Sutureless partial nephrectomy

Introduction. A century and a half of experience in renal surgery has shown the clinical feasibility of preserving a functioning renal parenchyma and the pathogenetic validity of nephron-sparing surgery (NSS) in renal cell carcinoma (RCC).Objective. To analyze the available scientific publications on nephron-sparing sutureless kidney surgery or without  so-called renorrhaphy.Materials and methods. We have searched the eLibrary, PubMed, Сochrane Library and Scopus databases without time limits. A total of 19365 publications were found in the databases, including 71 randomized controlled clinical trials, 987 reviews of which 168 were systematic and 2 were performed based on data from the Cochrane Library. This review includes publications on the sutureless NSS technique in patients with RCC; clinical cases and abstracts were excluded from the formal analysis of publications. Thus, 132 publications were selected for the analysis, which are presented in the following independently or included in previous literature reviews. The studies available for analysis were quite heterogeneous in terms of patient groups, inclusion criteria, and control points, which did not allow for a meta-analysis of the data presented.Results. An attempt to abandon the principle of kidney suturing after partial nephrectomy was implemented using methods of hemostasis based on the action of physical factors. At the same time, the value of any one of the methods that seemed at first glance did not show obvious unequivocal advantages in the NSS, the achievement of which would unequivocally reduce the severity of the problematic issue at the present stage. Significant prerequisites for such a state of the problem should be considered the monocentric nature of most studies and relatively little experience in the application of certain methods or their combinations. In the aspect of the foregoing, it is difficult to disagree with the statement that many different methods of hemostasis used during NSS appear not only to be the result of the tireless search for new opportunities by clinicians, but also the real lack of universal technologies.Conclusion. An analysis of the advantages and disadvantages of the final hemostasis methods during NSS in patients with localized RCC indicates that this problem has not been solved and requires further research

Experimental substantiation of kidney sutures

Introduction. Partial nephrectomy occupies a rightful priority position in the treatment of localized renal cell carcinoma. It not only provides high oncological results but also allows you to save the renal parenchyma. This reduces the risk of chronic kidney disease and cardiovascular accidents, which is especially important in young patients. The main technical problem is the closure of the renal wound with reliable hemostasis and low risk of urine leakage, especially in patients with large endophytic lesions.Objective. To study the mechanical properties of the renal parenchyma and to establish ways to prevent suture eruption under an experimental model.Materials and methods. The studies were carried out using the equipment of the Center for Collective Use "Technologies and Materials of the Belgorod State National Research University". Mechanical tests of the strength characteristics of the layers of the renal parenchyma were performed on 60 cadaveric kidneys. The tensile strength and tension of tissues during the application of various surgical sutures, as well as variants of the latter with the use of spacers made of materials that prevent thread eruption, were studied using a tensile machine.Results. During mechanical tests, the medulla was found to have the highest strength (23.58 ± 9.17 load (L)) between the layers of the renal parenchyma. The mechanical strength (8.40 ± 2.89 L) of the cortical substance in the absence of the capsule was minimal. When replacing the vertical suture through all layers by tied a knot along the resection line with a similar horizontal mattress suture, it significantly increased tensile strength (27.35 ± 12.04 L) to levels comparable to the tensile strength of the medulla. The use of a hemostatic mesh (SurgicelÒ) as a lining did not significantly affect the ultimate strength (23.58 ± 9.17 L) of the horizontal mattress suture. The use of a prolene mesh (LintexÒ mesh) for this purpose significantly prevented suture eruption (31.48 ± 9.98 L) compared to the native suture and the SurgicelÒ mesh. The maximum tensile strength (45.61 ± 6.1 L) of a horizontal mattress suture was obtained for a tape made of a polytetrafluoroethylene vascular prosthesis.Conclusion. The study of the mechanical strength of the layers of the renal parenchyma showed the inexpediency of performing a cortical suture. The use of a horizontal mattress suture significantly increases the tensile strength compared to a vertical one. Maximum mechanical strength characteristics were obtained using polytetrafluoroethylene inserts

The lower urinary tract symptoms in patients after transurethral resection of benign prostatic hyperplasia

We performed a retrospective analysis of medical records and prospective evaluation of TUR in the long term, which was carried out in patients with BPH. The real picture of the possibilities of examination and treatment of patients with LUTS together with urological can be accessed from portal UroWeb.ru. A survey of urologists in the public domain was conducted. Such an indication, as the ineffectiveness of conservative therapy has been established for young patients with a small volume of the prostat

