Analysis of the complications after ESWL in the treatment of renoureteral stones

IP USMF "Nicolae Testemiţanu", IMSP Spitalul Clinic Republican, Al VI-lea Congres de Urologie, Dializă şi Transplant Renal din Republica Moldova cu participare internaţională (21-23 octombrie 2015)Rezumat Aproximativ 80-90% din calculii reno-ureterali au ca indicaţie pentru tratament Litotriţia Extracorporeală cu unde de Şoc (ESWL). Fiind o procedură terapeutică, după ESWL pot apărea anumite complicaţii. Majoritatea complicaţiilor sunt minore, dar pot fi întâlnite şi complicaţii majore. Hematomul este o complicaţie gravă, dar are o frecvenţă scăzută. Pielonefrita acută apare în urma existenţei infecţiei sau datorită eliberării germenilor din calcul după fragmentare. Summary Approximately 80-90% of reno-ureteral stones have for treatment indication Extra Corporeal Shock Wave Lithotripsy (ESWL). Like a therapeutic procedure, extracorporeal lithotripsy may be accompanied by complications. Most of this complications are minor complications, but in a lower percentage, major complications can be appear. Hematoma is the most serious complication of extracorporeal lithotripsy, with a low incidence. Acute pyelonephritis (PNA) occurs either due to a pre-existing urinary infection, or by the release of germs located into the calculi during fragmentation

Tratamentul chirurgical al disfuncţiilor erectile cu proteze peniene sintetice semirigide

Summary The aim of this study is to represent the surgical treatment of the organic impotence, by implanting the synthetic semi-rigid proteases type Small-Carrion and to evaluate the efficiency and the complications of this method for 30 patients, during the period of 1989-2005 years, in Urology Department Republican Hospital. Introducere. Disfuncţia erectilă este cea mai frecventă patolgie care afectează viaţa sexuală a milioane de bărbaţi. Farmacoterapia orală şi administarea intracavernoasă de substanţe vasoactive reprezintă, la oara actuală, primele opţiuni terapeutice ale pacientului cu disfuncţie erectilă. Pacienţii care nu răspund la terapia conservatorie sunt candidaţi pentru tratamentul chirurgical, protezarea corpilor cavernoşi. Scopul lucrării. Analiza rezultatelor protezării peniene la pacienţii cu disfuncţie erectilă trataţi în Clinica Urologie a SCR. Materiale și metode. În perioada anilor 1989-2004 în Clinica de Urologie SCR s-au efectuat 30 de intervenţii chirurgicale pentru inserţia protezelor peniene. În toate cazurile am utilizat proteze peniene sintetice semirigide de tip Small - Carrion, în consecinţă penisul recapătă rigiditatea necesară efectuării unui act sexual. Vârsta pacienţilor a fost cuprinsă între 25 şi 55 ani. Repartiţia cazurilor, conform cauzelor disfuncţiei erectile, a fost urmatoarea: 1. Diabet zaharat - 8 (26.7%) cazuri 2. Leziuni vertebromedulare - 7 (23.3%) cazuri 3. Disfuncţii psihogene - 2 (6.7%) cazuri 4. Dereglări arteriogene - 12 (40%) cazuri 5. Sechele dupa priapism - 1(3.3%) caz. În toate cazurile algoritmul diagnostic a fost realizat întro manieră sistematică pentru a încerca să se deceleze cauzele vasculare, neurologice sau endocrine ale DE. Din punct de vedere etiologic, majoritatea cauzelor de disfuncţie erectilă organică sunt vasculare, cu răspuns foarte scăzut la tratamentul cu agenţi vasoactivi şi la tratament intracavernos. Inserţia protezelor peniene este gestul chirurgical care exclude definitiv alte modalitaţi de tratament al disuncţiei erectile şi trebuie considerat ca un procedeu ireversibil atât de către chirurg, dar mai ales de pacient. Abordul chirurgical a fost în exclusivitate penoscrotal. Dilatarea interiorului corpului cavernos este asigurată de înserarea unui Hegar de 10 mm. Dilatarea continuă până la mărimea de 13 mm a Hegarului. Lungimea protezei trebuie masurată foarte atent, ca să nu fie nici mai scurtă, pentru că determină deformări ale glandului şi nici prea lungă, deoarece în timpul utilizării poate cauza perforaţii ale corpului cavernos. Rezultate. În perioada postoperatorie imediată au fost atestate urmatoarele complicaţii: 1. Hematom fluctuient - 1 caz (3.3)% 2. Eroziunea şi migrarea protezei - la 2 pacienţi (6.7%) cu leziuni vertebromedulare 3. Necroza marginalizată a ţesutului cutanat fară afectarea corpilor cavernoşi - 1 caz (3.3%) În perioada postoperatorie tardivă am semnalat un caz (3.3%) de fractură a protezei survenită la un interval de peste 5 ani de la operaţie. Concluzii. Protezele peniene sunt indicate pentru tratamentul disfuncţiei erectile la subiecţii cu o relaţie stabilă şi reprezintă un tratament cu rezultate garantate, dar care trebuie rezervat cazurilor bine selectate, dupa eşuarea altor strategii terapeutice. În aspect general rezultatele implantării de proteze peniene sunt bune şi favorizează reintegrarea persoanelor respective într-o viată normală

