCLUSIONS: In patients with renal cell carcinoma, changes in the contralateral kidney in the early postoperative period after radical nephrectomy are significantly more pronounced than after partial nephrectomy, and are accompanied by changes in systemic and local hemodynamics and kidney function. The results of the study confirm the feasibility of performing organ-preserving surgeries in patients with renal cell carcinoma.
227-233
Kidney damage in COVID-19 patients
摘要
The results of the analysis of case histories of 100 deceased patients (55 women and 45 men), whose cause of death was the syndrome of multiple organ failure due to COVID-19, are presented. The case histories of patients who had no previous renal dysfunction were selected for the analysis. The average age of the patients was 76 years. At the terminal stage of the disease, microhematuria was detected in 27 patients, hypercreatininemia was noted in 17 patients, while the creatinine content in the blood did not exceed 437 μmol / L in any of 100 patients. Oliguria was observed in 9 patients, polyuria – in 43 patients. A possible cause of kidney damage is the damaging effect of SARS-CoV-2 on the proximal convoluted tubules of the nephron. At the same time, in no patient with a severe course of COVID-19, kidney damage did not determine the severity of the condition and was not the cause of death.
235-240
Reviews
Anatomical, physiological and pathophysiological features of the lower urinary tract in gender and age aspects
摘要
In the review article, based on the results of modern clinical and experimental studies, gender and age-related features of the anatomy, physiology and pathophysiology of the lower urinary tract are considered. The features of the structure and functioning of the urothelium, myothelium, neurothelium and endothelium of the lower urinary tract in men and women are described in detail. A separate section of the review is devoted to the peculiarities of hormonal regulation of the lower urinary tract, depending on gender and age.
241-256
Lectures for the doctors
泌尿科医师实践中的自主反射障碍
摘要
自主性反射障碍（AVD）是一种潜在的生命危险状态，发生在脊椎损伤患者的T6段或更高的水 平上。首先，这种状态表现为无法控制的动脉高血压，可能导致严重的并发症，甚至死亡。AVD发展的原因通常是泌尿系统并发症，以及对下泌尿道的诊断和治疗操作。对于执业泌尿科医生来说，了解AVD综合征V、其临床表现、诊断和治疗策略以及预防下尿路神经源性功能障碍患者的表现发作是很重要的。AVD被定义为收缩压高于基线20毫米汞柱，以响应发生在脊髓损伤水平以下的各种传入刺激。AVD基于在位于脊髓T6段上方的节前交感神经元去神经支配和外周α-肾上腺素能受体过度活跃的情况下，通过脊髓中的脉冲照射来提高脊髓反射活动。AVD的主要病理生理机制是高去甲肾上腺素血症，导致位于神经损伤水平以下的皮肤、腹腔和下肢肌肉血管收缩。
257-262
Сlinical observations
肾结核的外科治疗需要新辅助化疗吗？
摘要
泌尿生殖道结核的紧迫性及其社会意义仍然很高。随着抗结核药物的出现，进行器官保留手术成为可能，但是抗结核化疗，无论是在术前还是术后，都是极其重要的。临床观察表明，违反这一原则会导致严重并发症的发生。I.患者，40岁。诊断：“右肾多海绵体结核，左肾海绵体结核，第4期膀胱结核（微囊藻）”。她不规律地、随意地服用抗痨药。在这种背景下，在泌尿科的右侧进行腹腔镜肾切除术，在左侧进行穿刺肾造口术。抗结核药物治疗中断，导致肾功能衰竭的进展和肾盂肾炎的下一次发作。在这方面，她在Avicenna MC接受了再次手术：根据Studer的说法，腹腔镜下仅左侧肾脏的海绵体切开术、膀胱切除术、肠膀胱成形术。在术后期间，形成了水库-子宫瘘。她没有接受抗结核治疗。在9个月后患者返回Avicenna MC，采用腹腔镜切除萎缩的肠道储液罐，形成Bricker输尿管油切开术，近期和长期（随访10个月）效果良好。
263-270