RESUMEN
AIM: To evaluate the possibilities of textural analysis of 3D models in differentiating the degree of nuclear dysplasia of the clear cell renal cell carcinoma (ccRCC). MATERIALS AND METHODS: The specimens after surgical treatment of 190 patients with ccRCC were analyzed. In all cases, nephron-sparing surgery (NSS) was performed through laparoscopic access. The clinical characteristics were evaluated, including age, gender, tumor localization (side, surface and segments), absolute tumor volume, Charlson comorbidity index, body mass index, nephrometry scores (RENAL, PADOVA, C-index). Patients were divided into 2 groups. In group 1, there were 119 patients with the ccRCC of Grade 1 or 2, while group 2 consisted of 71 patients with ccRCC of Grade 3 and 4. All patients underwent 3D virtual planning of procedure using the 3D modeling program "Amira". At the first stage, two experienced radiologists performed manual segmentation of 3D models of kidney parenchyma tumors. At the second stage, the tumor shape was analyzed with a mathematical calculation of three indicators and more than 300 textural features of statistics of types 1-2 were extracted. Further, an intellectual analysis was carried out. For the evaluation of tumor grade according to Furman system, the classification problem was solved using the machine learning algorithm Stochastic Gradient Descent and cross-validation k=5. RESULTS: The accuracy of classification for the two groups of Grade 1 or 2 and Grade 3 or 4 on the F1 metric was 72.2. To build the model, the following parameters were selected: the absolute tumor volume, the Charlson comorbidity index, "Energy", the first quartile and the second decile of the pixel intensity distribution. CONCLUSION: The texture analysis of 3D models for the prediction of Fuhrman grade in ccRCC demonstrated satisfactory quality for two groups of Grade 1 or 2 and Grade 3 or 4 nuclear dysplasia.
Asunto(s)
Carcinoma de Células Renales , Neoplasias Renales , Humanos , Carcinoma de Células Renales/diagnóstico por imagen , Carcinoma de Células Renales/cirugía , Carcinoma de Células Renales/patología , Proyectos Piloto , Tomografía Computarizada por Rayos X/métodos , Estudios Retrospectivos , Riñón/cirugía , Neoplasias Renales/diagnóstico por imagen , Neoplasias Renales/cirugía , Neoplasias Renales/patologíaRESUMEN
INTRODUCTION: Urolithiasis (UCD) is the most common and most expensive urological disease in all regions of the planet. The study of the prevalence of types of urinary stones in different areas of the country and the world plays an important role in predicting the burden on the health care system as a whole and the urological community, including in terms of calculating the probability of recurrence of the disease, even against the background of effective metaphylactic therapy. PURPOSE: in connection with the above, we made an attempt to assess the prevalence of various types of urinary stones in various regions of the Russian Federation, Belarus, Kazakhstan and the dynamics of changes in the composition of urinary stones depending on age and gender. MATERIALS AND METHODS: the study is based on data from a study of the chemical composition of 6787 urinary stones, presented by INVITRO in an anonymized form for the period 2018-2021. The study of the chemical composition of stones was carried out by infrared spectroscopy and/or X-ray diffraction. RESULTS: The prevalence of one-, two- and multi-component urinary stones of the adult population and children in both sexes of the Russian Federation, the Republics of Kazakhstan and Belarus was estimated. Separate regularities in the distribution of the component composition of stones in each region, with age and gender, were noted. CONCLUSION: The study of the composition of urinary stones is important in choosing an adequate tactic for metaphylactic treatment.
