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Biomedical subjects

A G Pugachev

Publications and source records attributed to A G Pugachev.

At least 73 records · Page 4Linked to original sources
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[Varicocele in children and adolescents].

We made examinations (physical, clinical and laboratory) of 301 senior children and adolescents with varicocele admitted to Research Institute of Urology for the last 5 years. Spermatogenesis was assessed by WHO criteria for healthy men. 78% of the patients were operated by Ivanissevich, 22% received sclerotherapy. Sperm motility and morphological parameters were found subnormal. Taking into consideration relative subfertility of the patients, surgical results were positive. We continue follow-up of the patients and plan further studies of spermatogenesis.

Adolescent↗
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[Long-term results of treating children with kidney and ureteral stones with extracorporeal lithotripsy].

Long-term outcomes of urolithiasis treatment with extracorporeal lithotripsy (ECLT) have been analysed for 132 children using, as the basic criterion, data of dynamic nephroscintigraphy. The results of ECLT were considered regarding characteristics of the concrement, inflammatory process, parameters of the shock wave. It was found that low-energy restruction regimens in minimal number of impulses per session and adequate intervals between them prevent irreversible changes in renal parenchyma in response to focused shock waves. Monitoring and adequate treatment late after ECLT lead to recovery of renal function if obstructive complications and stone formation are found early and if the course of the inflammation is controlled.

Child↗
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[Intermittent bladder-ureteral reflux in children].

Basing on the results of a combined clinical and laboratory examination of 193 children treated in the Research Institute of Urology in 1992-1999, the authors studied causes underlying intermittent vesicoureteral reflux (IVR) in correlation with anatomo-functional changes in vesicoureteral anastomosis and severity of inflammation in the urinary bladder. They suggest a diagnostic algorithm of detecting IVR with assessment of gas cystography role in the diagnosis; give definition of IVR; describe therapeutic policy in accordance with functional state of the affected kidney and cause of IVR onset; analyse short- (6-12 months) and long-term (12-36 months) treatment results; outline methods of IVR prophylaxis to save and improve renal function.

Child↗
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[Telelithotripsy in the treatment of staghorn nephrolithiasis in children using the URAT-P lithotriptor].

The paper presents the results of telelithotripsy monotherapy for 34 staghorn stones in 32 nephrolithiasis children carried out at the RSFSR Research Institute of Urology, Moscow. Commonest manifestations of the disease were leukocyturia (87.5% of cases) and Proteus bacteriuria (31.8% of cases). Basing on roentgenological findings, the stones were classified into 3 groups: initial (K1), incomplete (K2) and complete (K3). All the children underwent treatment on Soviet lithotriptor "URAT-P" under a delicate regime using different techniques of disintegration which started from the periphery and advanced to the pelvic part of the calculus. No pretreatment drainage of the pelvicaliceal system was performed. The intended staged disintegration of the stones was achieved in 94.2% of cases at 2.4 sessions, on the average, and overall number of impulses 1973.1 per each stone. At discharge 76.4% of the children were free of the main mass of the stone dust. Acute pyelonephritis which appeared the most frequent postoperative complication developed in 7.8% of the patients one of which required open nephrostomy and one percutaneous puncture nephrostomy. Other cases were treated by specific antimicrobial therapy. Complete series of investigations in the postoperative period did not reveal any intra- or pararenal hematomas. Radioisotopic renography revealed improvement in renal function in 62% of cases in early postoperative follow-up. Thus, 93.8% of children with stag-horn stones were spared of traumatic operative intervention or invasive manipulations. This makes the method of telelithotripsy a valuable therapeutic tool in childhood staghorn nephrolithiasis.

Adolescent↗
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[Long-term surgical treatment outcome in ureteral neuromuscular dysplasia in children].

178 patients with ureteral neuromuscular dysplasia (UND) treated surgically were followed up for maximum 8 years. The following operations were made: resection of the stenosed part with antireflux operation by Politano-Leatbetter, Hendren operation, Lopatkin-Kalichinsky operation. Functional results depended on the condition of leiomyocyte regenerative reserves, deficiency of secretory renal function and the surgical method. In ureteral achalasia (by N. A. Lopatkin's classification) it is recommended to perform resection of the stenosed part by Politano-Leatbetter antireflux technique, in megaureter and ureterohydronephrosis Lopatkin-Kalichinsky operation is preferable.

Adolescent↗
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[Modern aspects of child urology].

