Diagnostics of acute kidney injury after surgery for invasive urinary bladder cancer

We have studied diagnostic techniques for renal dysfunction (glomerular filtration rate) and renal structure lesions (NGAL, p2-microglobulin in blood serum and urine) before and at different stages of radical surgery. Diagnostic criteria of acute kidney injury without changes in the concentration of functional markers have been identified. Evaluation of the predictability of the development of chronic kidney diseases in the remote postoperative period has been made.Изучены способы диагностики нарушения функции почек (скорость клубочковой фильтрации) и повреждения ренальных структур (NGAL, р2-микроглобулин в плазме крови и моче) до и на различных этапах радикального хирургического лечения. Выявлены диагностические критерии острого повреждения почек при отсутствии изменений концентрации функциональных маркеров. Проведена оценка возможности прогнозирования развития хронической болезни почек в отдаленном послеоперационном периоде

Реабилитация урологических больных

According to the literature data, up to 30—40% of patients who underwent radical cysrectomy for cancer of the urinary bladder suffer from diverse types of urinary incontinence. The current methods of treatment of urinary incontinence are not very effective due to frequent recurrences requiring repeated and more complicated surgical interventions. The perspective method of rehabilitation of patients with urinary incontinence is doing physical exercises for the pelvic muscles.По данным отечественных и зарубежных исследователей, 30—40% пациентов, подвергшихся радикальной цистэктомии по поводу рака мочевого пузыря, страдают различной степенью недержания мочи. Существующие методы лечения недержания мочи малоэффективны, так как часто возникают рецидивы заболевания, требующие повторных и более сложных оперативных вмешательств. Перспективным методом реабилитации больных с недержанием мочи является использование упражнений для мышц тазового дна

ГЕНЕТИЧЕСКИЕ МАРКЕРЫ РИСКА РАЗВИТИЯ ПОВЕРХНОСТНОГО И ИНВАЗИВНОГО РАКА МОЧЕВОГО ПУЗЫРЯ

To reveal possible associations of the polymorphic variants of the cytochrome P450 and enzymes glutathione-S-transferase genes with the risk for bladder cancer (BC), the authors analyzed the frequency of genotypes and alleles at the polymorphic loci of the CYP1A1 (A2454G), GSTM1 (del), and GSTP1 (A313G) genes in 208 patients diagnosed as having BC (104 patients with invasive BC and 104 with superficial BC) and in 367 patients without identified oncopathology. The *1A*2C (OR = 3.42) and *2C*2С (OR = 6.98) genotypes, *2C (OR = 3.73) allele of the CYP1A1 gene and the GG (OR = 2.53) genotype of the GSTP1 gene were ascertained to be genetic markers for a risk for BC. The presence of the *2C (OR = 1.69) allele of the CYP1A1 gene, the G (OR = 2.40) allele and the AG genotype (OR = 2.40) of the GSTP1 gene was associated with the invasive forms of BC. There were no substantial differences in the distribution of the frequency of genotypes of the GSTM1 gene between the samples of patients and healthy individuals.С целью выявления возможных ассоциаций полиморфных вариантов генов цитохрома P450 и ферментов глутатион-S-трансферазы с риском развития рака мочевого пузыря (РМП) нами проведен анализ частот встречаемости генотипов и аллелей полиморфных локусов генов CYP1A1 (A2454G), GSTM1 (del), GSTP1 (A313G) у 208 больных с диагнозом РМП (104 пациента с инвазивным и 104 – с поверхностным раком) и у 367 пациентов без выявленной онкопатологии. Установлено, что генетическими маркерами риска развития РМП являются генотипы *1A*2C (ОP 3,42) и *2C*2С (ОР 6,98), аллель *2C (ОР 3,73) гена CYP1A1, генотип GG (ОР 2,53) гена GSTP1. Наличие аллеля *2C (ОР 1,69) гена CYP1A1, аллеля G (ОР 2,40) и генотипа AG (ОР 2,40) гена GSTP1 ассоциировано с инвазивными формами РМП. Существенных различий в распределении частот встречаемости генотипов гена GSTM1 между выборками больных и здоровых не выявлено

РЕАБИЛИТАЦИЯ БОЛЬНЫХ ПОСЛЕ РАДИКАЛЬНОЙ ПРОСТАТЭКТОМИИ

According to the data obtained by Russian and foreign investigators, the major complication after radical prostatectomy (RPE) is urinaryincontinence that is recorded in 20-30% of cases.Objective. To improve the results of surgical treatment in patients with prostate cancer, by developing and introducing a well-rounded post-operative rehabilitation program.Subjects and methods. Seventy-four patients who were treated at the urology clinic, Bashkir State Medical University, and underwent RPEin 2005 to 2007 have been examined; 27 of them were diagnosed as having urinary incontinence (UI). After discharge from the clinic, acontrol group received rehabilitative treatment at the sanatorium “Krasnousolsk” of the Republic of Bashkortostan. Results and discussion. Therapeutic exercises and pelvic floor electrostimulation halve the number of day urinations and paddings used inpatients with UI, by increasing the bladder capacity from 138.2±12.7 to 196±11.2 ml and improving the trophism of the bladder neck andurethra in the sphincteral area. Реабилитация больных после радикальной простатэктоми