Asunto(s)
Cálculos Urinarios , Urolitiasis , Masculino , Niño , Adulto , Femenino , Humanos , Kazajstán/epidemiología , República de Belarús/epidemiología , Cálculos Urinarios/epidemiología , Cálculos Urinarios/química , Urolitiasis/epidemiología , Minerales , Federación de Rusia/epidemiologíaRESUMEN
INTRODUCTION: Uric acid stones (UA), consisting of uric acid/uric acid dihydrate, occur in 6.1-15.1% of all cases of urolithiasis in industrialized countries. At the same time, the frequency of these stones is directly dependent on age. Thus, the incidence of UA reaches 40% in men over 80 years of age and 27.3% in women over 90 years of age. UA are the only stones that are amenable to dissolution therapy with the use of citrate salts that alkalinize urine pH. A number of authors and European Association of Urology guidelines consider stone dissolution as a first-line therapy in the treatment of patients with UA, both as monotherapy and in combination with surgical procedures. MATERIALS AND METHODS: The results of conservative treatment of 86 patients aged 28 to 78 years with radiolucent ureteral stones ranging in size from 3 to 25 mm and a density of 133 to 728 HU, who underwent 89 courses of stone dissolution therapy from 2011 to 2018, are presented in the article. They had no obstruction or were prestented. There were 52 men (n=55 courses) and 34 women (n=34 courses). RESULTS: In 78 out of 89 clinical cases (87.6%), stone-free status was obtained within 14 to 181 days. Most often the duration of therapy was 30 days. In 11 (12.4%) cases the treatment was considered ineffective. However, only in 4 (4.5%) patients the stone size did not change, while in 7 (7.9%) cases it decreased. The results of the study suggest the high efficiency of citrate therapy in patients with ureteral stones in case of unobstructed urine outflow (including those with stents), which is comparable to surgical treatment.
Asunto(s)
Cálculos Renales , Nefrolitiasis , Uréter , Cálculos Ureterales , Urolitiasis , Masculino , Humanos , Femenino , Anciano de 80 o más Años , Ácido Úrico , Solubilidad , Cálculos Ureterales/tratamiento farmacológico , Cálculos Renales/terapiaRESUMEN
An analysis of domestic and foreign literature on the predictors of prostate cancer recurrence are presented in the article. A deep analysis of both pathological and histological risk factors for progression was provided, as well as of laboratory and clinical predictors.
Asunto(s)
Antígeno Prostático Específico , Neoplasias de la Próstata , Humanos , Masculino , Recurrencia Local de Neoplasia/patología , Estadificación de Neoplasias , Próstata/patología , Prostatectomía , Neoplasias de la Próstata/patología , Neoplasias de la Próstata/cirugíaRESUMEN
INTRODUCTION: surgical treatment of urinary stone disease plays an important role in urological practice. Stone fragmentation can be performed using various lithotripters, from which Holmium fiber laser (Ho: YAG) has currently taken the main place. According to the current literature, a superpulsed thulium fiber laser with a wavelength of 1.94 m and a maximum power output of 40 W showed in vitro higher efficiency compared to Ho: YAG, while having the same safety profile. The use of a thulium fiber laser with a pulse energy of 0.025-6 J and a high repetition rate (up to 1600 Hz) allows to most effectively perform stone dusting during retrograde intrarenal surgery (RIRS). AIM: to improve the performance of RIRS using the 1.94m superpulsed thulium fiber laser. MATERIALS AND METHODS: a total of 152 patients with renal stones who were treated during the period from February 2018 to July 2019 were included in the study. The analysis of the laser settings, their effect on retropulsion and visibility when performing RIRS using a superpulsed thulium fiber laser with a wavelength of 1.94 m and a maximum power output of 40 W, a peak power of 500 W, as well as an assessment of the stone-free rate the first postoperative day and 3 months after the procedure was done. RESULTS: The most frequently used settings were as following: 0.5 J, 30 Hz, 15 W (No. 1), 0.15 J, 200 Hz, 30 W (No. 2), 0.8 J, 31.25 Hz, 25 W (No. 3), 0.8 J, 37.5 Hz, 30 W (No. 4). The statistical analysis of the influence of the settings on the quality of endoscopic imaging and retropulsion was carried out. In addition, the features of each settings were analyzed. The stone-free rate on the first postoperative day was evaluated using low-dose CT. CONCLUSION: A superpulsed thulium fiber laser with a wavelength of 1.94 m and a maximum power of 500 W has shown high efficiency in clinical practice when performing RIRS, since it allows to have good endoscopic imaging, minimal retropulsion, and to perform stone dusting, which had a positive effect on the stone-free rate. Optimization of the settings of thulium fiber lithotripsy may improve the results of surgical treatment of urinary stone disease.
