Enhanced recovery after retrograde intra-renal surgery (RIRS) in comparison with mini-percutaneous nephrolithotomy (Mini-PCNL) for renal stone treatment.

OBJECTIVES: The study presents a comparative analysis of the mini-percutaneous nephrolithotripsy (mini-PCNL) and retrograde nephrolithotripsy (RIRS) with a logistic analysis of outcomes and complications. MATERIAL AND METHODS: The prospective study included 50 patients diagnosed with urolithiasis from 2018 to 2021 in the urological hospitals in Irkutsk. Patients were divided into two groups: RIRS (group I, n = 23) and Mini-PCNL (group II, n = 27). The comparison groups are statistically homogeneous. RESULTS: Both procedures equally lead to high stone free rates (SFR > 1 mm, 91.3% vs 85.1%; p = 0.867; SFR > 2 mm, 95.6% vs 92.5%; p = 0.936). The intergroup analysis of the total operation time (and lithotripsy) demonstrated similar times (p > 0.05). Postoperative complications of classes II-III (Clavien-Dindo) in the early and late postoperative period developed rarely and were comparable (p > 0.05). Class I complications were predominant in the PCNL group (p = 0.007). Some parameters demonstrated the superiority of RIRS over PCNL: less pronounced pain syndrome (p = 0.002), less drainage time (p < 0.001), no postoperative hematuria (p = 0.002), shorter hospitalization and total treatment period (p < 0.001). CONCLUSIONS: The study highlighted the positive effect of the oneday surgery principle on the risk of developing postoperative hematuria, urinary infection, or severe postoperative pain. RIRS and mini-PCNL have similar effectiveness, but RIRS meets the criteria of the enhanced recovery program more than PCNL.

Fast Track Surgery as the Latest Multimodal Strategy of Enhanced Recovery after Urethroplasty.

Fast track surgery (FTS), as well as ERAS (enhanced recovery after surgery/rapid recovery programs), is the latest multimodal treatment strategy, designed to reduce the disability period and improve the medical care quality. The study aims to analyze the enhanced recovery protocol effectiveness in a comparative study of elective urethral stricture surgery. A prospective study included 54 patients with an established diagnosis of urethral stricture in 2019-2020 in the urological hospital of the Irkutsk City Clinical Hospital No. 1. All 54 patients have completed the study. There were two groups of patients FTS-group (group II, n = 25) and standard group (group I, n = 29). In terms of preoperative parameters, the comparison groups have statistical homogeneity. The comparative intergroup efficacy analysis of the treatment based on the criteria established in the study demonstrated good treatment results for 5 (17.2%) patients of group I and 20 (80%) patients of group II (p=0.004). The overall efficacy of urethroplasty surgeries, regardless of the treatment protocol, was comparable (86.2% vs 92%; p=0.870), as well as the likelihood of relapse within two years (p=0.512). The predictors of recurrence were technical complications and urethral suture failure (OR 4.36; 95% CI 1.6; 7.11; p=0.002). The FTS protocol reduced the treatment period (p < 0.001) and decreased the severity of postoperative pain (p < 0.001). The use of the "fast track surgery" protocol in urethroplasty with generally similar treatment results makes it possible to achieve a better functional and objective condition of patients in the postoperative period due to less pain, shorter catheterization, and hospitalization.

The effectiveness of penile curvature treatment by cavernous body rotation and plication of the tunica albuginea.

