BACKGROUND: Benign prostatic hyperplasia is the most common urological disease in older men, leading to the development of bladder outlet obstruction and a decrease in the quality of life of patients. The choice of the method of surgical treatment of benign prostatic hyperplasia with large prostate volumes is the subject of discussion. There is also no unified approach to the management of patients with acute urinary retention due to benign prostatic hyperplasia. AIM: To evaluate the results of thulium laser enucleation of the prostate in patients with large benign prostatic hyperplasia associated with acute urinary retention. MATERIALS AND METHODS: The present study included the results of treatment of 237 patients with benign prostatic hyperplasia with a prostate volume of more than 80 cm3, of which 97 were hospitalized in the urology department for acute urinary retention. The age of the patients ranged from 51 to 89 years (average 70.2 years). The volume of the prostate gland ranged from 80 to 150 cm3 (mean 128.3 cm3). The control examination was performed on the 2nd day, as well as 3, 6 and 12 months after the surgery. RESULTS: Surgical intervention was performed using a thulium fiber laser device FiberLase U1 (IRE-Polyus, Russia) with a power of 120 W. The time of surgery ranged from 63 to 127 minutes (average 74.3 minutes). The irrigation system was turned off on the 1st day of the postoperative period. The duration of urethral catheterization averaged 2.7 days. None of the patients in the study required blood transfusion or repeated surgery to coagulate the vessels of the prostate bed. After removal of the urethral catheter, all patients urinated on the first attempt. In 7 patients (2.95%), after removal of the urethral catheter, urinary incontinence was observed, during the first 6 months after the operation, urinary retention was restored in all of them. We did not note significant differences during the intra-, early and late postoperative period in operated BPH patients with and without acute urinary retention. CONCLUSIONS: ThuLEP is an effective and safe method of surgical treatment of patients with benign prostatic hyperplasia with a prostate volume of more than 80 cm3, complicated by acute urinary retention.
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.
BACKGROUND: Radical cystectomy is the standard treatment for patients with muscle-invasive bladder cancer and superficial neoplasms in cases of resistance to intravesical immunochemotherapy. AIM: To establish the frequency of local pelvic recurrence in patients with bladder cancer after radical cystectomy. MATERIALS AND METHODS: From 1997 to 2022 radical cystectomy was performed in 407 patients with bladder cancer: 344 (84.5%) men and 63 (15.5%) women. Orthotopic urinary diversion methods were performed in 302 (74.2%) patients, including gastrocystoplasty 24 (5.9%), ileocystoplasty 253 (63.8%) and sigmocystoplasty 25 (6.1%) patients. Continent skin diversion of urine was performed in 13 (3.2%) patients, ureter transplantation into the sigmoid colon in 42 (10.3%) patients, and ureterocutaneostomy in 50 (12.3%) patients. RESULTS: Local recurrence in the pelvis after radical cystectomy was observed in 33 (8.1%) patients: 27 (81.8%) men and 6 (18.2%) women. The average age of men with relapses was 58.7 11.7 years (from 43 to 73 years), women 50.0 7.8 years (from 24 to 65 years). Simultaneous metastatic lesions of internal organs were detected in 6 (18.2%) patients. Local pelvic recurrence after radical cystectomy occurred more often in lymphopositive patients with extravesical spread of the primary low-grade tumor. The median time from radical cystectomy to detection of pelvic recurrence was 7.0 months, from the moment of detection of pelvic recurrence to the death of the patient 4.5 months. CONCLUSIONS: The frequency of local pelvic recurrence of bladder cancer after radical cystectomy is 8.1%. The survival rate of patients with local pelvic recurrence is extremely low.
BACKGROUND: Penile fracture is a rare injury that most often occurs during intercourse. In 238 % of cases, a penile fracture is accompanied by an injury to the urethra. AIM: To determine rational treatment of patients with urethral injuries of varying severity as a result of a penile fracture. MATERIALS AND METHODS: The retrospective group of the study included 8 patients in whom a penile fracture was accompanied by an injury to the urethra. Among them, in 6 (75%) patients, along with a rupture of the albuginea and urethra, unilateral damage of cavernous body was observed. The severity of trauma to the penis and urethra was assessed according to the classification of the American Association for the Surgery of Trauma (AAST). RESULTS: According to the diagnostic results, the fracture of the penis in all patients corresponded to the grade III according to the AAST classification. Urethral injury in 7 patients was grade III, and one was grade I according to the AAST classification. Patients with grade III urethral injury underwent primary urethral plastic surgery. A patient with grade I was treated conservatively. In all patients the bladder was drained with a urethral catheter. Penile fracture was treated surgically in all cases. CONCLUSIONS: A penile fracture associated with urethral trauma always requires immediate surgical treatment. In case of injuries of the urethra III grade according to AAST, the urethral catheter installation and conservative management are indicated. In case of injury of the urethra III, IV, V grade according to AAST, urgent primary urethroplasty is necessary. Damage to the corpora cavernosa and albuginea require surgical treatment after restoration of the integrity of the urethra.
BACKGROUND: Alpha-blockers are the first-line treatment for the elimination of symptoms of impaired urination due to benign prostatic hyperplasia. At the same time, the focus is not only on efficiency, but also on the safety of their appointment. AIM: Comparison of the efficacy and tolerability of the alpha1-blocker tamsulosin at a dosage of 0.2 mg twice a day and 0.4 mg once a day in patients with benign prostatic hyperplasia presenting with mild to moderate LUTS. MATERIALS AND METHODS: The study is based on the results of examination and treatment of 90 patients with symptoms of impaired urination in benign prostatic hyperplasia, aged 50 to 80 years. In the 1st group (n = 45) patients received tamsulosin 0.2 mg twice a day, in the 2nd group (n = 45) 0.4 mg once a day. The duration of treatment was 4 weeks. RESULTS: In patients of both groups, according to the IPSS questionnaire, a statistically significant decrease in the severity of obstructive and irritative symptoms, an improvement in the quality of life, an increase in the maximum urine flow rate, and a decrease in the volume of residual urine were revealed. When comparing the dynamics of clinical indicators in patients of the 1st and 2nd groups, no significant differences were found between the groups. At the same time, treatment tolerance was somewhat better in patients of the 1st group, which manifested itself in a smaller number of adverse events from the cardiovascular system and ejaculatory function disorders. CONCLUSIONS: The results of the study demonstrate the same efficacy of tamsulosin 0.2 mg twice a day and 0.4 mg once a day. At the same time, taking tamsulosin at a dose of 0.2 mg twice a day was characterized by better tolerability of therapy.