Asunto(s)
Cálculos Renales , Láseres de Estado Sólido , Litotripsia por Láser , Cálculos Urinarios , Humanos , Tulio , Cálculos Urinarios/cirugíaRESUMEN
AIM: In a retrospective study, we evaluated factors associated with the early development of septic shock in patients with severe COVID-19. MATERIALS AND METHODS: We collected medical records of the intensive care unit patients submitted by the local COVID-19 hospitals across Russia to the Federal Center for the Critical Care at the Sechenov First Moscow State Medical University (Sechenov University). Septic shock in crticially ill patients requiring mechanical ventilation was defined as a need in vasopressors to maintain blood pressure. RESULTS: We studied 1078 patients with severe COVID-19 who were admitted to the intensive care units for respiratory support. There were 611 males and 467 females. The mean age was 61.013.7 years. Five hundred twenty five medical records (48.7%) were received from the Moscow hospitals, 159 (14.7%) from the Moscow region, and 394 (36.5%) from the hospitals located in 58 regions of the Russian Federation. In 613 (56.9%) patients, diagnosis of SARS-CoV-2 infection was confirmed by PCR, and in the other cases it was established on the basis of the clinical picture and the results of the chest CT scan. Septic shock developed in 214 (19.9%) of 1078 patients. In the logistic regression model, the risk of septic shock in patients older than 50 years was higher than in patients of a younger age (OR 2.34; 95% CI 1.533.67; p0.0001). In patients with more severe SARS-CoV-2 infection, there was an increase in the prevalence of cardiovascular diseases, including coronary heart disease and atrial fibrillation, type 2 diabetes and malignant tumors. The risk of septic shock in patients with three or more concomitant diseases was higher than in patients without any concomitant chronic diseases (OR 1.76; 95% CI 1.762.70). CONCLUSION: The risk of septic shock in patients with acute respiratory distress syndrome induced by SARS-CoV-2 is higher in patients older than 50 years with concomitant diseases, although a severe course of the disease is also possible in younger patients without any concomitant disorders.
Asunto(s)
COVID-19 , Diabetes Mellitus Tipo 2 , Choque Séptico , Femenino , Humanos , Masculino , Persona de Mediana Edad , Moscú/epidemiología , Estudios Retrospectivos , Factores de Riesgo , Federación de Rusia/epidemiología , SARS-CoV-2 , Choque Séptico/diagnóstico , Choque Séptico/epidemiología , Choque Séptico/etiologíaRESUMEN
An analysis of national and foreign literature dedicated to recurrence of prostate cancer, is presented in the article. The diagnostic utility of positronic emission tomography, fused with computer tomography and magnetic resonance tomography in case of biochemical recurrences of prostate cancer is discussed.
Asunto(s)
Imagen por Resonancia Magnética/métodos , Tomografía Computarizada por Tomografía de Emisión de Positrones/métodos , Neoplasias de la Próstata/diagnóstico por imagen , Humanos , Masculino , Recurrencia Local de Neoplasia , Neoplasias de la Próstata/patologíaRESUMEN
Multidisciplinary studies in urology is becoming a new global trend which is associated with an emerging of omix technology, big data, the development of IT and other technologies. The concept of "multidisciplinary approach" as well as a brief historical analysis of the development of urologic science are discussed in the article, based on the international Scopus database. An example of a multidisciplinary approach implemented in the Science and Technology Park for Biomedicine of Sechenov University is given. The stages of the creation and implantation of the tissue-engineering urethral wall are described. For the successful development of urologic researches, the active involvement of specialists from various fields of knowledge is required. Such a combination of competencies has already allowed to solve problems of an extremely high level of complexity now, and not in the distant future.
