[Rationale of pharmacotherapy duration in patients with benign prostatic hyperplasia (a clinical-morphological study)].

AIM: To investigate the nature of morphological alterations in the urinary bladder wall in BPH patients receiving pharmacotherapy to establish treatment time limits. MATERIALS AND METHODS: The study comprised 120 BPH patients who underwent a transvesical adenomectomy. Prior to the surgery, 110 patients received pharmacotherapy (-blockers and 5-reductase inhibitors) lasting from 1-6 months to 5-10 years. Preoperative evaluation included a standard diagnostic algorithm. During the surgery, the urinary bladder wall specimens were taken for morphological examination. Histologic specimens were stained with hematoxylin-eosin and according to van Giesonn, and underwent immunohistochemical examination using desmin, vimentin, CD31, type IV collagen and pancitokeratin monoclonal antibodies. In patients who did not take medications or used them for less than 6 months, the bladder preserved the normal histological structure. Pharmacotherapy lasting 1 to 5 years resulted in microcirculatory alterations characterized by extensive hemorrhages, damage to the endothelium and vessel basal membranes, hypertrophy of the bladder muscle membrane. In patients taking the medications for 6 to 10 years, microcirculatory alterations resulted in the vascular wall sclerosis and thickening, narrowing of the vessel lumen, hypoplasia of the transitional epithelium and muscle layer atrophy. RESULTS: The study findings suggest that prolonged (over 1 year) pharmacotherapy can adversely affect the urinary bladder wall and worsen the results of radical adenomectomy.

[Suprapubic transvesical adenomectomy of external glands of prostate with blind suture of bladder].

The article presents the experience of 524 open suprapubic transvesical prostatectomies with blind suture of bladder and hemostasis of adenoma bed by removable catgut ligatures. The advantages of this type of operation include early recovery of urethral urination (2 to 4th day), the normalization of urodynamic parameters, the restoration of anatomical and functional status of the upper urinary tract (91% of patients), rapid epithelialization of adenoma bed and low incidence of inflammatory and obstructive complications.

[Prevention and treatment of complications in patients after cystectomy with enterocystoplasty].

Surgical outcomes have been analysed for 211 patients with urinary bladder tumors. The operation consisted in cystectomy with one- or multistage creation of intestinal neocystis. Causes of early and late postoperative complications were studied. Original surgical techniques with creation of orthotopic intestinal bladder preventing complications of cystectomy are proposed.

[Choice of a method of surgical treatment of urinary bladder neoplasms]. / Vybor metoda operativnoogo lecheniia novoobrazovanii mochevogo puzyria.

The results of treatment of 850 patients with urinary bladder cancer (UBC) are analysed. Precise staging of the tumor should be made in the following order: suprapubic ultrasonic investigation (USI), cystoscopy and microcystoscopy, transrectal, transurethral USI. Indications for different treatments are outlined: typical and atypical papillary fibroepithelioma, papillary cancer in stage T1 should be managed with TUR after previous electrocoagulation; cancer in stage T2-3--with urinary bladder resection and uni- or bilateral pelvic lymphadenectomy; total papillomatosis, multiple lesions in stage T3, in cases of recurrent cancer--with cystectomy including one-stage or multistage replacement of the urinary bladder by intestinal transplant. The only physiologically sound method of treating patients after cystectomy with ureterocutaneostomy and ureterocolostomy is creation of intraperitoneal intestinal urinary bladder with reestablishment of transurethral urination. Arguments against creation of artificial urinary bladder made of detubularized segments consist in the absence of advantages.

[The formation of an artificial bladder from the intestines]. / Formirovanie artifitsial'nogo kishechnogo mochevogo puzyria.

Basing on the long-term experience in radical surgery of 252 patients with invasive bladder cancer, the authors come to the conclusion that the establishment of intestinal bladder with postcystectomy recovery of physiological uresis is the most proper therapeutic approach. Extra- or intraperitoneal position of the transplant was decided upon regarding the type and stage of cystectomy and prior methods of derivation. The techniques of one- and multistage operations are presented. Clinical practice evidences that more rapid recovery of urethral uresis can be obtained with application of primary continuous suture of artificial intestinal bladder (ideal enterocystoplasty) at the end of the surgery. Urodynamic low urinary tract findings are provided. The technique developed by the authors offers new surgical opportunity for bladder cancer patients following cystectomy.

[The treatment of urethral strictures]. / Lechenie striktur uretry.

Analysis of the results of many-year treatment of 788 patients with traumatic urethral strictures indicated that it was advisable to perform Khol'tsov's operation without leaving a catheter in the urethra in short strictures of the anterior urethral segment, Solovov's operation was indicated for occlusive strictures of the posterior urethral portion, whereas endourethral interventions (urethrotomy, resection) were beneficial in short patent strictures. Vesicourethral strictures required transurethral electroresection. Stenotic urethral changes were seen at different levels in 3.7% of postoperative patients. Some recommendations were proposed by the authors for prevention of the changes. A classification of urethral strictures was also presented.

[Iatrogenesis in urology]. / Iatrogeniia v urologii.

The proportion of misdiagnosis and errors in the treatment of urological diseases holds high, this being particularly true for iatrogenic pathology of the ureter and urinary bladder. The disturbances used to arise in response to traumatic gynecological and proctological surgical interventions and often remained undetected. The traumas are mainly induced by inaccurate use of the instruments and defects in surgical techniques. One of the serious iatrogenic complications is microcystic involvement of the urinary bladder as a result of radiotherapy for cancer. The method proposed by the authors for medical and social rehabilitation of such patients implies the replacement of the affected urinary bladder with isolated intestinal segment providing the recovery of natural uresis. Systemic endotoxinemia, another variant of urologic iatrogenesis, is associated with massive-dose antibiotics and extensive intracavitary operations. Early diagnosis and management of the conditions are supposed an effective protection against endotoxin shock.

[Replacement of the bladder with isolated intestinal loop]. / Zameshchenie mochevogo puzyria izolirovannoi kishechnoi petlei

Based on the experience with 98 operations performed for replacement of the urinary bladder with an isolated intestinal segment, it was demonstrated that the most frequent complications were peritonitis, inflammation of the lung that develop mainly with the postoperative paresis of the digestive tract in the background. Therefore, a complex of prophylactic and therapeutic measures for the postoperative intestinal paresis is recommended, the technic of surgical intervention being described in detail. A comparison of the results of surgery, taking into account the mode of the urine outflow in cystectomy, enabled to consider cystectomy with replacement of the bladder with an intestinal graft as the method of choice.