Metabolic syndrome and lower urinary tract symptoms

We study the relationship between metabolic syndrome (MS) and urinary disorders. This article shows that MS is a risk factor for cardiovascular disasters, insulin resistance, and androgen deficiency in developed and developing countries. Methods: Patients with MS had statistically significantly more symptomatic on the International Prostatic Symptom Score scale and a lower quality of life inde

Combination therapy for benign prostate hyperplasia-related urinary symptoms

Introduction. Non-neurogenic lower urinary tract symptoms (LUTS) are a serious polyetiologic problem in the male population. The side effects of the medication agents used to treat LUTS significantly reduce treatment compliance. According to the literature data, the frequency of refusal for the proposed treatment during the year varies from 20 to 80%. Several studies have shown the benefits of herbal medicine for LUTS concerning the fewer side effects and increased adherence to treatment. However, to obtain a high-level recommendation base, clinical trials are required.Purpose of the study. To evaluate the effectiveness of Gardaprost® in LUTS combination therapy.Materials and methods. The study included 57 men aged 60 – 70 years with diagnosed medium- or large-volume benign prostatic hyperplasia (BPH) and moderate-to-severe LUTS according to I-PSS, morphologically excluded prostate cancer, without urinary infection signs. The patients were randomized into two follow-up groups. Tamsulosin 0.4 mg q.d. was prescribed to patients in the control group. Patients of the main group received Gardaprost® 0.4 mg q.d. in addition to Tamsulosin. The follow-up period in both groups was one-year. The statistical analysis includes data from 56 men. To evaluate therapy at the screening visit and on days 180 and 360, I-PSS, urination diary, IIEF-5, urinalysis, prostate-specific antigen, uroflowmetry, ultrasound were analyzed. Paired t-test and one-way ANOVA test were used to determine intergroup differences in normally distributed variables. For variables with a distribution other than normal, Friedman's two-way ANOVA for related samples was used. Events with a probability greater than 95% were considered statistically significant.Results. At the time of inclusion in the study, the groups were comparable concerning the control parameters. In the main group, there was a more pronounced positive dynamics in the I-PSS score, maximum urine flow rate, and post-void residual urine volume, which corresponded to 7.9 ± 2.1 points, 18.0 ± 7.3 ml/sec, 23.6 ± 13.6 ml vs 19.7 ± 7.2 points, 10 ± 3.5 ml/sec, 65.9 ± 33.2 ml in the main and control groups, respectively (p < 0.001). Additionally, in the main observation group, a decrease in prostate volume was recorded by 18.8% (p < 0.001) was recorded.Conclusion. We have obtained encouraging long-term results from the use of Gardaprost® in combination therapy of moderate-to-severe LUTS caused by medium- and large-volume BPH

Treatment of overactive bladder symptoms in women with Diunorm®: preliminary results report

Introduction. Overactive bladder (OAB) with or without urgent incontinence tends to progress with age and occurs in both men and women. However, the frequency of occurrence in the female population averages about 25%.Purpose of the study. To assess the effectiveness and safety of the drug Diunorm® (in caps.) in the prevention and treatment of OAB in women.Materials and methods. The statistical analysis includes the results of a survey of 28 women with symptoms of OAB, whose average age was 35.3 years. The drug Diunorm® was used for treatment in dosage 400 mg QD for 90 days. Patients completed the Overactive Bladder Awareness Tool and a urination diary. Additionally, urinalysis, bacteriological examination of urine, uroflowmetry, bladder ultrasound and cystoscopy were performed.Results. All women throughout the study had negative urine cultures and no pyuria in urinalysis, which excluded an infectious etiology of urinary dysfunction. During therapy, a statistically significant decrease in irritative symptoms was recorded according to the Overactive Bladder Awareness Tool questionnaire. The sum of points after 1 and 3 mo decreased by 3.0 and 4.3 points, respectively (p < 0.05). Positive dynamics in terms of the points' sum was noted in 75%, in relation to nocturia in 82% of patients (p < 0.01). The average urination rate increased from 13.3 ± 0.7 ml/s to 15.1 ± 0.7 ml/s and 15.4 ± 0.5 ml/s after 1.5 and 3 months, respectively (p < 0,0001). A similar trend was observed for maximum urine flow and residual urine volume. The maximum urine flow when taking Diunorm® increased from 15.9 ± 0.6 ml/s to 17.4 ± 0.5 ml/s and 18.1 ± 0.4 ml/s (p < 0.001). Residual urine volume decreased throughout the study. When included in the study, after 1,5 and 3 mo, this indicator was 19.9 ± 1.4; 12.2 ± 1.6 and 6.4 ± 1.1 ml, respectively (p < 0.001).Conclusion. Diunorm® can become a worthy alternative to traditional first-line OAB therapy. Comparative studies are required to obtain a high-level evidence base