Asunto(s)
Ingeniería de Tejidos , Enfermedades Urológicas/terapia , Urología , Materiales Biocompatibles , HumanosRESUMEN
Laser technology has taken a place among the methods of treatment of various urological diseases. The new laser devices are being developed in addition to commonly used. Physicists of the russian NTO "IRE Polus" in collaboration with doctors from Sechenov University have developed a new generation laser device - thulium fiber laser. It has been actively used since 2017 for laser enucleation of prostate. Later the laser was used for treatment of bladder tumor, lithotripsy. The device has already managed to prove its efficacy in in-vitro experiments and clinical practice surpassing foreign analogues.
Asunto(s)
Cálculos Renales/terapia , Coagulación con Láser/instrumentación , Terapia por Láser , Litotripsia por Láser/instrumentación , Tulio , Urología , Humanos , Litotripsia por Láser/métodos , Masculino , Próstata/patología , Próstata/cirugía , Cálculos Ureterales/terapia , Cálculos de la Vejiga Urinaria/terapia , Neoplasias de la Vejiga Urinaria/terapiaRESUMEN
A solving diagnostic and therapeutic problems in patients with various urologic diseases often requires a cooperation between different specialists which emphasizes the interdisciplinarity of our discipline. A number of clinical manifestations and diseases that urologists have to deal with and in which they definitely need a timely assistance from other specialists are described in the article. Determining the connecting links in the work of different specialists, we tried to recall the main " intersection points" and draw attention to the necessary cooperation.
Asunto(s)
Grupo de Atención al Paciente , Prostatitis , Enfermedades Urológicas , Humanos , Masculino , Prostatitis/diagnóstico , Prostatitis/terapia , Enfermedades Urológicas/diagnóstico , Enfermedades Urológicas/terapia , Urología/tendenciasRESUMEN
In the Russian Federation, a proportion of bladder cancer in the overall structure of malignant tumors is about 2.8% and among oncological diseases of genitourinary system its incidence is second only to prostate cancer. Bladder cancer ranks as ninth most prevalent in males and as eighteens in females. The most important issue is to determine a recurrence rate of non-muscle invasive bladder cancer, which can reach 80%. In this regard, currently, all over the world much more attention is paid to studying and creation of early detection, including non-invasive, which will be reliable in the early stages. It can possibly lead to a reduction the number of cystoscopy and become as "golden" standard of non-invasive diagnosis bladder cancer.
Asunto(s)
Neoplasias de la Vejiga Urinaria , Cistoscopía , Femenino , Humanos , Masculino , Recurrencia Local de Neoplasia , Federación de RusiaRESUMEN
INTRODUCTION: Prostate cancer is one of the most common types of cancer in men. The gold standard for the detection of prostate cancer is ultrasound guided transrectal prostate biopsy. The detectability of cancer using this method is from 30 to 50%. As a result, many men undergo multiple repeat biopsies for suspected prostate cancer. The European Association of Urology does not give any recommendations on this matter. A revolutionary new method in the diagnosis of prostate cancer is a targeted prostate biopsy using a fusion of multiparametric magnetic resonance imaging (MRI) and ultrasound. MATERIALS AND METHODS: At the R.M. Fronstein Clinic of Urology, 55 patients with suspected prostate cancer from September 2017 to January 2018 underwent fusion prostate biopsy. Of them, 21 patients had negative primary biopsies. Two patients had verified prostate cancer. 32 patients did not undergo primary biopsies. RESULTS: The findings of the study suggest that using MRI-ultrasound fusion for guidance of targeted prostate biopsy improves the quality of the histological material, allows patients to avoid unnecessary biopsy, reduces the number of punctures, thereby offering higher diagnostic performance in detecting prostate cancer. MRI-ultrasound fusion targeted biopsy has a high sensitivity in detecting clinically significant cancer and low for clinically insignificant cancers. CONCLUSION: The technique affords accurate detection of the location and extent of pathological lesions in the prostate thus allowing focal therapy for prostate cancer.
