No abstract

The stimulation of alpha-adrenoreactive structures of the amygdaloid complex, both in isolation and against the background of disengaged beta-adrenoreactive structures, was carried in experiments on male cats in chronic experimental conditions through an implanted chemotrode. It was shown that the alpha-adrenoreactive structures of the amygdaloid complex exert an influence mainly on blood coagulation phases I-II. Blood coagulation phase III changes indirectly through the shortening of phases I-II. The stimulation of beta-adrenoreactive structures of the amygdaloid complex induces the elongation of blood coagulation phases I-III over the duration of the entire experiment. The stimulation of these structures in conditions of the disengagement of the alpha-adrenoreactive structures of the amygdala leads to insignificant changes in phases I-II, after which a hypercoagulation effect is observed. Blood coagulation phase III in these conditions reflects a marked hypocoagulation effect. The data obtained suggest a modulating role of the adrenoreactive structures of the amygdaloid complex in the regulation of the processes of blood coagulation.

Применение дистанционной литотрипсии (ДЛТ) позволило улучшить результаты лечения пациентов с мочекаменной болезнью (МКБ), снизить количество осложнений, оптимизировать ближайшие и отдаленные результаты терапии, однако ее успех зависит от исходного размера и формы камня. Цель исследования. Оценить клиническую эффективность и безопасность электромагнитной ДЛТ простых лоханочных камней с учетом их размеров. Материалы и методы. В исследование включены 110 пациентов с простыми лоханочными камнями, подвергнутых электромагнитной ДЛТ. Первую группу составили 75 пациентов с камнями ≤ 15 мм в диаметре, вторую-35 пациентов с камня > 15 мм. Результаты. Полное разрушение камней размерами ≤ 15 мм в 74,7% случаев происходит за 1-2 сеанса дробления, а через 3 месяца резидуальные фрагменты определяются только в 4% наблюдений. Освобождение чашечно-лоханочной системы от камней размерами > 15 мм осуществляется существенно медленнее, всем больным требуется более 1 сеанса дробления. Через 3 месяца после ДЛТ резидуальные камни отмечены у 17,2% пациентов. Частота и тяжесть болевого синдрома, а также активация мочевой инфекции не связаны с размером камней. Макрогематурия, почечные гематомы и повышение уровня креатинина крови в сравнении с исходным чаще встречаются у пациентов с камнями размерами > 15 мм. Выводы. Электромагнитная ДЛТ является эффективным и безопасным методом монотерапии больных с простыми лоханочными конкрементами. Клиническая эффективность ДЛТ при камнях ≤15 мм к 3 месяцу мониторинга достигает 96,0%, а при камнях >15 мм-82,8 % (р<0,05). Уровень и тяжесть осложнений выше при камнях лоханки >15 мм в сравнении с камнями, имеющими диаметр < 15 мм (р<0,05).

Introduction. Multi-stage urethral surgery is used in cases of the most complex urethral strictures. The evaluation of surgical treatment results given by patients is a significant criterion for the efficacy of urethroplasty along with the assessment of urethral patency through instrumental examinations.Objective. To evaluate the long-term efficacy of multistage urethroplasty for complex anterior urethral strictures considering the patients' quality of life and satisfaction with the surgical outcomes.Materials and methods. The study included 73 patients aged 18 – 84 years with anterior urethral strictures who underwent multi-stage urethroplasty in 2010 – 2019. Surgical and functional outcomes of urethroplasty were assessed through general blood and urine tests, physical examination, uroflowmetry, and retrograde urethrography and urethroscopy in case of urinary disorders.  Subjective parameters of treatment efficacy were studied using questionnaires: International Prostate Symptom Score (IPSS); Quality of life (QoL); Patient-reported Outcome Measure for Urethral Stricture Surgery (USS-PROM); Patient Global Impression of Improvement (PGI-I).Results. Recurrent urethral stricture was detected in 19 (26,0%) patients with the average follow-up period being 65 months. Independent urination was restored in 71 (97.3%) cases, including repeated interventions. After surgery, there was a significant increase in urinary flow rate parameters (Q max: 8.1 vs 19.1 ml/s, p < 0.0001; Q ave: 5.5 vs 10.7 ml/s; p = 0.0004), decrease in residual urine volume (62.4 vs 18.6 ml, p < 0.0001), decrease in total IPSS score (18.7 vs 5.7 points; p < 0.0001) and QoL index (4.3 vs 1 .8 points, p < 0.0001). A comparative analysis of preoperative and postoperative USS-PROM questionnaire results demonstrated an improvement in indicators assessing LUTS (12.9 vs 3.4 points; p < 0.0001; 3.6 vs 1.7 points; p < 0.0001), and urination-associated quality of life (2.6 vs 0.6 points; p < 0.0001) and overall health (EQ-5D index: 0.73 vs 0.91 points; p = 0.025; EQ-VAS: 68.0 vs 88.1 points, p = 0.004). Fifty-seven (81.4%) men were “very satisfied” or “satisfied” with the treatment outcomes, while nine (12.9%) respondents noted a moderate effect of residual urinary disorders on the quality of life. Significantly higher satisfaction was observed among cystostomy patients and in cases where repeated interventions were unnecessary.Conclusion. Multi-stage urethroplasty for complex anterior urethral strictures achieves efficacy in 97.3% of cases and is accompanied by high levels of quality of life and patient’s satisfaction during long-term follow-up.

BACKGROUND: The progress made in reconstructive urethral surgery over the past 20 years has shown the effectiveness of one-stage repair of anterior urethral strictures. Nevertheless, multi-stage urethroplasty retains its primary role in the treatment of patients with the most complex urethral narrowing and obliterations. AIM: To evaluate the immediate and long-term surgical results of multi-stage urethroplasty for penile and bulbar urethral strictures. MATERIALS AND METHODS: The study included 110 men aged 1884 years who underwent multi-stage urethroplasty for the anterior urethral structures in 20102019. The techniques of buccal and skin augmentation or urethral replacement plastics were applied. Before surgery, all patients underwent a standard urological examination. Early surgical complications were evaluated from medical records. Late surgical complications were determined according to examinations that included symptomatic assessment with specialized questionnaires, laboratory tests of serum and urine, physical examination, uroflowmetry, and retrograde urethrography and ureteroscopy (if urinary disorders were detected). The median follow-up was 5 years and 2 months. RESULTS: Early surgical complications were detected in 27 (24.5%) patients. Surgical interventions to resolve them were required in 7 (31.8%) cases: urethrocutaneous fistulas (5), acute urinary retention (1), scrotal hematoma (1). Late surgical complications were detected in 33 (30.0%) patients, including 29 (26.7%) cases of recurrent urethral strictures. All late complications cases were classified as Clavien-Dindo IIIb, and a total of 49 additional operations were performed to eliminate them. The primary success rate for multi-stage urethroplasty was 67.3 % with a median follow-up of 62 months. Only 73 (66.4%) completed all stages of the planned surgery. Urethral integrity throughout its entire length was restored in 67 (60.9%) cases, spontaneous urination in 106 (96.4%) cases. CONCLUSIONS: Multi-stage surgery for anterior urethral strictures is associated with relatively high risks of surgical complications at each stage of treatment. The probability of surgical revision of complications can reach 31.8%. Patients should be informed about the risks of developing surgical complications and the potential for more than two surgeries to achieve treatment goals when planning multi-stage urethroplasty.