The results of multicentric study of prostate pathology in some localities of Republic of Moldova

IP USMF "Nicolae Testemiţanu", IMSP Spitalul Clinic Republican, IMSP Spitalul Republican ACSR, IMSP SR Cahul, IMSP SR Edineţ, IMSP SR Drochia, IMSP SR Orhei, Compania farmaceutică Berline-Chemie Menarini, Reprezentanţa în R. Moldova, Al VI-lea Congres de Urologie, Dializă şi Transplant Renal din Republica Moldova cu participare internaţională (21-23 octombrie 2015)Rezumat. în lucrare sunt analizate rezultatele unui studiu multicentric a patologiei prostatei efectuat în baza screening-ului la bărbaţi din 7 localităţi ale R. Moldova. Conform protocolului adoptat au fost examinaţi 508 pacienţi cu vârsta medie de 63,3±9,1 ani. Au fost studiate structura patologiilor depistate (adenom de prostată (HBP), cancer de prostată (CP), prostatită), particularităţile clinice ale HBP, incidenţa CP, metodele de tratament recomandate în dependenţă de rezultatele screening-ului. Cea mai frecventă patologie a constituit HBP - 425 cazuri, sau 83,7%, în 8 cazuri (1,6%) a fost diagnosticat CP, iar prostatita cronică la 62 (12,2%) pacienţi. Majoritatea pacienţilor cu HBP - 76,8% au primit indicaţii pentru tratament conservator, 9,1% din pacienţi pentru prostatită cronică; tratamentul chirurgical a fost indicat la 30 pacienţi (5,9%) pentru HBP, iar tratament specializat pentru CP s-a indicat la 3 pacienţi (0,6%). La 12 pacienţi a fost necesar de efectuat o serie de investigaţii suplimentare pentru diferenţierea diagnosticului dintre adenom şi cancer de prostată.Summary. In article were analyzed the results of a multicenter screening study of the prostate pathology in men from 7 regions of R. of Moldova. According to the adopted protocol were examined 508 patients with a mean age of 63,3 ± 9,1 years. The structure of the identified pathologies (binign prostatic hyperplasia (BPH), prostate cancer (PC), prostatitis, the clinical features of BPH, the incidence of PC, the recommended treatment methods depending on the results of the screening were studied. The most frequent pathology was BPH - 425 cases or 83,7%, PC was diagnosed in 8 patients (1,6%) and chronic prostatitis in 62 (12,2%) patients. Most of the patients with BPH — 76,8% received indications for conservative treatment, 9,1% of patients received treatment for chronic prostatitis. Surgical treatment was indicated in 30 patients (5,9%) with BPH and specialized treatment for PC was indicated in 3 patients (0,6%). In 12 patients it was necessary to perform a number of additional investigations for differential diagnosis of adenoma and prostate cancer

Insulin-like growth factors and related proteins in plasma and cerebrospinal fluids of HIV-positive individuals

