scholarly journals EXTRAPERITONEOSCOPIC PROSTATEСTOMY: SURGICAL TECHNIQUES PRESERVING THE QUALITY OF LIFE OF THE PATIENT

2019 ◽  
Vol 21 (1) ◽  
pp. 140-143
Author(s):  
V V Parshin ◽  
B R Gvasalia ◽  
D I Stegantsev ◽  
A S Esipov ◽  
A D Kochetov

Objective.Radical prostatectomy (RPE) performed without preserving the neurovascular bundles and the pubovesical complex has a great risk of developing urinary incontinence and erectile dysfunction, which significantly impairs the quality of life of patients with prostate cancer in the postoperative period. Methods. The effectiveness of surgical treatment was assessed in 22 patients (mean age 57.6 ± 6.4 years) with a diagnosis of prostate cancer, who underwent extraperitoneoscopic intrafascial nerve-saving radical prostatectomy with preservation of the pubovesical complex. The criteria for the effectiveness of this technique of surgical treatment were considered the preservation of erectile function and the absence of urinary incontinence in the early and late postoperative period. Results. In the postoperative period, all patients were continent; in 3-4 months, erectile function was restored without additional stimulation by phosphodiesterase-5 inhibitors. Conclusions.The described technique demands detailed understanding by the surgeon of the surgical anatomy of the prostate and the basic surgical principles of nerve preservation in order to significantly improve the quality of life of patients in the postoperative period.

2021 ◽  
Vol 22 (3) ◽  
pp. 44-48
Author(s):  
E. V. Shpot’ ◽  
D. V. Chinenov ◽  
Ya. N. Chernov ◽  
A. Yu. Votyakov ◽  
E. N. Gasanov ◽  
...  

Background. Considering decreasing age of patients with prostate cancer, increasing cancer alertness of first-line doctors as well as increased frequency of radical prostatectomies (RP), the problem of preservation of erectile function (EF) is vitally important (erectile dysfunction develops in 25–75 % of all patients who underwent surgery).The study objective is to analyze preservation of EF after RP depending on the type of endoscopic access and nerve preservation.Materials and methods. Between February of 2015 and February of 2016, in the Urology Clinic of the Sechenov University, 507 RPs were performed; the retrospective single-center study included 231 patients with localized prostate cancer. Surgery was performed with the following accesses: laparoscopic, extraperitoneal laparoscopic, and robotic. Indications for nerve preservation were formulated based on the Briganti nomogram, Partin table as well as patient’s desire to preserve EF. Further evaluation of EF was performed using the International Index of Erectile Function (IIEF5), evaluation of quality of life – using the QoL (Quality of Life) scale.Results. RP with nerve preservation was performed in 150 patients. Surgical time and blood loss did not significantly differ for surgeries with and without nerve preservation (р = 0.064 and р = 0.073 respectively). Pathomorphological examination showed that in all cases (n = 231) integrity of the prostatic capsule and negative surgical margin were achieved. Frequent significant erectile dysfunction and full loss of EF were observed in patients after RP without nerve preservation compared to the group with preserved neurovascular bundles (5.0 (0.0–10.0) points compared to 6.5 (0.8–19.0) points per the IIEF5 scale, р = 0.271): 96.2 % versus 72.2 % (p <0.001). Nerve preservation significantly improved quality of life: 1.63 ± 1.16 points versus 1.88 ± 1.02 points per the QoL scale (р = 0.035).Conclusions. The best results were achieved in the robotic access group. Surgery with nerve preservation decreased frequency of EF loss. This benefit in conjunction with the radical nature of the operative intervention allows to consider RP techniques with nerve preservation as reasonable approach to erectile dysfunction prevention in patients with localized prostate cancer.


2021 ◽  
Vol 9 (2) ◽  
pp. 153-162
Author(s):  
Dmitry N. Kokushin ◽  
Michael A. Khardikov ◽  
Sergey V. Vissarionov ◽  
Vera V. Sokolova ◽  
Nikita O. Khusainov ◽  
...  