LYMPH NODE DISSECTION IN PATIENTS WITH RENAL-CELL CARCINOMA OF THE PROS AND CONS

Radical nephrectomy involves removal of the kidney with paranephrium within Gerota's fascia. The need to perform adrenalectomy, the appropriateness and extent of lymph node dissection remains controversial. The results of treatment of patients with renal cell carcinoma are in the article. In this group, 38.6% of patients had vascular invasion. Nephrectomy was performed from laparotomy, the proximal and distal boundaries of dissection became superior mesenteric artery and the aortic bifurcation. Morphological examination did not reveal highly differentiated tumors. The frequency of renal capsule and perinephric invasion reached 40.9%, unchanged adrenal - 9.1%, regional lymph nodes - 22.7%. This is higher than the published data on the frequency of neoplastic lesions of the lymph nodes. Patients affected appeared to 2 lymph nodes. In conclusion, the authors concluded that such an aggressive approach could improve treatment outcomes

COMPLICATIONS OF STENTINGOF UPPER URINARY TRACT

Restoring the passage of urine through the upper urinary tract routinely is achieved by installing of external or internal drainage. Due to its objective advantages, internal drainage has been successfully used in surgery of the upper urinary tract. This review outlines the problems associated with the use ofinternal stents, namely difficultyin installation, migration, and reflux and stent obstruction, bacterial colonization of the stent, the development of functional and morphological changes in the drained segment of urinary tract

EVALUATION OF KIDNEY DRAINAGE OF THE IN ACUTE OBSTRUCTIVE PYELONEPHRITIS

Introduction. Currently, there are no generally recognized indications for the choice of methods of drainage of the upper urinary tract in obstructive uropathy. Both external and internal drainage involve a number of shortcomings affecting the quality of life of the patient.Purpose of research. To evaluate the effectiveness of internal stenting (IC) and puncture nephrostomy (PN) as a method of temporary drainage of the upper urinary tract in acute obstructive pyelonephritis.Materials and methods. During 2012-2017 we observed 156 patients of both sexes aged from 25 to 74 years with the clinic of acute obstructive pyelonephritis against the background of urolithiasis. To restore the passage of urine is made stenting jj-stent or puncture nephrostomy. Materials and methods. During 2012-2017, we observed 156 patients of both sexes aged 25 to 74 years with a clinical picture of acute obstructive pyelonephritis on the background of urolithiasis. To restore the passage of urine is made stenting jj-stent or puncture nephrostomy.Results. Clinically, fever in the PN group was stopped for 1.8±0.5 days, and in the IC group this indicator was 5.5±2.8. In the IC group, 18 (58.1%) patients complained of irritative symptoms of varying severity, and in 9 (29.0%) patients pain syndrome in the lower back associated with myction was noted. No similar complications were observed in the PN group. The inability to install and inadequate function of the IC group in 45.5% of cases required conversion in the PN group. The need for revision of the kidney after the PN group was noted in 0.8% of cases (p<0.01).Conclusion. Subject to adequate techniques of puncture of the kidney and the combined (ultrasonic and radiographic) control the conduct of puncture nephrostomy is a safe method of drainage of the kidney in acute obstructive pyelonephritis, ensuring laying of drainage is of adequate diameter that allows you to get the best results for the relief of pyelonephritis in comparison with the inner stent

The lower urinary tract symptoms in patients after transurethral resection of benign prostatic hyperplasia

We performed a retrospective analysis of medical records and prospective evaluation of TUR in the long term, which was carried out in patients with BPH. The real picture of the possibilities of examination and treatment of patients with LUTS together with urological can be accessed from portal UroWeb.ru. A survey of urologists in the public domain was conducted. Such an indication, as the ineffectiveness of conservative therapy has been established for young patients with a small volume of the prostat