[CLASSICAL RADICAL EXTRAURETHRAL METHOD OF ADENOMECTOMY--BEYOND 30 YEARS].

Introduction of transvesical extraurethral adenomectomy into clinical practice was preceded by the clinical and morphological study of the prostate, prostatic urethra, bladder, upper urinary tract and renal function. It was found that at any volume of adenomatous (hyperplastic) tissue in the prostate, front semicircle around the prostatic urethra remains intact, and changes occur only in the proximal part of its back semicircle. Front semicircle adherent to the anterior commissure of the prostate has no adenomatous tissue. Extraurethral method enables you to perform a prostatectomy at any size of adenomatous tissue (fragmentarily) with preservation of the prostatic urethra, urethral vascular plexus and, if necessary, to carry out the vesico-urethral segment correction without blood loss. Free independent urination is recovered at days 10-12 after the healing of the suprapubic surgical wound and removal of drainage tube. Since the introduction of transvesical extraurethral prostatectomy into clinical practice, more than 3,000 radical adenomectomies at different stages in patients with co-morbidities were performed only at Burdenko Central Military Clinical Hospital and the 2nd Mandryka CMCH.

[On the question of the so-called gold standard of surgical treatment of benign prostatic hyperplasia].

The article presents the comparative analysis of results of surgical methods used for the treatment of patients with BPH. The standardization of surgical TURP interventions as the "gold standard" in comparison with transvesical extraurethral adenomectomy is estimated. After TURP, according to the data from domestic and foreign authors, taking into account own author's data, complications develop in 28.7 to 100% cases after non-radical removal of adenomatous (hyperplastic) tissue, and only in 5.6% of cases after radical extraurethral prostatectomy. Thus, open transvesical or retropubic extraurethral adenomectomy is considerably superior to "closed" transurethral resection of the prostate as consistent with immediate and long-term results.

[High-technology extraurethral adenomectomy].

The article presents a method of organ-sparing radical transvesical extraurethral adenomectomy in which adenomatous prostate tissue are removed as individual fragments from semi-oval or wedge-shaped incision of the bladder neck and initial part of the prostatic urethra. Preservation ofprostatic urethra and its vascular plexus provides minimal intraoperative blood loss and less traumatic treatment. Correction of vesico-urethral segment is carried out with full preservation ofthe closing apparatus of the bladder. More than 2,000 patients were followed-up for postoperative immediate and long-term results. Mortality after this type of intervention was 0.89%. Urinary incontinence and urethral stricture were not reported in any patients.

[Retropubic urethro- and vessel-preserving extraurethral adenomectomy].

The article presents the results of an advanced method for retropubic removal of adenomatous prostate tissue. Retropubic extraurethral adenomectomy (REUA) was performed in 29 patients with benign prostatic hyperplasia. Distinctive features of REUA from Lidsky-Millin surgery consist in the fact that the new method of prostatectomy preserve dorsal and urethral vascular plexus and the integrity of the prostatic urethra. Adenomatous tissues fragments are removed through a parallel longitudinally incisions made on the front surface of the fibrous capsule to adenoma. Surgical intervention is accompanied by minimal blood loss and minimal postoperative complications. Hemodynamics of the prostate and external genitalia is not disturbed.

[Gender differences of acute pyelonephritis in the North].

To investigate results of treatment in patients with acute pyelonephritis (AP) among the population of giving age in the North of Russia for prognostication of the disease and decision on further therapy, we studied 1109 case histories of patients treated for urinary infections (UI) including 794 patients with pyelonephritis (119 with AP). Age of both males and females with AP was younger than of UI patients. AP among female inpatients with UI occurred twice more frequently than in males. Ascending AP was characterized by dysuria, mild lumbar pain, symptoms of general intoxication, leukocyturia, bacteriuria, moderate leukocytosis, elevated leukocytic intoxication index (LII) both in males and females. Hematogenic AP in young males presented with lumbar pain, symptoms of general intoxication, leukocytosis, LII elevation in the absent or mild leukocyturia. The main route of renal infection in population of giving age in the North in AP - ascending. Hematogenic route of infection occurs in young males and is typical for pyodestructive AP.

