Двусторонний рак почек

Among 1430 patients with renal tumors who have been treated and followed up in urologic clinic of I.M. Sechenov Moscow Medical Academy from 1973 to 2006, bilateral tumors were found in 117 (8,2%) of whom in 81 (5,7%) bilateral renal cancer was diagnosed: 51 (3,6%) patients had synchronous and 30 (2,1%) — asynchronous cancers. Bilateral renal cancer is an absolute indication for renal-conserving surgery. Side of initial operation is decided individually taking into consideration clinical manifestations of disease and local tumor characteristics. In case of overt clinical manifestations the side of more extensive disease is selected for first stage surgery. Otherwise, surgical treatment should be started from kidney which is more suitable for organ-conserving surgery: the reference points are size, localization and growth direction of tumor and to lesser extent stage of disease. Analysis of morphologic structure of renal cancer revealed similar patterns of tumors on both sides in 92,5% of patients with synchronous and 85,2% with asynchronous bilateral renal cancer. The same grade of tumor differentiation of cancerous tissue of both sides was found in 72,5% patients with synchronous and 48,1% with asynchronous cancers. Among patients with asynchronous bilateral renal cancer of different grades of differentiation of their tumors, second tumors were of higher grade of malignancy in 92,9% of these patients. Molecular genetics revealed mutations of genes VHL and FHIT of 3rd pair of chromosomes in all patients with bilateral renal cancer. Our data demonstrates that bilateral renal cancer is genetically determined pathology which can manifest itself synchronously or asynchronously, quite often in considerable time interval. Overall and adjusted 5-year survival rates were 62,7% and 68,6% for patients with bilateral synchronous renal cancer and 53,3% and 60,0% for patients with asynchronous cancer.

X-ray endoscopic treatment of strictures of the upper urinary tract

The purpose of this work is: to evaluate the effectiveness of X-ray endoscopic methods of treatment of strictures of the upper urinary tract. Patients and methods: the results of examination and treatment of 134 patients (age 24 to 78 years, 51 men, 83 women) with supravesical obstruction due to stricture or obliteration of the hospital, who were on inpatient treatment at the Urology Clinic UKB №2 of the First MGMU them. THEM. Sechenov, who underwent endoscopic treatment (balloon dilatation, endopyelotomy, endoureterotomy, recanalization of the ureter, installation of the stent Memokat). Results: 116 (86.6%) patients achieved good and satisfactory results. The best results were obtained in patients with stricture up to 1 cm, which performed a combination of balloon dilatation and laser endotomy (95.8% efficacy). Unsatisfactory results of endotomy were noted in 18 (13.4%) observations. 15 patients underwent various reconstructive operations. Nephrectomy was performed in 3 (2.2%) patients due to loss of kidney function in case of severe stricture recurrence. Conclusion: in the presence of strictures of the VMP, endotomy is indicated for patients with primary or postoperative strictures of the VMP up to 2 cm. The best results are achieved in the treatment of patients with strictures up to 1 cm and with the combination of balloon dilatation and laser incision. The obtained data point to the effectiveness and expediency of the selected minimally invasive treatment tactics, which makes it possible to reduce the likelihood of open surgical benefits in some patients.Целью настоящей работы является: оценка эффективности рентген-эндоскопических методов лечения стриктур верхних мочевых путей. Пациенты и методы: в основу работы легли результаты обследования и лечения 134 пациентов (возраст — от 24 до 78 лет, 51 мужчины, 83 женщин) с суправезикальной обструкцией, обусловленной стриктурой или облитерацией ВМП, находившихся на стационарном лечении в клинике урологии УкБ№2 Первого МГМУ им. И.М. Сеченова, которым было выполнено эндоскопическое лечение (баллонная дилатация; эндопиелотомия; эндоуретеротомия; реканализация мочеточника; установка стента Мемокат). результаты: хорошие и удовлетворительные результаты достигнуты у 116 (86,6%) пациентов. Лучшие результаты были получены у пациентов со стриктурой до 1 см, которым выполнялось сочетание баллонной дилатации и лазерной эндотомии (95,8% эффективность). Неудовлетворительные результаты эндотомии отмечены в 18 (13,4%) наблюдениях. 15 пациентам в последующем выполнены различные реконструктивные операции. Нефрэктомия произведена 3 (2,2%) пациентам вследствие потери функции почки при рецидиве стриктуры. Заключение: при наличии стриктур ВМП эндотомия показана больным с первичными или послеоперационными стриктурами ВМП протяженностью до 2 см. Лучшие результаты достигаются при лечении пациентов со стриктурами до 1 см и при сочетании методов баллонной дилатации и лазерной инцизии. Полученные данные указывают на эффективность и целесообразность выбранной малоинвазивной лечебной тактики, которая позволяет уменьшить вероятность открытых оперативных пособий у части больных

