Рецензия на статью «Осложнения после радикальной цистпростатэктомии с различными вариантами гетеротопической уретероилеокутанеостомии»

На сегодняшний день существует не так много тем в урологии, которые порождают среди отечественных и иностранных специалистов столь же много оживленных споров и дискуссий, как вопрос выбора метода отведения мочи после цистэктомии

TREATMENT OF INVASIVE BLADDER CANCER IN PATIENT AFTER RENAL TRANSPLANTATION

There are case report and literature review of the treatment recurrent bladder cancer after kidney transplantation. Radical cystectomy and Bricker ileal conduit was performed. Detailed operative technique is described. Radical cystectomy is an effective curative treatment for recurrent disease. Bricker ileal conduit is safe and feasible in renal transplant patients

Selective serotonin reuptake inhibitors and spermatogenesis

Introduction. According to the WHO data, depression is a common disease among women and men of reproductive age. One line of the correction of depressive disorders is selective serotonin reuptake inhibitors (SSRIs). The ingestions have shown that using SSRIs harms sperm quality. The literature date of evaluation of male fertility after discontinuation of antidepressants is quite limited.Purpose of the study. To evaluate the influence of Fluoxetine intake on semen parameters, sperm DNA fragmentation and hormonal status.Materials and methods. Twenty-five men (mean age - 35.2 ± 4.5 yo) with depression were included in the study. Fluoxetine (20 mg per day) was prescribed to all the patients for 12 wk. Semen parameters, sperm DNA fragmentation, sex hormones levels were measured before-after treatment and 3 mo behind discontinuation.Results. After 12 weeks of the treatment the mean semen volume decreased from 3.1 ± 0.7 to 2.9 ± 0.7 ml (p = 0.638), sperm concentration - from 39.4 ± 18.5 to 34.3 ± 16.8 mln/ml (p = 0.384), sperm motility decreased from 41.7 ± 7.6 to 35.5 ± 7.8% (p < 0.05), the mean percent of normal morphology form - from с 12.7 ± 2.8 to 10.7 ± 2.2% (p < 0.001). Sperm DNA fragmentation increased 16.2 ± 4.9 to 22.2 ± 4.3% (p < 0.001). The mean semen volume, sperm concentration, motility, percentage of normal morphology increased and reverted to the normal levels after 3 mounts of drug discontinuation. Sperm DNA fragmentation index decreased, and it had the values less than before the treatment that positively correlated with the reduction of depression's symptoms. It was not significant dynamics in hormonal parameters before and after the therapy.Conclusion. Using fluoxetine has a reversible negative effect on male fertility. It is important to inform the patients about the temporary side effects of SSRIs in fatherhood planning cases

ЛЕЧЕНИЕ ИНВАЗИВНОГО РАКА МОЧЕВОГО ПУЗЫРЯ ПОСЛЕ ТРАНСПЛАНТАЦИИ ПОЧКИ

There are case report and literature review of the treatment recurrent bladder cancer after kidney transplantation. Radical cystectomy and Bricker ileal conduit was performed. Detailed operative technique is described. Radical cystectomy is an effective curative treatment for recurrent disease. Bricker ileal conduit is safe and feasible in renal transplant patients. В статье приведен клинический случай и обзор литературы радикального лечения инвазивного рака мочевого пузыря у пациентов с ренальным трансплантатом. Описана техника выполнения операции. Результат свидетельствует об эффективности радикальной цистэктомии с кишечной деривацией мочи при лечении инвазивного рака мочевого пузыря и возможности ее применения у пациентов после пересадки почки.