BACKGROUND: Congenital scoliosis with disorders of the formation of the vertebrae is the most common cause of pronounced deformities of the spine in early childhood. This pathology can be treated surgically using various techniques that differ in invasiveness, severity of the condition in the postoperative period, achieved result of deformity correction, and nature of the long-term prognosis. Numerous studies have assessed the quality of life of patients who underwent surgery for acquired deformities, trauma, and degenerative and neoplastic diseases of the spine in adults. However, features of the childs quality of life following surgical technique for congenital scoliosis have not been sufficiently studied. AIM: This study aimed to compare the quality of life of children with congenital scoliosis of the thoracolumbar localization after extirpation of the hemivertebra from the dorsal and combined approaches. MATERIALS AND METHODS: An intergroup prospective analysis of the results of a survey of 60 patients with congenital deformity of the spine against the background of an isolated violation of the formation of the thoracic or lumbar vertebra was carried out. Patients underwent standard surgical treatment. Patients were divided into two groups according to the surgical approach to the abnormal vertebral body: dorsal group (n = 28) and combined group (n = 32). The average age of the patients was 75 (minmax, 26196) months. The follow-up period was 18 months after surgery. To assess the quality of life, a specialized Russian version of the PedsQL v4.0 questionnaire and a modified visual analog scale were used. RESULTS: After surgical treatment of congenital spinal deformity, quality of life indicators decreased more than two times than the results of a preoperative survey. At 18 months postoperatively, the physical activity and psychoemotional state were restored to the preoperative level, while patients of the combined group had a higher satisfaction score on the quality of life (p 0.05). CONCLUSIONS: The combined approach provides the best correction of congenital deformity of the spine and allows maintaining of the achieved result throughout the observation period. In the early postoperative period, the combined group demonstrated a significant decrease in the level of satisfaction with the quality of life, while the pain syndrome was higher than that in the dorsal group. Dynamic observation revealed the leveling of these differences and a subsequent increase in the level of satisfaction with the quality of life of these patients.


Author(s):  
Alexander V. Yashkov ◽  
Tatyana A. Sivokhina ◽  
Svetlana A. Burmistrova ◽  
Natalia G. Rybakova

Background. The main side effect of most of the methods of treating prostate cancer is incontinence of urine in varying degrees of severity. Although in most cases incontinence is a temporary phenomenon, this problem occurs in 3963% of patients during the first two years after treatment, and about 2456% of patients have to use urological pads or condoms. Incontinence of urine is also a serious psychological traumatic factor, which has аn extremely negative effect on patients quality of life. Aim: to substantiate the effectiveness of the use of complex rehabilitation programs in the correction of urinary incontinence in men who have undergone radical treatment for prostate cancer. Materials and methods. The study included patients with stage IIII prostate cancer, mean age 55 6 years, with complications after radical prostatectomy for at least 2 months without a tendency to improve in the form of moderate and severe urinary incontinence. Results. The combined technique of correction of urinary incontinence, modified by us, using neuromuscular stimulation, physiotherapy exercises and psychocorrectional exercises, has demonstrated its effectiveness in improving the quality of life in this group of patients. Conclusions. The combined technique of correction of an incontience of urine with use of neuromuscular stimulation, physiotherapy exercises and the psychocorrection of occupations is presented in this article, the assessment of efficiency of this comprehensive program of rehabilitation, and also improvement of quality of life of patients is carried out.


2010 ◽  
Vol 28 (31) ◽  
pp. 4687-4696 ◽  
Author(s):  
Yolanda Pardo ◽  
Ferran Guedea ◽  
Ferrán Aguiló ◽  
Pablo Fernández ◽  
Víctor Macías ◽  
...  

Purpose Earlier studies evaluating the effect on quality of life (QoL) of localized prostate cancer interventions included patients receiving adjuvant hormone therapy, which could have affected their outcomes. Our objective was to compare the QoL impact of the three most common primary treatments on patients who were not receiving adjuvant hormonal treatment. Patients and Methods This was a prospective study of 435 patients treated with radical prostatectomy, external-beam radiotherapy, or brachytherapy. QoL was assessed before and after treatment with the Short Form-36 and the Expanded Prostate Cancer Index Composite. Differences between groups were tested by analysis of variance. Distribution of outcome at 3 years was examined by stratifying according to baseline status. Generalized estimating equation models were constructed to assess the effect of treatment over time. Results Compared with the brachytherapy group, the prostatectomy group showed greater deterioration on urinary incontinence and sexual scores but better urinary irritative-obstructive results (−18.22, −13.19, and +6.38, respectively, at 3 years; P < .001). In patients with urinary irritative-obstructive symptoms at baseline, improvement was observed in 64% of those treated with nerve-sparing radical prostatectomy. Higher bowel worsening (−2.87, P = .04) was observed in the external radiotherapy group, with 20% of patients reporting bowel symptoms. Conclusion Radical prostatectomy caused urinary incontinence and sexual dysfunction but improved pre-existing urinary irritative-obstructive symptoms. External radiotherapy and brachytherapy caused urinary irritative-obstructive adverse effects and some sexual dysfunction. External radiotherapy also caused bowel adverse effects. Relevant differences between treatment groups persisted for up to 3 years of follow-up, although the difference in sexual adverse effects between brachytherapy and prostatectomy tended to decline over long-term follow-up. These results provide valuable information for clinical decision making.