BACKGROUND: There are several approaches to the surgical treatment of the penile curvature conditionally divided into three large groups: tunica albuginea plication (TAP), corpus cavernosum rotation (CR), and transplantation of various materials. The study aims to compare the effectiveness of TAP and CR techniques in the treatment of penile curvature. There was a prospective randomized study of the effectiveness of surgical treatment of patients with an established diagnosis of the penile curvature from 2017 to 2020 in Irkutsk, Russian Federation. The final analysis of the results included 22 cases. RESULTS: The analysis of the comparative intergroup effectiveness of the treatment performed based on the criteria established in the study showed good treatment results in 8 (88.8%) patients in the CR group and 9 (69.2%) patients in the TAP group (p = 0.577). The other patients obtained satisfactory results. There were no negative outcomes. Simple logistic regression analysis showed that the preoperative flexion angle > 60 degrees (OR 2.7; 95% CI 0.12; 5.28; p = 0.040) was significant in predicting the complaints of penile shortening during TAP. Both methods are safe, effective, and bring minimal risk of complications. CONCLUSION: Thus, the effectiveness of both treatment methods is comparable. However, TAP surgery is not recommended for patients with an initial curvature of more than 60 degrees.

RéSUMé: CONTEXTE: Il existe plusieurs approches du traitement chirurgical de la courbure pénienne, divisées en trois grands groupes : plicature de la tunique albuginée (PTA), rotation du corps caverneux (RCC) et transplantation de divers matériaux. La présente étude vise à comparer l'efficacité des techniques PTA et RCC dans le traitement de la courbure du pénis. Il s'agit d'une étude prospective randomisée de l'efficacité du traitement chirurgical de patients ayant un diagnostic établi de courbure du pénis, de 2017 à 2020 à Irkoutsk, en Fédération de Russie. L'analyse finale des résultats comprend 22 cas. RéSULTATS: L'analyse de l'efficacité comparative intergroupe du traitement effectué sur la base des critères établis dans l'étude, a montré de bons résultats du traitement chez 8 (88,8%) patients du groupe RCC et 9 (69,2%) patients du groupe PTA (p = 0,577). Les autres patients ont obtenu des résultats satisfaisants. Il n'y a eu aucun résultat négatif. Une analyse de régression logistique simple a montré qu'un angle de flexion préopératoire > 60 degrés (OR 2,7 ; IC à 95 % 0,12 ; 5,28 ; p = 0,040) était significatif pour prédire les plaintes de raccourcissement du pénis avec l'approche de la PTA. Les deux méthodes sont sûres, efficaces et présentent un risque minimal de complications. CONCLUSIONS: Ainsi, l'efficacité des deux méthodes de traitement est comparable. Cependant, la chirurgie avec l'approche de la PTA n'est pas recommandée chez les patients ayant une courbure initiale de plus de 60 degrés.

Effectiveness of the Fast Track Surgery Program for Patients with Planned Cholecystectomy.

PURPOSE: This study analyzed the effectiveness of minimizing surgical trauma, reducing the severity of the stress reaction, and restoring the normal functioning of the body after planned gallbladder operations under an enhanced recovery program. MATERIALS AND METHODS: This prospective comparison study included 30 patients from the surgical department of Irkutsk Clinical Hospital No. 1 who had been diagnosed with cholelithiasis in 2019-2020. All 30 patients completed the study and were randomly assigned to one of two groups: the FTS group (group I, n = 15) and the standard group (group II, n = 15). The comparison groups were statistically homogeneous in terms of preoperative parameters. All patients underwent prescribed surgeries. In the early and late postoperative period, there were no cases of mortality or significant complications. RESULTS: A comparison of the groups with respect to the effectiveness of treatment according to established criteria showed good treatment results for 13 (86.6%) patients in group I and 2 (13.3%) patients in group II (p = 0.016). The FTS treatment protocol was a significant predictor of treatment success (OR 3.1; 95% CI 0.2; 6.0; p = 0.033). CONCLUSION: The fast track surgery protocol gave superior results for surgical treatment in comparison with the standard protocol in patients with cholelithiasis.

Efficacy Evaluation of a Case-Specific Approach for Surgical Treatment of Inicisional Ventral Hernia.

