Biomedical subjects
Publications and source records attributed to A I Strel'nikov.
The authors describe a technique of ureterocystoneostomy based on the principle suggested by Politano-Leadbetter but using an original set of instruments approved by the patent committee. The technique was applied in the treatment of 12 children aged 11 months to 5 years. The operation was highly effective: it became easier to perform in reduced duration and traumatism.
31 children aged 1 to 9 years with malformations of the kidneys and upper urinary tracts were preoperatively examined for immune status. After plastic operation 14 children developed early postoperative infectious-inflammatory complications. It is suggested that early postoperative complications in some children with renal and upper urinary tract maldevelopments may arise because of weak compensatory abilities and immunodeficiency resultant from the operative stress. These created favourable conditions for activation of latent infection. Immunological assessment of the patient prior to surgery predicts early postoperative complications and thus enables proper preventive measures.
Urodynamics of the upper urinary tract (UUT) was examined in 327 children aged 1.5 months to 15 years with congenital vesicoureteral reflux (VUR) dysplasia treated surgically. 230 patients were followed up for 1 to 20 years. Staging of chronic disorders of UUT urodynamics is thought to be the key criterion of objective assessment of VUR effective surgical treatment. The better long-term treatment outcomes are the earlier the disease was diagnosed and corrected. Early defects of urodynamics in the absence of marked dilatation of the ureter are better corrected by Lich-Gregoir operation which is physiological, low traumatic, technically available and most effective (97% of favourable long-term outcomes). Ureterocystoneostomy by Politano-Leadbetter (in modification of the authors) is indicated in urodynamic disorders stage III and marked ureteral dilatation as providing improvement of urodynamics or stabilization in 93.7% patients.
Functional activity of the lower and upper urinary tract was examined in 169 patients with infravesical obstruction and in 20 controls. Combined investigation included: radioisotope uroflowmetry, retrograde cystomanometry, urethrosphincterometry, miction videocystourethrography, excretory urography, radioisotope renography, pharmacorenography, dynamic nephroscintigraphy and renal angiography. An analysis of lower urinary urodynamic findings has demonstrated stages as an important regularity in the development of functional lower urinary disturbances. As a result, a standard system has been evolved for the assessment and classification of stages in chronic lower-urinary urodynamic disorders. Four stages are identified in the classification. Evaluation of upper-urinary urodynamics in the same 169 patients with lower urinary tract disorders of varying severity demonstrated that upper urinary functional parameters become worse as lower urinary parameters deteriorate, but there is no strict correlation between those. A systematic study of the pattern of combined disorders of the lower and upper urinary tract has made it possible to develop a standard system for the assessment and classification of stages of combined urodynamic insufficiency, with 4 stages identified. The use of this system improves objective assessment of the severity of patient's condition and specifies indications for surgical treatment of infravesical obstructions.
The authors offer a new techniques of ureterocystoneostomy using instrument set patented in the Russian Federation. The set consists of a detachable metal tube and forceps. The tube has a conic end and holds the ureter cut from the bladder. The forceps (standard vascular dissector) has jaws 4-5 cm long. The instrument's curvature and long jaws make it possible to form sufficiently long submucosal tunnel without damage to the mucosa above the tunnel. The ureter is fixed inside the metal tube and than is inserted into the tunnel. The technique is low traumatic and may be used in congenital pathology of the ureterovesical segment in children and adults, in bladder tumors.