[Iliac neobladder - 10-year experience].

Surgeons of the clinic of P.V. Mandryka Central Military Hospital have rich 10-year experience in creation of neobladders after cystectomy. So, from 2000 to 2009 a total of 90 cystectomies were made for different diseases of the urinary bladder and prostatic gland as well as in cancer of the other pelvic organs. Vesicoplasty, both heterotopic and orthotopic, was performed from an iliac segment by an original technique with creation of antireflux bypass with the ureters. The examination of the patients in different terms after operation (up to 10 years later) provided information about changes in the neobladder under the influence of urine and systemic changes in the body. The analysis of the results show that creation of the iliac neobladder in our modification is perspective, while side effects are rare. Further long-term follow-up will give new arguments for and against this procedure.

[Erectile dysfunction: choice of the treatment method].

The 15-year clinical experience with falloendoprosthetic operations (FEPO) in patients with erectile dysfunction is reviewed including algorithm of diagnostic examination, prostheses of different generations, indications and contraindications for falloendoprosthetic surgery. The results of 117 FEPO are outlined with special emphasis on 19 cases of postoperative complications. The conclusion is made that FEPO is most effective in erectile dysfunction by the presented criteria of the erectile dysfunction treatment efficacy.

[Current views on surgical treatment of patients with prostatic adenoma].

The article focused on the urgent problem of surgical treatment of patients with BPH. Drug therapy is ineffective in some cases and is mainly used for the initial stages of the disease. Therefore, in urological practice using methods of surgical treatment. The authors are on personal material (more than 2000 patients) comparing the results of surgical treatment of patients with prostatic adenoma after adenomectomy made in ekstraurethral, endourethral, transurethral and retropubic ways.

[Transvesical extraurethral adenomectomy and transurethral prostatic resection in adenoma: specific features].

The procedure of transvesical extraurethral adenomectomy (EUA) and the results of its application were characterized in comparison with transurethral resection (TUR) of the prostate in adenoma. EUA is made via the approach through the extraperitoneal cut of the soft tissues of the anterior abdominal wall, anterior wall of the urinary bladder, semioval or sphenoid incision of the vesicourethral segment. Dissection is conducted of the affected posterior half-round of only proximal prostatic part of the urethra in unaffected anterior and lateral urethral surface. Adenomatous tissues are removed in fragments and radically. Enucleation of the adenomatous nodes is followed by correction of the vesicourethral segment and hemostasis. TUR of the prostate is made without incision of the soft tissues of the anterior abdominal wall, but with removal of the prostatic portion of the urethra, sphincter mechanism of the bladder. After TUR the prostate contains residual adenomatous tissue, inner wound cavity in adenoma bed. The wound of the anterior abdominal wall, anterior wall of the bladder and vesicourethral segment healed by primary intention for 10-14 days, while adenoma bed heals for 6-18 months. EUA does not cause such complication as "adenoma bed", urethral stricture, scar deformation of the bladder neck, urinary incontinence. Radical EUA produces complications 5 times less frequently than TUR of the prostate.

[Treatment of multiple carbuncles of the kidneys in military servicemen].

The article presents the analyzes of medical histories of 16 patients, treated from suppurative diseases of burgeon (13 carbunculosis, 1 nephrepostasis, 2 abscesses of paranephric cellulose) from 1997 to 2009. Effectuated examinations and treatment of patients with suppurative diseases of burgeon speak to insufficient educating work of the medical service of a military unit in the sphere of prophylaxis if suppurative and catarrhal diseases, what leads to delayed call for medical aid. The second place by level of negative influence of appearance of supparative diseases of urinary organs is taken by conditions of service in northern climate and not full adaptation of service men to these conditions. Changing of food ration also leads to decreasing of immunity and organism general-defense status in conditions of extreme conditions of military service. The article presents indications to operative and conservative treatment of carbunculosis of burgeon.

[The 20th anniversary of Urological Center of Main Military Clinical Hospital named after N. N. Burdenko].