BACKGROUND: The research aims to improve the surgical treatment results of incisional ventral hernia by applying a case-specific approach and a new method of anterior abdominal wall surgery. MATERIALS AND METHODS: The paper reports the results of the prospective dynamic cohort study on 219 patients under 60 years of age, with small and medium hernias and up to 10 cm defects in the anterior abdominal wall (W1-W2), who underwent incisional ventral hernia treatment with mesh endoprostheses. RESULTS: The paper offers a selection algorithm for anterior abdominal wall repair surgery and an original proprietary technique. We have developed and described in detail a new 'extra-sublay' technique of surgical intervention. The paper displays the frequency and pattern of complications, as well as the quality of life of patients after different prosthetic surgeries. In the main group, 65.0% of patients showed improvement, 88.4% showed long-term surgical success, 13.6% faced complications, and 4.5% experienced recurrence. CONCLUSION: After receiving the "on lay" treatment, 59.4% of patients showed positive results, 74.7% showed long-term surgical success, 40% had complications, and 3.1% experienced recurrence. After the "sub lay" intervention, 40.0% of patients demonstrated excellent results, 81.9% reached long-term success, 12% had complications, and 1.4% encountered recurrence. HIGHLIGHTS: The article shows a selection algorithm for anterior abdominal wall plastic repair method.One of the factors that cause relapses and ventral hernias themselves is obesity.The authors' method of the VH surgical treatment has shown good results.Excellent indicators showed 65.0% of patients of the main group.

Comparison of efficiency of vascular-preserving urethroplastic methods of the bulbo-membranous part of the urethra.

INTRODUCTION: There are several options for vessel-sparing anastomotic procedures that allow one to avoid disturbances in the normal blood supply to the spongy body and successfully perform plastic surgery of distal urethral strictures. AIM: To perform a comparative analysis of the effectiveness of reconstructive surgical treatment of strictures of the bulbo-membranous urethra with anastomotic surgery with and without vessel-sparing. MATERIAL AND METHODS: A prospective study was carried out on 28 patients with a diagnosis of stricture of the bulbo-membranous urethra who underwent treatment in the period 2012-2018 in the conditions of a urological hospital of Irkutsk City Clinical Hospital No. 1. Anastomotic urethroplasty was performed using one of two methods: with full mobilization of the spongy body bulb and a vessel-sparing method when the spongy body does not intersect. RESULTS: The effectiveness of the classical method of anastomosing EPA-TWW ((excision and primary anastomosis urethroplasty (Turner-Warwick) and excision and Jordan's technique of vessel sparing excision and primary anastomosis)) was comparable with the method of anastomosing without crossing the (spongy body of EPA-J). Postoperative changes in the parameters of the functional status of patients based on the International Prostate Symptom Score (IPSS), International Index of Erectile Function, and Quality of Life were comparable in patients undergoing EPA-TWW and EPA-J. The final data indicate a statistically equivalent risk of developing complications such as urinary incontinence, shortening of the penis, and decreased erectile function. CONCLUSIONS: The study did not demonstrate a statistically significant difference in the effectiveness of the treatment and the risks of complications during anastomotic surgery with or without vessel-sparing. However, an unformalized assessment demonstrates the best state of erectile function in patients after vascular-preserving surgery.

Urinary System Iatrogenic Injuries: Problem Review.