ИЛЕОЦИСТОПЛАСТИКА ПРИ ИНВАЗИВНОМ РАКЕ МОЧЕВОГО ПУЗЫРЯ

Objective: to assess the results of surgical treatment of patients with the intestinal urinary bladder, to characterize its early and late postoperative complications, and to develop their correction tactics.  Subjects and methods. The results of treatment in 198 patients who had undergone ileocystoplasty were analyzed.  Results. The developed diagnostic approach and the determined examination periods could reduce the number of late postoperative complications of ileocystoplasty: acute and chronic pyelonephritis from 19.4 to 7.6%, urolithiasis from 17.2 to 1.9%, bladder dysfunction from 25.8 to 7.6%, and metabolic acidosis from 4.3 to 1.9%, and prevent the development of ureterovesical anastomosis stricture.  Conclusion. Radical cystectomy with the ileoplasty using an isolated segment of the ileum in patients with invasive urinary bladder carcinoma has been the operation of choice no longer; it has become an essential surgical adjunct. This method permits overall 5-year survival to be achieved in 69.7% of patients.  Цель исследования — оценка результатов хирургического лечения больных с кишечным мочевым пузырем; характеристика ранних и поздних послеоперационных осложнений; выработка тактики коррекции осложнений.Материалы и методы. Проведен анализ результатов лечения 198 пациентов, которым была проведена кишечная пластика мочевого пузыря. Результаты. Применение разработанной тактики диагностики и сроков обследования позволило снизить число поздних послеоперационных осложнений кишечной пластики мочевого пузыря: острого и хронического пиелонефрита с 19,4 до 7,6%, мочекаменной болезни — с 17,2 до 1,9%, дисфункции мочевого пузыря — с 25,8 до 7,6%, метаболического ацидоза — с 4,3 до 1,9% — и предотвратить развитие стриктуры уретеровезикального анастомоза.Выводы. Радикальная цистэктомия с кишечной пластикой из изолированного сегмента подвздошной кишки у больных инвазивным раком мочевого пузыря перестала быть операцией выбора, превратившись в жизненно необходимое хирургическое пособие. Метод позволяет добиться общей 5-летней выживаемости у 69,7% пациентов.

Изменения ультраструктуры и микроциркуляции стенки мочевого пузыря у пациентов с неинвазивными формами рака

Bladder cancer relapses are associated with diffuse pattern of neoplastic changes in the mucous layer of the bladder; treatment efficacy depends on the degree of structural alterations in the bladder wall.Materials and methods: for evaluation of microcirculation characteristics and structural alterations of mucous layer of the bladder we have used laser analyzer of capillary blood circulation («ЛАКК-01» produced by НПП «ЛАЗМА», Russia) and compact mobile optic tomograph (ИПФ РАН, Russia).Results: conducted researches have shown alterations affecting both epithelial and submucous layers with their microcirculatory bed in perifocal to bladder tumor tissues.Conclusions: complimentary application of laser Doppler flowmeter and compact mobile optic tomograph allows defining the type and extent of pathologic process in the bladder wall in superficial tumors and choosing optimal method of correction.

Competitive wholesale market of the electric power and power: state and new calls

In article features of functioning of the main segments of the wholesale market of the electric power and power (OREM) are considered. The factors exerting impact on competitiveness of the generation companies come to light. Results of functioning of OREM, since the moment of his full liberalization are analyzed, merits and demerits of the operating market mechanisms reveal

SPARING CYSTECTOMY IN THE TREATMENT OF BLADDER CANCER WITH UROLOGICAL COMPLICATIONS

Bladder cancer (BC) accounts for 5 to 10% of all cancers and ranks fourth in the prevalence of male cancers. In Russia, its morbidity increases with age and amounts to 8.1—9.6 per 100,000 with the annual increase being 3.34%.Objective: to assess the results of sparing cystectomy (CE) for BC in the presence of urological complications.Subjects and methods. From February 1999 to December 2007, the study consequently included 196 patients receiving surgical treatment for the aggressive form of BC, of whom 101 patients received surgical treatment for CE with intestinal plastic repair. There were 33 (84.6%) males and 6 (15.4%) females. The patients' mean age was 69.4 (range 35-81) years; the duration of the disease averaged 1.4 years (range 6 months to 5 years). The proportion of the males who has undergone sparing CE was 48.5% of the total number of patients. There were no women who had been operated on.Results. Examination of 101 patients with invasive CE revealed that 69 patients had the following types of complications: intractable bleeding, hydronephrosis, acute pyelonephritis, chronic renal failure, progressive cancer intoxication, and acute urinary retention. These patients were determined as having undergone sparing CE. Group 2 comprised 127 patients who had received organ-preserving therapy.Conclusion. Physical examination, instrumental, and X-ray studies established a correlation of the tumor aggression with the severity of urological complications; sparing CE for urological involvement in patients with invasive UBC has an advantage over organ-preserving treatment (33.3% versus 4.7%) in providing 5-year survival. However, the early postoperative mortality from occurring complications was higher in Group 1 than that in Group 2 without radical treatment