Asunto(s)
Imagen por Resonancia Magnética/métodos , Próstata/patología , Neoplasias de la Próstata/patología , Ultrasonido Enfocado Transrectal de Alta Intensidad/métodos , Humanos , Masculino , Clasificación del Tumor , Próstata/diagnóstico por imagen , Neoplasias de la Próstata/diagnóstico por imagen , Sensibilidad y EspecificidadRESUMEN
The article presents a rare case of urinary bladder reconstruction using thoracodorsal revascularized autograft in a patient with a bladder injury resulting from a road traffic accident. The area and size of the thoracodorsal flap (2215 cm) were determined using a 500 ml latex model of the bladder. The autograft was revascularized through external iliac vessels. From the thoracodorsal autograft, the dome was formed with the dermal part inward, which was fixed along its circumference to the bladder edges with 3/0 prolene sutures. The muscular part of the thoracodorsal flap was fixed along the perimeter to the remaining aponeurosis and covered by a free expanded cutaneous autograft. The surgery resulted in a newly constructed neobladder of sufficient volume (250-300 ml) with elements of the patients own bladder (posterior wall and neck) while sparing the patient from a cystostomy and improving his quality of life.
Asunto(s)
Colgajo Miocutáneo/trasplante , Procedimientos de Cirugía Plástica/métodos , Colgajos Quirúrgicos/trasplante , Vejiga Urinaria/cirugía , Procedimientos Quirúrgicos Urológicos/métodos , Accidentes de Tránsito , Adulto , Humanos , Masculino , Colgajo Miocutáneo/irrigación sanguínea , Colgajos Quirúrgicos/irrigación sanguínea , Resultado del Tratamiento , Vejiga Urinaria/lesionesRESUMEN
Endoscopic enucleation of the prostate (EEP) techniques such as HoLEP (holmium laser enucleation of the prostate), ThuLEP (thulium laser enucleation of the prostate) and electroenucleation (mono- or bipolar) are highly effective and safe. They have been endorsed by the latest version of the European Association of Urology guidelines as an alternative to not only open adenomectomy but also transurethral resection of the prostate (EAU Guidelines on Treatment of Non-neurogenic Male LUTS 2018). Therefore, many urologists face the possibility of replacing the treatments of BPH. In this article, we analyze the history of EEP techniques, both their pros and cons and, what are they today - just a popular trend or a new standard procedure for the surgical treatment of BPH?
Asunto(s)
Terapia por Láser/métodos , Próstata/cirugía , Hiperplasia Prostática/cirugía , Resección Transuretral de la Próstata/métodos , Ureteroscopía/métodos , Humanos , MasculinoRESUMEN
AIM: To evaluate the 5-year results of renal denervation (RDN) in patients with resistant arterial hypertension (AH). MATERIALS AND METHODS: The study included 14 patients to whom, during the 2011-2013 period RDN has been completed. Before and after the intervention, office blood pressure, quality of life indicators according to the EQ-5D questionnaire, mass index bodies, indicators of kidney function were duly assessed. RESULTS: Five years after RDN, office BP decreased from 165/110 to 139/95 mm Hg. Art. (p<0.05), with the average number of of drugs decreased from 4.6 to 3.1. 12 months after the RDA, the quality of Life, based on the questionnaire EQ-5D has increased from 60 to 80 points, by the fifth year the indicator fell to 74 points. Body mass index during 5 years decreased from 33.8 ± 3.5 to 30.9 ± 3.0 kg/m2. Mean plasma creatinine initially and after 5 years remained within the normal range, the mean the GFR score after 5 years being decreased by 9.5 ml/min/1.73 m2. CONCLUSION: RDN can be regarded as effective and safe method of additional treatment of patients with resistant hypertension.