INTRODUCTION: From May to December 2019, a literature review of the urinary system iatrogenic injury problem was performed. The most cited, representative articles in PubMed, Scopus, and WoS databases dedicated to this problem were selected. Urinary system iatrogenic injuries include ureter, bladder, urethra, and kidney traumas. It is widely thought that the main causes of such injuries are urological, obstetric, gynecological, and surgical operations on the retroperitoneal space, pelvis, or perineum. METHODS: The purpose of the study is to describe all aspects of the iatrogenic injure problem, under the established scheme and for each of the most damaged organs: the urethra, bladder, kidney, and ureter. The treatment of confirmed iatrogenic injuries largely depends on the period of its detection. Modern medical procedures provide conservative or minimally invasive treatment. An untimely diagnosis worsens the treatment prognosis. "Overlooked" urinary system trauma is a serious threat to society and a particular patient. Thus, incorrect or traumatic catheterization can lead to infection (RR 95%) and urethral stricture (RR ≥11-36%), and percutaneous puncture nephrostomy can cause the risk of functional renal parenchyma loss (median 5%), urinary congestion (7%), or sepsis (0.6-1.5%). RESULTS: Lost gain, profits, long-term and expensive, possibly multistage treatment, stress and depression, and the risks of suicide put a heavy financial, moral, and ethical burden on a person and society. Also, iatrogenic injury might have legal consequences. DISCUSSION/CONCLUSION: Thus, the significant problem of urinary tract iatrogenic injuries is still difficult to solve. There is a need to implement mandatory examining algorithms for patients at risk, as well as the multidisciplinary principle for all pelvic surgery.

Buccal mucosal graft urethroplasty of the bulbomembranous part of urethra.

INTRODUCTION: Urethral stricture is a partial or complete narrowing of the urethra, caused by damage to the urethral epithelium. This disease leads to a persistent urination dysfunction, the elimination of which is a difficult task. The aim of this study was to perform a comparative analysis of the immediate and long-term narrowing treatment results of the proximal part of the bulbar and membranous urethral parts using the developed magnifying and anastomotic methods. MATERIAL AND METHODS: A total of 102 patients with a confirmed diagnosis of stricture of the bulbomembranous urethral part of the urethra who underwent treatment in the urological hospital in Irkutsk City Clinical Hospital No. 1 during the period 2012-2018 participated in this prospective study. Urethroplasty operations were performed in two ways, using the anastomotic and intra-urethral substitution techniques. Through the assessment of preoperative parameters, statistical homogeneity of comparison groups was established. RESULTS: The final data analysis showed relapse for 4 patients from Group I and for 2 patients in Group II. The absence of relapse during the entire observation period was equal in both groups and after 2 years amounted to 83.0 ±7.9% in Group I and 92.5 ±5.1% in Group II. CONCLUSIONS: In both groups, the desired result was achieved - adequate independent urination was restored. The anastomotic method of urethroplasty should be used with caution in patients at risk groups, as well as with the presence of predictors of complications: previous transurethral surgeries on the urethra and prostate, anastomotic urethroplasty, radical prostatectomy. The developed minimally invasive substitution technique has a similar effectiveness with a lower risk of complications.

A multidisciplinary approach to urinary system iatrogenic injuries.

INTRODUCTION: Urinary system iatrogenic injuries appear because of urological, obstetric-gynecological, and surgical manipulations in the retroperitoneal space, pelvis, or perineum. The purpose of this research was to analyze and obtain knowledge about the issue of iatrogenic injuries, to apply injury prevention algorithms, and to assess multidisciplinary perspectives in modern surgery. MATERIAL AND METHODS: The research was interdisciplinary and consisted of several modules: a prospective, single-centre study of urinary system iatrogenic injuries (476 patients) along with four interregional and international procedural types of research. RESULTS: The analysis results indicate an extremely high significance of urinary system injuries evoking numerous negative consequences that are hard to eliminate. A comparative assessment of interdisciplinary interaction demonstrates the more effective interpretation of examination results, more comprehensive and credible clinical diagnosis, more qualitative evaluation of a patient's condition, more effective choice of initial treatment policy, and more satisfactory treatment in patients' opinion. The research allowed for the identification of a typical procedural mistake in the urethral catheter setting causing a high risk of urethra injuries followed by urethra strictures or consecutive infections of the urinary tract. CONCLUSIONS: More complicated treatment procedures cause a higher probability of urinary system iatrogenic injuries. The absence of unified algorithms and typical procedural mistakes cause such incidents. A partial solution to this issue could be found in a more profound interdisciplinary interaction in all treatment phases as well as in identifying and eliminating procedural mistakes.