Renal transplantation in children managed with lymphocyte depleting agents and low-dose maintenance tacrolimus monotherapy

OBJECTIVE. Describe the safety and efficacy of antithymocyte globulin or alemtuzumab preconditioning, steroid avoidance and reduced calcineurin inhibitor (CNI) immunosuppression in 34 children undergoing renal transplantation. METHODS. ATG (n=8) or alemtuzumab (n=26) were infused at the time of transplantation. This was followed by low-dose twice a day tacrolimus monotherapy with consolidation to once daily dosing by 6 months and once every other day dosing by 12 months. Follow-up ranged from 0.5-2.9 years (mean 1.33 years), with a minimum of 6 months. RESULTS. Both ATG and alemtuzumab were well tolerated. Lymphopenia occurred routinely and resolved after 3-6 months. Acute cellular rejection occurred in 9%; it was related to medical nonadherence in two patients and resulted in one graft loss at 1.5 years. Important adverse events included transient neutropenia in 10 children (none with serious infection), and autoimmune hemolytic anemia in two (resolved with a steroid course in both and conversion to sirolimus in one). Estimated glomerular filtration rate (e-GFR) was stable and averaged 88 mL/min/1.73 m at latest follow-up. Fifteen preadolescents had a greater increase in height Z-score at 1 year (1.3 vs. 0.5, P=0.001), and a higher e-GFR (94.8±21 vs. 76.6±20 ml/min/1.73 m, P<0.05), when compared to case-matched historical controls who were weaned off steroids by 6 months after transplantation and received twice daily tacrolimus monotherapy. CONCLUSION. This simple regimen appears safe, has a low risk for acute cellular rejection or other adverse effects, and is associated with excellent growth and renal function. Such a regimen may also improve compliance and limit CNI nephrotoxicity. © 2007 Lippincott Williams & Wilkins, Inc

Опухолевые маркеры при скрининге и мониторинге больных раком мочевого пузыря

The study was undertaken to evaluate the specificity and sensitivity of a rapid method for qualitative determination of the content of NMP 22 in the diagnosis of cancer of the bladder, as well as the efficiency of the method in detecting recurrences of this disease.The method is based on enzyme immunoassay of the nuclear matrix proteins that are incorporated into the cell nuclear membrane, whose levels are approximately 20—80 times higher in the cancer cells of the bladder. The study included 83 patients. Group 1 comprised 18 patients with new-onset bladder cancer. Group 2 comprised 26 patients with histologically verified recurrent bladder cancer. Group 3 consisted of 19 patients who had a history of bladder cancer, received surgical treatment, and had no recurrences for at least 6 months. The control group included 20 healthy donors.The test urine was put into a test well and the results were assessed 30 minutes later.The resultant sensitivity of the test was 50% (p &lt; 0.05) in the patients with new-onset cancer of the bladder and 54% (p &lt; 0.05) in those with its recurrent cancer. With staging and grading of the disease and with higher tumor anaplasia, the sensitivity of the test increases: 37, 75, and 80% in T1, T2, T3, respectively (p &lt; 0.05); 30, 50, and 87% in G1 (p &gt; 0.05), G2 (p &lt; 0.05), G3 (p &lt; 0.05). Its specificity was 100% in Group 3 and 90% in the control group (p &lt; 0.05). Thus, its total specificity was 95% (p &lt; 0.05). The study has led to the conclusion that detection of NMP 22 is a promising marker of bladder carcinoma, which show a rather high specificity and specificity not only in identifying primary tumors, but a recurrence of the disease.

Качество жизни больных инвазивным раком мочевого пузыря после радикальной цистэктомии

Notwithstanding the fact that advances have been made in various urine derivations, the assessment of life quality in patients who have undergone this type of surgical treatment is still not only a medical problem, but, to a greater extent, a social one. Eighty-seven patients who had undergone radical cystectomy and urine derivation for invasive bladder cancer were examined. According to the type of urine derivation, the patients were divided into groups. Then early and late complications, survival rates, and quality of life were estimated. The latter was assessed by three components: physical, psychological, and urological health. Emphasis is laid on physical health component in assessing the quality of life. The special questionnaire applied to the assessment of life quality in patients undergoing urine derivation may be useful for this purpose in those after other urological operations.