In 1988, for the first time according to Directive of Central Command of Armed Forces of USSR in Main Military Clinical Hospital by Burdenko N.N. was founded a interhospital unit - Urological center. The article presents the analyze of work of the Center during 20 years. The most frequent diseases--adenoma of prostate, malignant swelling and benign tumour of urological organs, urolithiasis, traumatic damages of urological organs. During a year 4500-4700 persons are treated, 1450-1500 are operated. Every year 44-77 military medical men are studying, 20-26 clinical attending physicians study for 2 or 3 years. During last 8 years 422 military medical men and 68 clinical attending physicians have studied.

[Current combat wounds of the scrotum and its organs].

Wounds of the scrotum and its organs are frequent among injuries of the urogenital system in local military conflicts. The scrotum is often wounded in mine explosions which result in severe multitraumas, crushing and abruptions. As a rule, scrotal wounds are not life threatening, but late diagnosis and inadequate surgery may provoke serious complications. Surgical policy should be most sparing and secure preservation of the scrotal organs.

[The morphologic and functional state of the kidneys exposed to focused waves during remote nephro-lithotripsy].

Clinical and experimental research has shown that complications connected with negative influence of focused waves in distant lithotripsy in litotripters with an electrohydravlic system of focused waves generation depend on many factors, including the regime of wave generator work, an electrode interval, defocusing the wave as a result of an electrode interval center displacement, the amplitude of pressure and the length of a wave impulse in positive and negative phases. The wave impulse is distorted, which leads to kidney tissue damage.

[Etiopathogenetic basis for using magnetolaser therapy in the complex treatment of male infertility]. / Etiopathogeneticheskoe obosnovanie primeneniia magnitolazernoi terapii v kompleksnom lechenii muzhskogo besplodiia.

Up to 12-15% couples are infertile. The "responsibility" for infertility rests with the husband in 40-45% cases. The effects of routine drug therapy (n = 95) on a generative function are compared to those of magnetolaser therapy (n = 93) in 188 males with excretory-inflammatory infertility suffering from chronic prostatitis. Low-intensity laser infra-red radiation was used in a permanent magnetic field produced by Azor-2K unit. The magnetolaser therapy more significantly than the routine therapy raised concentration and number of mobile forms of the spermia, reduced their degenerative forms, elevated the level of serum sexual and gonadotropic hormones. In 1 year pregnancy occurred in 41.7 and 55.4% of 83 and 87 families (groups 1 and 2), respectively. The delivery took place in 35.8 and 49.7%, respectively.

[Errors, hazards and complications in transurethral resection of prostatic hyperplasia]. / Oshibki, opasnosti i oslozhneniia pri transuretral'noi rezektsii giperplazii predstatel'noi zhelezy.

Transurethral resection of hyperplastic prostate was carried out in 667 patients. Complications associated with the intervention occurred in 146 (21.89%) patients: intraoperative in 31 (4.6%), immediately after surgery in 68 (10.2%), and during remote period in 47 (7.04%) patients. Causes of complications are discussed, probable errors in transurethral resection are enumerated, and recommendations on prevention of complications in endosurgery for prostatic hyperplasia are offered.

[The transpubic surgical approach and experience with using it to treat posttraumatic strictures of the posterior urethra]. / Chrezlobkovyi operativnyi dostup i opyt ego ispol'zovaniia v lechenii posttravmaticheskikh striktur zadnei uretry.

Anatomic researches on 15 cadavers of male adults were conducted to study the transpubic access to the urethra and substantiate its possible application for the treatment of the urethral strictures. The authors make a comparative evaluation of transpubic and perineal methods of the access. As for basic indices (the depth of operative wound, direction and the angle of the operative axis inclination), the transpubic method of access has a number of advantages over the perineal access, and is an optimal one for surgical interference on the urethra. The transpubic access was applied on 21 patients who were operated for strictures or obliterations of the urethra. In all the patients the transitivity of the urethra was restored. No complications were marked.

[Complications during the treatment of victims with kidney wounds and injuries]. / Oslozhneniia pri lechenii postradavshikh s travmami i raneniiami pochek.

An analysis of treatment outcome in 141 patients with kidney traumas and 75 kidney open wounds. Conclusions and recommendations on conservative and operational treatment.