BACKGROUND: Clinically significant dysregulation of the insulin-like growth factor (IGF) family proteins occurs in HIV-infected individuals, but the details including whether the deficiencies in IGFs contribute to CNS dysfunction are unknown. METHODS: We measured the levels of IGF1, IGF2, IGFBP1, IGFBP2, and IGF2 receptor (IGF2R) in matching plasma and cerebrospinal fluid (CSF) samples of 107 HIV+ individuals from CNS HIV Antiretroviral Therapy Effects Research (CHARTER) and analyzed their associations with demographic and disease characteristics, as well as levels of several soluble inflammatory mediators (TNFα, IL-6, IL-10, IL-17, IP-10, MCP-1, and progranulin). We also determined whether IGF1 or IGF2 deficiency is associated with HIV-associated neurocognitive disorder (HAND) and whether the levels of soluble IGF2R (an IGF scavenging receptor, which we also have found to be a cofactor for HIV infection in vitro) correlate with HIV viral load (VL). RESULTS: There was a positive correlation between the levels of IGF-binding proteins (IGFBPs) and those of inflammatory mediators: between plasma IGFBP1 and IL-17 (β coefficient 0.28, P = 0.009), plasma IGFBP2 and IL-6 (β coefficient 0.209, P = 0.021), CSF IGFBP1 and TNFα (β coefficient 0.394, P < 0.001), and CSF IGFBP2 and TNF-α (β coefficient 0.14, P < 0.001). As IGFBPs limit IGF availability, these results suggest that inflammation is a significant factor that modulates IGF protein expression/availability in the setting of HIV infection. However, there was no significant association between HAND and the reduced levels of plasma IGF1, IGF2, or CSF IGF1, suggesting a limited power of our study. Interestingly, plasma IGF1 was significantly reduced in subjects on non-nucleoside reverse transcriptase inhibitor-based antiretroviral therapy (ART) compared to protease inhibitor-based therapy (174.1 ± 59.8 vs. 202.8 ± 47.3 ng/ml, P = 0.008), suggesting a scenario in which ART regimen-related toxicity can contribute to HAND. Plasma IGF2R levels were positively correlated with plasma VL (β coefficient 0.37, P = 0.021) and inversely correlated with current CD4+ T cell counts (β coefficient −0.04, P = 0.021), supporting our previous findings in vitro. CONCLUSIONS: Together, these results strongly implicate (1) an inverse relationship between inflammation and IGF growth factor availability and the contribution of IGF deficiencies to HAND and (2) the role of IGF2R in HIV infection and as a surrogate biomarker for HIV VL. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12974-015-0288-6) contains supplementary material, which is available to authorized users

The cellular and humoral immunity assay in patients with complicated urolithiasis

Department of Urology and Surgical Nephrology, “Nicolae Testemiţanu” State University of Medicine and Pharmacy, Chişinău, Republic of Moldova, Clinic of Urology, Clinical Republican Hospital, Chişinău, Republic of MoldovaAbstract. Especially complicated, renal lithiasis contributes to the general inflammatory syndrome development that interferes with nonspecific, humoral and cellular immune system. The surgical treatment of nephrolithiasis is closely related to drug therapy of urinary infection, one of the reasons being the reduction of the immune status. The work is performed by evaluating the immunological status preoperatively in 58 patients with complicated lithiasis. The analysis of the status in these patients demonstrated that complicated urolithiasis results in significant changes in the immune system, these changes being expressed at the cellular and humoral level of immunity

Oxidative stress and antioxidant status in patients with complicated urolithiasis

In recent years, intense efforts have been made to clarify the pathogenesis of urolithiasis, which affects more than 10% of the population of developed countries. Currently, a number of studies have assumed a key role in the pathogenesis of oxalate urolithiasis, which is the most common one that belongs to the active forms of oxygen generated in the kidney, as a result of the activation of free radical oxidation that occurs in the interaction of calcium oxalate crystals with renal tubular epithelial cells. In the current work, oxidant and antioxidant status were assessed in the blood of patients with complicated urolithiasis pre – and post surgery. The surgical treatment of complicated urolithiasis leads a decrease of the oxidative stress and an increase in the potential of antiradical and antiperoxidative protection

The role of contemporan lithitripters in the treatment of reno-uretheral stones

Republican Clinical Hospital, Chisinau, Moldova Republic Department of Urology and Surgical Nephrology, State University of Medicine and Pharmacy, Chisinau, Moldova Republi

The tubeless percutaneous nephrolithotomy – Advantages and safety

Departament of Urology and Surgical Nephrology, State Univercity of Medicine and Pharmacy, Chisinau, Moldova Republic Republican Clinical Hospital, Chisinau, Moldova Republi

Extracorporeal shock-wave lithotripsy for treatment of ureteral stones

Universitatea de Stat de Medicină și Farmacie “Nicolae Testemitanu”, IMSP Spitalul Clinic Republican, Chișinău, Republica Moldov