10.12737/6454 ◽  
2014 ◽  
Vol 8 (1) ◽  
pp. 0-0
Author(s):  
Антонов ◽  
A. Antonov

Use elixir Altai (&#34;Vitavis&#34;) in combination with ion-activated with water by means of such a complex contingent cancer patients as patients with metastatic bone fractures of the upper and lower limbs can reduce the early postoperative period, and to reduce to a minimum infectious complications and improve quality of life. The problem of postoperative complications, until now, is not solved. In oncologic patients, and those more in by III and As IV stages occurs it immunnodefitsit, which is caused not only by basic disease, but also by conse-quences of khimio- beam therapy. In connection with this appears the difficulty in the surgical treatment, caused by postoperative complications. As a result surgical treatment appears surgical injury, oxidizing stress, disturbance of homeostasis and oppression of immunity, which leads to an even larger disturbance of immunity in oncologic patients, which decreases the unspecific resistibility of organism. The application of adaptogena of the elixir of Altai (“Vitavis”) in combination with the ionic- activated aqueous means makes it possible to level and to reduce on no oxidizing stress, to increase the unspecific resistibility of the organism of oncologic patient and to increase immuni-ty. Moreover, powerful antioxidant - the ionic- activated aqueous means strengthens the action of adaptogena of the elixer of Altai (“Vitavis”), which leads to the decrease of postoperative infectious complications, reduces postoperative period, improves the quality of life and enlarges indications to the surgical treatment in oncologic patients with III it and IV by the stages of diseases.


2019 ◽  
Vol 23 (3) ◽  
pp. 166-168
Author(s):  
A. E. Soloviev

Purpose. To study the clinical picture, diagnosis and treatment of epispadias in girls. Material and methods. 22 girls with epispadias of various forms were under supervision for 50 years. During diagnostics the following issues were used: anamnesis, examination, catheterization and uroflowmetry, cystoscopy of the bladder, ultrasound and X-ray examination. Results and discussion. Out of 22 girls with epispadias, clitoral epispadia (partial ) was in 10 patients; sub-symphisal (subtotal) - in 4; symphisal (total) - in 8 girls. In 10 girls with the clitoral form, urological examination was made because of changes in the urine. Girls with sub-symphisal epispadia complained of irritation and itching in the vulva. All had vulvitis, cystitis, chronic pyelonephritis. In 2 patients, renal doubling was diagnosed; in other 2 patients ureterohydronephrosis and kidney dystopia were diagnosed. Uroflowmetry revealed hyperactive bladder in all. 8 girls with the total (symphisial) form of epispadia and urinary incontinence were operated by the Derzhavin technique; after the surgery the function of bladder sphincter was restored and the patients could have a normal quality of life. Conclusion. Epispadia in girls is a rare case . There are clitoral, sub-symphisal and symphisal (total) forms of epispadias. Cluster and sub-symphisial forms do not require surgical treatment. While in the symphisial (total) form, plastic surgery on the bladder neck by the Derzhavin technique is recommended. It is a good option for recovery.


2017 ◽  
Vol 7 (1) ◽  
pp. 25 ◽  
Author(s):  
Yuliya S Moscaleva ◽  
Igor A Korneyev

Surgical methods of treatment of Peyronie’s disease by plication corporoplasty proved to be effective in the near and distant postoperative periods in the examined group of patients. These methods made it possible to quickly achieve the normalization of the shape of the penis without affecting the erectile function which enabled for patients to restore copulative activity and improve the quality of life.


2018 ◽  
Vol 25 (6) ◽  
pp. 149-153
Author(s):  
A. N. Sergienko ◽  
V. V. Dashina ◽  
A. V. Malyshev ◽  
O. I. Lysenko ◽  
S. V. Yanchenko

Aim.The study was designed for the evaluation of the quality of life of children with retinal detachment during vitrectomy.Materials and methods. 23 children with retinal detachment aged from 10 to 17 years were treated. Surgical treatment consisted of a three-port vitrectomy and a laser endocoagulation of the retina. 3 groups were formed with the help of a random sampling. During the surgical treatment of group I (n=8), only balanced non-oxidant solutions of salts (Balsed Salt Solution − BSS) were used. Tablets of antioxidant preparations were not assigned. Saline solutions with antioxidants (BSS plus) were used to carry out surgery for group II (n=8). Group III (n=7) was additionally taking antioxidant preparations peros for 3 months in the postoperative period . The quality of life was studied using the abridged Russian version of the VFQ-25 questionnaire. 10 children of the same age with no indications of surgical treatment of retinal detachment were selected for the control group. Statistical analysis of the obtained data was carried out using a set of programs for applied statistical analysis Analyst Soft, Bio Stat 2007.Results.A week after the surgical treatment, no increase in visometric data was observed. Six months later, a significant increase in visual acuity was revealed. The highest visometric data were observed in group II due to the minimal progression of lens opacities. Group I patients had the lowest values of this index.Conclusion.The positive effect of the surgical treatment of retinal detachment positively influenced the patients’ quality of life in the early and late postoperative period.


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