ВАКУУМ ИНДУЦИРОВАННАЯ ЭРЕКЦИЯ – ПРОФИЛАКТИКА ГИПОКСИИ КАВЕРНОЗНОЙ ТКАНИ У ПАЦИЕНТОВ ПОСЛЕ РАДИКАЛЬНОЙ ПРОСТАТЭКТОМИИ

Patients, after radical prostatectomy with the use of nerve-sparing techniques, without carrying out penile rehabilitation, are at risk of forming cavernous fibrosis with the emergence of subsequent persistent erectile dysfunction. In order to minimize damage to cavernous tissue and early restoration of erectile function during the period of neuropraxia, it is necessary to ensure a sufficient level of oxygenation. The role of applying vacuum in penile rehabilitation for the prevention of hypoxia of cavernous tissue is not fully understood, due to the lack of data on the gaseous composition of the blood at the time of reaching the vacuum of erection. The purpose of this work was to review the scientific studies devoted to the study of vacuum induced penile erection in animals or humans, which indicates high results due to increased oxygenation of cavernous tissue.Пациенты, перенесшие радикальную простатэктомию с применением нервосберегающей техники по поводу рака предстательной железы без проведения соответствующей программы пенильной реабилитации в послеоперационном периоде, подвержены риску формирования кавернозного фиброза с возникновением последующей стойкой эректильной дисфункции. С целью минимизации повреждения кавернозной ткани и раннего восстановления эректильной функции во время периода нейропраксии необходимо обеспечение достаточного уровня оксигенации. Роль применения вакуума в пенильной реабилитации для профилактики гипоксии кавернозной ткани до конца не ясна из-за отсутствия данных о газовом составе крови в момент достижения вакуум-индуцированной эрекции. Целью данной работы являлся обзор научных исследований, посвященных изучению вакуум-индуцированной эрекции полового члена на животных или людях, свидетельствующий о высоких результатах за счет увеличения оксигенации кавернозной ткани

ВАКУУМ ИНДУЦИРОВАННАЯ ЭРЕКЦИЯ – ПРОФИЛАКТИКА ГИПОКСИИ КАВЕРНОЗНОЙ ТКАНИ У ПАЦИЕНТОВ ПОСЛЕ РАДИКАЛЬНОЙ ПРОСТАТЭКТОМИИ

Patients, after radical prostatectomy with the use of nerve-sparing techniques, without carrying out penile rehabilitation, are at risk of forming cavernous fibrosis with the emergence of subsequent persistent erectile dysfunction. In order to minimize damage to cavernous tissue and early restoration of erectile function during the period of neuropraxia, it is necessary to ensure a sufficient level of oxygenation. The role of applying vacuum in penile rehabilitation for the prevention of hypoxia of cavernous tissue is not fully understood, due to the lack of data on the gaseous composition of the blood at the time of reaching the vacuum of erection. The purpose of this work was to review the scientific studies devoted to the study of vacuum induced penile erection in animals or humans, which indicates high results due to increased oxygenation of cavernous tissue.Пациенты, перенесшие радикальную простатэктомию с применением нервосберегающей техники по поводу рака предстательной железы без проведения соответствующей программы пенильной реабилитации в послеоперационном периоде, подвержены риску формирования кавернозного фиброза с возникновением последующей стойкой эректильной дисфункции. С целью минимизации повреждения кавернозной ткани и раннего восстановления эректильной функции во время периода нейропраксии необходимо обеспечение достаточного уровня оксигенации. Роль применения вакуума в пенильной реабилитации для профилактики гипоксии кавернозной ткани до конца не ясна из-за отсутствия данных о газовом составе крови в момент достижения вакуум-индуцированной эрекции. Целью данной работы являлся обзор научных исследований, посвященных изучению вакуум-индуцированной эрекции полового члена на животных или людях, свидетельствующий о высоких результатах за счет увеличения оксигенации кавернозной ткани

MANAGEMENT OF PATIENTS WITH PARKINSON’S DISEASE AND AN OVERACTIVE BLADDER

The lecture is about сurrent achievements in fundamental studies in the problem of urination disorders in Parkinson’s disease. We have updated diagnostic algorithms that allow to identify different type of lower urinary tract symptoms, to spot infravesical obstruction which can radically change the treatment of a particular patient