Basing on the results of modern investigations applied preoperatively, postoperatively and for 20 years of follow-up in more than 36,000 children with urogenital diseases, the author believes that further progress of childhood urology should advance in the scope of general urology. He proposes basic principles underlying decision making on the treatment of urological diseases in different age groups. It is shown that many open and endoscopic interventions used in the adults are converted into pediatric urological practice disregarding pathogenetic and compensatory features in urological diseases in children. Basing on specific features of the course of compensatory processes in various age groups of children, new terms of corrective operations are proposed.

Adolescent↗
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[Conservative surgery--a basic principle of childhood urology].

Dysfunction of the solitary kidney was established in 58 patients after the contralateral kidney removal in childhood. The tests were made at senior school age, at adolescence, at adult age. The disorders in the renal function were more severe in pathological processes in the solitary kidney: chronic pyelonephritis, nephron dysplasia, etc. In 49 children the kidney was preserved even in functional failure 70-90%. These patients had less evident renal failure. Basing on this evidence and other arguments, the authors recommend to limit indications for nephrectomy in children.

Adolescent↗
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[Endoscopic correction of neuromuscular ureteral dysplasia in children].

The authors present pathogenetic rationale for using endoscopic intervention in neuromuscular ureteral dysplasia in children. A positive effect of this treatment occurs primarily in patients with a small area of sclerosis focus in the ureter. Such patients have high percentage of leiomyocytes with a great regenerative potential. This explains a response to endoureterotomy.

Child↗
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[Morphological reasons of development of recurrent cystitis in children].

Chronic cystitis was diagnosed in 36% of children with neuromuscular ureteral dysplasia, in 69% of those with vesicoureteral reflux, in 42% of girls with urolithiasis. Recurrent inflammation was registered in 96, 11% of patients with fibrinous cystitis and catarrhal cystitis, respectively, and in 62% of girls with bullous cystitis. Histological examination of 130 biopsies of bladder mucosa from girls with frequent recurrences of chronic cystitis provided a clear morphological picture of each endoscopic cystitis form. In bullous cystitis there are 2 congenital variants of mucosal structure: overdevelopment of lymphoid tissue as massive lymphoid follicules and lymphangioectatic form. Catarrhal cystitis is characterized by vascular angiomatosis. All the patients with fibrinous cystitis had squamous cell epithelial metaplasia. Morphological findings evidence that fibrinous cystitis is the most severe and unfavorable form of cystitis, bullous cystitis is less severe while catarrhal cystitis is favorable.

Adolescent↗
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[The surgical treatment of urinary incontinence in children].

The paper reports examination, treatment and follow-up data on 8 children aged 4-13 suffering from total enuresis, who failed previous conservative or operative treatment. Upon examination enuresis was attributed to trauma or malformations of the neck of the urinary bladder (NUB) or urethra (in 2 and 6 patients, respectively). Out of the latter, NUB congenital defect was in 4, total epispadia in 1, spina bifida in 1 patient. Urodynamic studies showed the absence of detrusor-sphincter dyssynergia and confirmed organic nature of NUB lesion. Six children underwent NUB electromyography which recorded no uniform, preformed complexes with adequate voltage. All the children were operated on: NUB reconstruction according to Davis, bilateral uretero-cystostomy according to Coen. An immediate postoperative response was seen in 7 children who were able to retain urine for 40 min-2.5 hours. Long-term response (6 months-3 years) was achieved in 7 children who recovered normal uresis. Total enuresis persisted in 1 patient with spina bifida. 2.5-3 years after the treatment the bladder capacity increased in spite of its resection by 1/3.

Adolescent↗
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[X-ray endovascular research in varicocele in children].