Super selective embolization of the renal arteries with iatrogenic bleeding after percutaneous nephrolithotomy

The aim of this work is to study the results of superselective embolization of bleeding renal vessels after percutaneous aids for urolithiasis. 1723 percutaneous nephrolithomies performed in the urology clinic of the First Moscow State Medical University named after I,M,Sechenov until 2015 were analyzed. Hemorrhagic complications were detected in 83 (4.8%) patients, transfusion was required in 37 (2.1%) observations, SSE in 28 (1.6%). 2 (0.1%) patients underwent nephrectomy at the stage of development and introduction of PNl and lack of the possibility of performing SSE. In all the observations, it was possible to achieve a good clinical effect without resorting to open surgery. Complications during embolization and postembolization period were not observed. SSE is an effective minimally invasive method for endovascular diagnosis and treatment of bleeding caused by iatrogenic AVF kidney. This method avoids the organ-carrying benefit and eliminates a formidable complication.Цель данной работы – изучить результаты суперселективной эмболизации кровоточащих почечных сосудов после чрескожных пособий по поводу мочекаменной болезни. Проанализировано 1723 перкутанных нефролитомий выполненных в клинике урологии Первого МГМУ им. И.М. Сеченова до 2015 года. Геморрагические осложнения выявлены у 83 (4,8%) пациентов, переливание потребовалось в 37 (2,1%) наблюдениях, ССЭ в 28 (1,6%). 2 (0,1%) пациентам на этапе освоения и внедрения ПНЛ и отсутствии возможности выполнения ССЭ выполнена нефрэктомия. Во всех наблюдениях удалось достичь хорошего клинического эффекта, не прибегая к открытой операции. осложнения в ходе эмболизации и в постэмболизационном периоде не наблюдались. ССЭ является эффективным малоинвазивным методом эндоваскулярной диагностики и лечения кровотечения, вызванного ятрогенной АВФ почки. Данный метод позволяет избежать органоуносящего пособия и ликвидировать грозное осложнение

Bilateral renal cancer

Among 1430 patients with renal tumors who have been treated and followed up in urologic clinic of I.M. Sechenov Moscow Medical Academy from 1973 to 2006, bilateral tumors were found in 117 (8,2%) of whom in 81 (5,7%) bilateral renal cancer was diagnosed: 51 (3,6%) patients had synchronous and 30 (2,1%) — asynchronous cancers. Bilateral renal cancer is an absolute indication for renal-conserving surgery. Side of initial operation is decided individually taking into consideration clinical manifestations of disease and local tumor characteristics. In case of overt clinical manifestations the side of more extensive disease is selected for first stage surgery. Otherwise, surgical treatment should be started from kidney which is more suitable for organ-conserving surgery: the reference points are size, localization and growth direction of tumor and to lesser extent stage of disease. Analysis of morphologic structure of renal cancer revealed similar patterns of tumors on both sides in 92,5% of patients with synchronous and 85,2% with asynchronous bilateral renal cancer. The same grade of tumor differentiation of cancerous tissue of both sides was found in 72,5% patients with synchronous and 48,1% with asynchronous cancers. Among patients with asynchronous bilateral renal cancer of different grades of differentiation of their tumors, second tumors were of higher grade of malignancy in 92,9% of these patients. Molecular genetics revealed mutations of genes VHL and FHIT of 3rd pair of chromosomes in all patients with bilateral renal cancer. Our data demonstrates that bilateral renal cancer is genetically determined pathology which can manifest itself synchronously or asynchronously, quite often in considerable time interval. Overall and adjusted 5-year survival rates were 62,7% and 68,6% for patients with bilateral synchronous renal cancer and 53,3% and 60,0% for patients with asynchronous cancer

Experimental study of urinary stones

Study of urinary stones of surgical removal has been fulfiled by complex methods. Information of phase and element composition have been received, microstructural examination has been made, causes of anomalous hardness of some stones have been found

Методы исследования мочевых камней

Study of urinary stones of surgical removal has been fulfiled by complex methods. Information of phase and element composition have been received, microstructural examination has been made, causes of anomalous hardness of some stones have been found.Проведены исследования комплексом методов мочевых камней, дезин- тегрированных в результате опе- рации. Получена информация о фазовом и элементном составах каждого конкре- мента; изучена микроструктура камней, выяснены причины аномальной твердо- сти некоторых образцов