Asunto(s)
Antihipertensivos/uso terapéutico , Resistencia a Múltiples Medicamentos , Hipertensión , Riñón , Calidad de Vida , Simpatectomía/métodos , Adulto , Presión Sanguínea/efectos de los fármacos , Presión Sanguínea/fisiología , Monitoreo Ambulatorio de la Presión Arterial/métodos , Femenino , Humanos , Hipertensión/diagnóstico , Hipertensión/fisiopatología , Hipertensión/psicología , Hipertensión/cirugía , Riñón/inervación , Riñón/fisiopatología , Masculino , Persona de Mediana Edad , Evaluación de Procesos y Resultados en Atención de Salud , Estudios Retrospectivos , Federación de Rusia , Encuestas y CuestionariosRESUMEN
The article reviews the domestic and international literature on local recurrence of prostate cancer both after surgery and non-invasive treatments. The authors describe modern high-precision techniques used in magnetic resonance imaging that are used today in clinical practice for the most accurate detection of recurrent prostate cancer lesions.
Asunto(s)
Prostatectomía , Neoplasias de la Próstata , Humanos , Imagen por Resonancia Magnética , Masculino , Recurrencia Local de Neoplasia , RecurrenciaRESUMEN
AIM: To compare electro- and laser enucleation (thulium, holmium) of prostate hyperplasia. MATERIAL AND METHODS: 693 prostate hyperplasia patients were enrolled. 489 patients underwent holmium enucleation (HoLEP), 51 - monopolar enucleation, 153 - thulium enucleation (ThuLEP). Prostate volume was 91.7 (50-250) cm3. There were no significant differences in preoperative variables between both groups (I-PSS, QoL, Qmax, residual urine volume) (p>0.05). RESULTS: Mean time of HoLEP was 97.0±42.2 min, monopolar enucleation - 112.9±36.3 min, ThuLEP duration was significantly less (77.4±36.3 min, p<0.01). An efficacy of all methods was confirmed in 6 months after surgery by significant (p<0.01) improvement of functional parameters (I-PSS, QoL, Qmax, residual urine volume). CONCLUSION: High efficiency of thulium and holmium enucleation allows to consider them as 'gold standard' of prostate hyperplasia management. Despite higher incidence of complications an efficacy of monopolar enucleation is comparable to that in laser techniques.
Asunto(s)
Terapia por Láser , Complicaciones Posoperatorias , Hiperplasia Prostática , Prostatismo , Calidad de Vida , Anciano , Investigación sobre la Eficacia Comparativa , Endoscopía/métodos , Holmio/uso terapéutico , Humanos , Terapia por Láser/efectos adversos , Terapia por Láser/instrumentación , Terapia por Láser/métodos , Masculino , Persona de Mediana Edad , Tamaño de los Órganos , Periodo Perioperatorio , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/prevención & control , Complicaciones Posoperatorias/psicología , Hiperplasia Prostática/patología , Hiperplasia Prostática/fisiopatología , Hiperplasia Prostática/terapia , Prostatismo/diagnóstico , Prostatismo/etiología , Prostatismo/psicología , Estudios Retrospectivos , Federación de Rusia , Tulio/uso terapéutico , Resultado del TratamientoRESUMEN
AIM: To determine the place of laparoscopic pyelolithotomy in surgical management of nephrolithiasis. MATERIALS AND METHODS: We analyzed 16 laparoscopic pyelolithotomies performed in our clinic over the last few years for large and stag-horn stones of anomalous kidneys (n=8), the "giant" (>30-40 cc) monolithic stones of the large extrarenal pelvis (n=3), multiple stones of PCS with the stone burden of more or equal 40 cm (n=2) and large recurrent (after PCNL) kidney stones in patients at risk of bacteriotoxic complications of percutaneous nephroscopy (n=3). The age of the patients ranged from 39 to 72 years (mean age 51+/-8 years). The average density of stones was 1012 (160-1483) HU. RESULTS: There were no conversions to open surgery. The mean operating time of laparoscopic pyelolithotomy was 137 (96-255) minutes, flexible transabdominal pyelocalycoscopy 31.2 (12-110) min. The stone-free rate was 87%. Residual clinically insignificant stones were found in two (13%) patients with staghorn horseshoe kidney calculi and complex PCS. The preoperative hospital stay was 1 day, postoperative-from 2 to 18 (mean 6) days. DISCUSSION: We believe that laparoscopic pyelolithotomy supplemented by transabdominal flexible pyelocalycoscopy may be recommended for surgical management of patients with "giant", multiple and infected kidney stones, because the length of their percutaneous removal is beyond the recommended time intervals and it is accompanied by an increased risk of septic complications.