60 patients with varicocele first diagnosed and 38 with postoperative recurrences of varicocele were examined with use of digitalis subtraction renal and testicular phlebography as an optional diagnostic method. In the patients' group with varicocele recurrences the roentgeno-endovascular method allowed the causes of relapses associated with inadequate ligation of testicular vein influxes to be revealed (73.3%) and collateralization of the operated region (26.3%). In patients with firstly diagnosed varicocele the phlebography confirmed the diagnosis in 98.3%; revealed associated urogenital diseases; allowed indications for a specific mode of surgical correction to be formulated. 78 patients underwent testicular vein roentgeno-endovascular occlusion with 3% solution of thrombovar, 15 were operated on by the method of Ivanissevich in whom a level and character of surgical ligation were defined by phlebographic data; one patient had the operation testicular-saphenous anastomosis; one patient was not operated due to his systemic blood disease. By digitalis subtraction angiographic data recurrence rates after a proper treatment were 2%. 4.1% had thrombophlebitis of the racemose plexus after a sclerotherapy conservatively abolished. The use of digitalis subtraction testicular phlebography allowed one to properly choose a surgery and to decrease relapse rates due to its high preoperative diagnostic efficacy. In addition, preoperative X-ray endovascular examination made it possible to reveal the cause of relapses after early performed operations, to detect synchronous renal lesions in time, and to prevent recurrences by reducing the amount of a contrast medium by a factor of 2-3.

Adolescent↗
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[The role of electropyelo- and electroureterography in assessing operations on the upper urinary tract].

Biopotential recording is currently used in patients with urologic diseases to determine the status of the upper urinary tract, to assess the electric activity of detrusor urinae, as additional objective indications while choosing an organ-preserving or organ-removing surgery, to check the effects of direct electric stimulation, to elucidate the magnitude of lesion and its extension. Electropyelo- and electroureterographies were performed by the routine procedures by employing foreign and Soviet-made devices in 76 patients with various urologic diseases resulting in upper urinary contractility: hydronephrosis, neuromuscular dysplasia, vesicoureteral reflux, as well as with other diseases. Electroureterography of the ureteropelvic segment will help choose a correct tactics of surgical therapy for patients with hydronephrosis; in case of markedly lower electric activity, the terms of nephrostoma removal after ureteropelvic plastic operation may be increased up to 2 months, as evidenced both by electropyelographic and clinical findings. Electropyelography was found to contribute to definition of indications for electrostimulation of the renal pelvis when its tension was decreased in patients with urolithiasis, which enabled the nephrostomic drain to be healed subsequently, as well as to assessment of electric stimulation used in postoperative reflux, as confirmed by electroureterographic findings. The findings led to the conclusion that it was advisable to use electropyelo- and electroureterography to choose a method of surgical treatment, electrostimulation and as criteria for recovered urinary contractility.

Adolescent↗
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[Remote lithotripsy with the URAT-P apparatus in treating urolithiasis in children].

The Soviet-made device "URAT-P" for remote lithotripsy was used for the treatment of urolithiasis in children aged from 22 months to 14 years who suffered from various clinical patterns of urolithiasis with solitary or dendritic calculi. Out of 64 treated persons, 21 children had undergone 1-2 surgeries for the disease. The majority of them had pains and frequent aggravations of pyelonephritis. Excretory urography revealed the signs of hydronephrosis and hydrocalycosis. There was no need for additional adjustments to perform the procedure in patients with a height of under 75 cm. The authors employed erosive operating conditions of a shock-wave generator for lithotripsy in case of large or dendritic calculi and to avoid preliminary renal drainage. One treatment session was a success in 43 patients, 2 sessions were needed for 15, 3 for 4 and 4 for 2 patients. A beneficial effect (total disintegration and fragmental discharge) was reached in 64 (98.4%) of the patients. Partial disintegration was recorded only in 1 patient who was exposed to 2 sessions. Radioisotope, immunological, ultrasonic, and biochemical investigations failed to reveal inhibition of the renal functional parameters after remote lithotripsy. No renal injuries associated with hematogenesis were revealed in the parents. The signs of hematuria were observed in the first portion of the postoperative urine only. The only serious complication calling for close attention is acute pyelonephritis observed in 6 patients, one case requiring a surgical application of nephrostoma.

Adolescent↗
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[Bladder neck sclerosis in children].

Nowadays there are contradictory opinions of the prevalence of urinary cervicovesical sclerosis in children and therefore the high incidence of the disease is explained by some investigators as hyperdiagnosis. This article presents the results of examination performed in 15 children with urinary cervicovesical sclerosis who were referred to hospital for other diagnoses. Morphological examination, including electron microscopy, failed to demonstrate the congenital origin of the disease. The authors suspect that the development of cervicovesical sclerosis in children was associated with some secondary reasons. Clinical signs of the disease are characteristic of intravesical obstruction confirmed by uroflow, profilo- and cystomanometries. The findings failed to confirm the dysfunction of the detrusor. In general, cystoscopic examination documented a heterogeneous, more commonly mosaic picture which was not infrequent in the presence of chronic inflammation. Trabecularism of the mucosa was documented in all examinees, false diverticula in four of them. When the irrigation liquid passed the neck of the urinary bladder the latter opened but the stricture was not continuous. X-ray examination revealed the rigidity, compression and high position of lower cervical segments. Cervicovesical sclerosis was treated by transurethral [correction of transureteral] electroresection with a subsequent multiple urodynamic study which proved the correctness in the choice of the treatment policy and its beneficial impact. In case of a "dry urinary bladder', the authors first made operative corrections for the recovery of the urine passage, followed by transurethral [correction of transureteral] electroresection of the neck of the urinary bladder.

