About suprapubic transvesical adenomectomy with a blind suture of the bladder according to the Gelfer-thug method

Russian surgeons were the first to open the way for radical surgery to remove the prostate gland. In 1889 M. Druzhinin published the perineal method of removing the prostate gland, and in 1899 S.P. Fedorov was the first to perform a typical suprapubic prostatectomy.

SURGICAL TREATMENT OF LARGE BENIGN PROSTATIC HYPERPLASIA: TRANSVESICAL ADENONECTOMY VS THULIUM: YAG LASER VAPOENUCLEATION OF THE PROSTATE

According to current guidelines, the surgical treatment of benign prostatic hyperplasia is the main therapeutic option, being refractory to conservative approach. Transurethral resection of the prostate and open transvesical adenomectomy have been considered a reference standard in the treatment of medium (<80ml) and large (> 80ml) benign prostatic hyperplasia. To reduce postoperative complications and promote faster postoperative recovery, there have been proposed several minimally invasive techniques for the treatment of large benign prostatic hyperplasia, the most innovative being laser surgery. Lasers used in retrograde transurethral endoscopic vapoenucleation of the prostate has become a new concept in transurethral surgery. This surgical approach provides promising results and is becoming increasingly popular for the management of severe lower urinary tract symptoms secondary to large benign prostatic hyperplasia.

Morphological features of hyperplastic prostate tissue in patients with chronic prostatitis

Introduction. Benign prostatic hyperplasia (BPH) is a common disease wich is characterized by the proliferation of periurethral prostate glandular tissue. Infectious and inflammatory processes in the prostate play an important role in proliferation and hyperplasia, causing a significant deterioration in prostate metabolism and proliferation acceleration. This leads to progressive growth of the hyperplastic tissue in the prostate gland (PG). Тhe aim of study was to perform a comparative analysis of morphological changes in prostate hyperplastic tissue in patients with chronic prostatitis, who underwent various types of surgical treatment for BPH. Materials and methods. A comparative analysis of morphological changes in prostate tissue was performed, using a material from 276 patients with chronic prostatitis and BPH, who underwent various types of surgical treatment. The patients were divided into three groups: group I (n = 50) - patients who underwent surgical transvesical adenomectomy, group II (n = 76) - patients who underwent transurethral resection of the prostate (TURP) and group III (n = 150) - men who underwent holmium laser enucleation of the prostate. Fragments of the removed prostate tissue were fixed with neutral 10% formalin. The tissue samples were numerated automatically, using DIAPATH Donatello processor. Microscopic examination was carried out using a light microscope ZEISS «Axioskop 40» (eyepiece x 10, objectives x 5, x 10, x 20, x 40, 100). Results. Morphological features of resected prostate from patients with BPH and from patients with its combination with chronic bacterial inflammation were analyzed. The morphological picture varies from acute purulent inflammation to pronounced chronic lymphoplasmacytic inflammation around the acini. The features of morphological changes in the prostate after transvesical adenomectomy, TURP and laser enucleation were also studied. It was shown, that against the background of a chronic infectious and inflammatory process as well as a gross cicatricial process in the prostate, the organ anatomy, as well as the architectonics of vessels are disrupted, which can lead to a decrease in surgical treatment effectiveness. Discussion. In the majority of patients with BPH histological examination reveals a lymphoplasmacytic reaction of varying severity, which causes anatomical abnormalities and microcirculation deterioration. This condition significantly increases the risk of postoperative complications, requiring long-term conservative therapy and sometimes another surgical intervention. Conclusions. Against the background of a chronic infectious and inflammatory process, a gross cicatricial process in the prostate, its anatomy as well as vessel architectonics become disrupted, leading to a decrease in the effectiveness of surgical treatment. In the comparative study of morphological characteristics after various types of surgical procedures, it was revealed that the least significant changes were detected after laser enucleation of prostatic hyperplasia.

Professor A.Ya. Damsky – an urologist-innovator and a teacher (the 150th anniversary of his birth)

The article is devoted to the 150th anniversary of the birth of Professor Albert Yakovlevich Damsky who was an urologist-innovator and a teacher. The main stages of scientific and pedagogical activity and practical activity of the scientist are presented. A.Ya. Damsky published about 60 scientific papers, also he was the author of the first two Soviet urology textbooks and a creator of an operating cystoscope of his own design. Moreover he was the first to perform transvesical adenomectomy.

Prevention of complications of transvesical adenomectomy with a blind suture of the urinary bladder

Aim. To determine the frequency and develop methods for prevention of possible complications of transvesical adenomectomy. Methods. Conducted was an analysis of results of surgical treatment of 492 patients with prostate adenoma. One-stage suprapubic transvesical adenomectomy with a primary blind suture of the urinary bladder and hemostasis of the adenoma bed was performed in 347 patients. Results. In the postoperative period inflammatory complications of the urinary tract were observed in 5 (1.4%) out of 347 operated patients. It was established that the frequency and nature of both early and late pyo-inflammatory and obstructive postoperative complications of the suprapubic adenomectomy depend on the method of hemostasis of the bed of the adenoma and on the time of urination recovery. Conclusion. The main measures of prevention of complications during suprapubic adenomectomy are hemostasis of the bed of the adenoma by temporary retriganization with removable hemostatic ligatures, early recovery of urethral voiding (2-4 days) and application of antibiotics to the bed of the adenoma via the drainages of the deference ducts.