Asunto(s)
Nefrolitiasis/cirugía , Adulto , Anciano , Humanos , Pelvis Renal/cirugía , Laparoscopía , Masculino , Persona de Mediana Edad , Procedimientos Quirúrgicos UrológicosRESUMEN
INTRODUCTION: The estimated recurrence rate of benign prostatic hyperplasia (BPH) after transurethral resection of the prostate is about 5 to 15%. Laser enucleation of the prostate results in a much lower recurrence rate (not exceeding 1-1.5%). At the same time, laser enucleation of the prostate is still not widely used for recurrent prostatic hyperplasia since it believed to be technically difficult in cases. AIM: To describe the distinctive features of thulium and holmium laser enucleations of the prostate in the management of recurrent BPH and show that the technical difficulties are not an obstacle to the wide application of this technique. MATERIALS AND METHODS: This was a retrospective study comprising 676 patients aged 54 to 87 years with clinically pronounced infravesical obstruction due to prostatic hyperplasia (IPSS>20, Qmax<10). All patients were divided into four groups. Groups 1 (n=489) and 3 (n=153) underwent holmium (HoLEP) and thulium (ThuLEP) laser enucleations of the prostate, respectively. Groups 2 (n=23) and 4 (n=11) included patients with BPH recurrence after HoLEP (group 2) and ThuLEP (group 4). All patients underwent diagnostic evaluation at baseline and at 6 months after surgery. RESULTS: The mean ThuLEP operating time was shorter than that of HoLEP (p=0.02). The mean duration of repeat and primary ThuLEP and HoLEP did not differ statistically significantly (p>0.05). There was no difference in the length of hospitalization and catheterization between the four groups (p>0.05). At six months after surgery, a statistically significant improvement in I-PSS, Qmax, QoL, and RUV was observed in all groups compared with preoperative values (p>0.05)). CONCLUSION: We found that the technical difficulties of the re-operation, such as the difficult separation of adenomatous tissue from the prostate capsule, the multinodular nature of the adenoma, increased tissue density are easy to overcome and do not confer a significant complexity. In turn, better completeness of resection, low complication and recurrence rates and the possibility of surgery, even in elderly patients with multiple comorbidities - these features allow us to conclude that laser enucleation of the prostate is not only an effective treatment for infravesical obstruction due to benign prostatic hyperplasia, but is also a method of choice in the treatment of patients with recurrent BPH.
Asunto(s)
Láseres de Estado Sólido/uso terapéutico , Próstata/cirugía , Hiperplasia Prostática/cirugía , Anciano , Anciano de 80 o más Años , Humanos , Masculino , Persona de Mediana Edad , Recurrencia , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
The article presents an analysis of domestic and international literature on local recurrence of prostate cancer after radical prostatectomy. The authors describe the most advanced methods of diagnosis and treatment of local recurrence commonly used in clinical practice.