Adolescent↗
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[Ureterocutaneostomy. A view of the method today].

The paper presents the authors' opinion of ureterocutaneostomy (UCS) as a technique for the drainage of the urinary tract in case of its obstruction-related changes. The opinion was based on the analysis of 12 UCS outcomes. Routine indications to UCS are presented and principal shortcomings of the technique discussed. Topographical and anatomical abnormalities of the retroperitoneal ureter position, a decrease in the functional performance of the ureter result in certain technical difficulties that face the surgeon in the following reconstructive operations. There is a well-known complication of UCS, so-called "dry" urinary bladder, which excludes any further surgical correction in the infravesical part of the urinary tract. Presenting the clinical data and regarding percutaneous paracentetic nephrostomy as an optimum technique for the clinical practice, the authors concluded UCS to be impracticable.

Child↗
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[Cohen's operation in the treatment of vesico-ureteral reflux in children].

The present study is a review of the results of Cohen's operation performed on 43 ureters in 32 children. Treatment results were assessed through the comparison of cystographic and 131I-hippuran renographic findings obtained before and after surgery. Urodynamic recovery in the affected ureter was demonstrated in all children. One year after surgery, there was no improvement in the activity of the resected kidney in 37% of patients. In the remaining patients, secretion improved by 10-13% in the affected kidney. Seventeen children returned for follow-up examination 2 years after surgery. The activity of the affected kidney and the contralateral one improved in 13 of 17 patients. There was no upper urinary retention due to ureteral stricture in any of the children. The rate of recurrent vesico-ureteral reflux (VUR) was 5.3%. Augmentation or persistence of purification deficiency in the affected kidney, detected in 12 patients at first postoperative follow-up, was qualified as a result of aggravated chronic pyelonephritis rather than that of surgical complications related to methodologic specifics. This assumption was verified by the results of the next follow-up examination 2 years after surgery. Therefore, Cohen's method can be recommended for large-scale application in the treatment of VUR in children and is expected to essentially reduce the rate of relapses and improve the standards of surgical care of children with this grave disease.

Child↗
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[The early stages of chronic kidney failure in children with congenital obstructive uropathies and results of surgical treatment].

Ninety-six children, aged 4 to 14, with congenital obstructive uropathies were subjected to 131I-hippuran renography, followed by mathematical processing of renographic curves, the measurement of blood mean molecular levels, and blood and urinary immunochemical tests before, and 1 month as well as 1 year after surgery. Intraoperative renal biopsy was taken from 20 patients with unilateral hydronephrosis. Latent chronic renal failure (CRF) was identified where a deficiency of total renal clearance of 131I-hippuran (20 to 56%) was combined with a rise in blood mean molecules from 0.3 to 0.41 conventional units at 254 nm. Latent CRF was detected in 40 of 64 children with unilateral uropathy and in all 32 patients with bilateral uropathy. In patients with unilateral hydronephrosis, the presence of CRF was unrelated to the morphological pattern of pyelonephritis in the affected kidney. Children with latent CRF showed high levels of urinary IgG and albumin and blood mean molecules. One year after the operation, renal function improved in patients whose contralateral kidney had no secretory deficiency. One year after surgery, renal reabsorption mechanisms tended to recover in CRF-free patients only. The clinical pattern of latent CRF and its elimination following surgery were unrelated to roentgenologic markedness of hydronephrosis and VUR, but were dependent on the recovery of compensatory mechanisms in the contralateral kidney. By the end of the first postoperative year, latent CRF was diagnosed in 31% of children with unilateral hydronephrosis (as compared to the preoperative 68%), 43% (vs. the preoperative 60%) of children with unilateral VUR, and in 44% (vs. the preoperative 50%) of patients with unilateral neuromuscular ureteral dysplasia.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