Benign prostatic hyperplasia - etiology, clinical features and management. Historical and contemporary aspects

Introduction. Benign prostatic hyperplasia and chronic prostatitis are the most common conditions in men, the frequency of which varies with age. Chronic prostatitis (infectious or inflammatory) has a frequency of 8-35% in patients aged 20-50 years, reaching a maximum of 60-70% in those aged over 50 years. Materials and methods. Materials for the study served the medical literature regarding benign prostatic hyperplasia and chronic inflammation, published in the local and international scientific journals. Scientific databases like Cochrane Library, Medline, Scopus, Medicus, NCBI, PubMed, Google Scholar were used to find the necessary articles. Research methods – analysis, synthesis, systematization, and description. Results. After analyzing the available data, a review of the literature was conducted which highlighted both the strong and weak points of the historical medical approaches to addressing benign prostatic hyperplasia, as well as the ontogenetics and anatomical characteristics of the prostate gland. This included examining the incidence rates, concepts of causation and development, principles of diagnosis and classification of benign prostatic hyperplasia. The review also revealed the pros and cons of using mini-invasive treatment strategies versus traditional transvesical approaches in treating this condition, as well as the ongoing and significant socioeconomic impact in underdeveloped countries. Conclusions. There remains the issue of reducing intra- and post-operative complications after benign prostatic hyperplasia surgery, especially a voluminous one, which imposes itself as a very critical problem in the development of an effective treatment strategy. For the first time, a problem was described by assessing the particularities of some biochemical criteria at local surgical site and in blood serum, histological - at the level of nodular prostatic hyperplasia and at the border of the surgical site. This requires a complex correlational study to assess the biochemical, histological and immunohistochemical parameters, including the evaluation of the associations or coexistence of benign prostatic hyperplasia and chronic prostatitis

The post-surgical complications after transvesical adenomectomy made in the Urological Department of the Municipal Clinical Hospital „Sf. Treime” in the period 2005-2009

Secţia urologie IMSP SCM „Sfânta Treime”, Al V-lea Congres de Urologie, Dializă şi Transplant Renal din Republica Moldova cu participare internaţională (1-13 iunie 2011)Summary. The most frequent post-surgical complications after surgical treatment of the benign prostatic hyperplasia through transvesical adenomectomy, performed in the Urological Department of the Municipal Clinical Hospital „Sfanta Treime”, in the period 2005-2009 were late hemorrhages, which have a frequency of 3,8%, followed by urethral strictures (2,8%), the tamponade of the bladder (1,9%) and acute orhoepididymitis (1,4%), which required both surgical treatment (in 6,1% cases) and medical treatment

Morphopatologicaf peculiarities in nodular benign prostatic hyperplasia

Universitatea de Stat de Medicină şi Farmacie „Nicolae Testemiţanu”, Catedra Morfopatologie, Instituţie Medico- Sanitară Publică Spitalul Clinic Municipal “ Sf. Treime”, Secţia Urologie, Universitatea de Stat de Medicină şi Farmacie „Nicolae Testemiţanu”, Catedra Urologie şi Nefrologie ChirurgicalăScopul studiului vizează efectuarea unei cercetări complexe macromicroscopice în estimarea particularităţilor morfopatologice ale prostatei în hiperplazia nodulară benignă, pentru soluţionarea chirurgical-terapeutică şi a pronosticului postoperatoriu. Rezultatele studiului aplicat au detectat unele particularităţi patogenetice şi histopatologice a proceselor lezionale identificate în teritoriul prostatic restructurizat nodular. Acestea aveau origine diferită, printre care predominau procesele inflamatorii cronice proliferativ-fibroplastice şi acute cu implicaţii în divers raport a parenchimului prostatic. În lanţul patogenetic al proceselor lezionale sunt unele reflecţiuni etiologice ale rolului infecţiei virale. În concluzie, explorările efectuate au permis specificarea caracterului proceselor patologice coexistente hiperplaziei nodulare de prostată, formularea unui concept evolutiv ale asocierilor patogenetice ale prostatitei şi hiperplaziei nodulare, implicaţiile directe în procesele lezionale a zonei de frontieră (enucleare) ce au permis stabilirea certă a fondalului real patologic al cavităţii reziduale de clivaj, facilitând astfel alegerea unui plan chirurgical şi terapeutic optim.The purpose of the study consist in the effectuation of some complex macroscopically researches in the estimation of morphopatological peculiarities in nodular benign prostatic hyperplasia for surgical-therapeutic solving and of the postoperative prognosy.The results of the study detected some pathogenic peculiarities and of the activity of the identified lesion processes in the nodular prostatic territory, these manifested a diverse origin, including acute and inflammatory chronic proliferative fibroplastic processes with implications in the prostatic parenchyma. In the pathogenetic chain of the lesion processes are given some ethiological reflections of the role of viral infection. In conclusion, the performed explorations allowed the specification of the character of pathological processes coexisting to prostatic nodular hyperplasia, the. formulation of an evolving concept of pathogenetic associations ofprostatitis and nodular hyperplasia, direct implications in the lesion processes of the border area that allowed the definite establishment of the real pathological fund of the residual cavity of the cleavage that facilitates the choice of the best

Clinical case: Mayer-Rokitansky-Kuster-Hauser syndrome, atypic form

Secţia Urologie IMSP SCM „Sf. Treime”, Catedra Urologie şi Nefrologie Chirurgicală, USMF „N. Testemiţanu”, Al V-lea Congres de Urologie, Dializă şi Transplant Renal din Republica Moldova cu participare internaţională (1-13 iunie 2011)Summary The Mayer-Rokitansky-kuster-Hauser (MRkH) syndrome is a rare anomaly in the prenatal development of the female genital tract. In this paper we report a clinical case of this syndrome observed in its atypical form with affected urogenital system, as well as uterine and renal agenesia. This case is interesting, as the patient did not receive any specific treatment associated with the syndrome until the age of 29. We provide a detailed description of the clinical case, its specifics and anamnesis. A literature review on the prenatal development of the female genital tract, urogenital system and the renal agenesia is also given

Особенности активности лизосомальных энзимов в сыворотке крови при аденоме простаты и их уровень в ложе после черезпузырной аденомэктомии при трансуретральном дренировании ложе

USMF Nicolae Testemiţanu, IMSP SCM Sfânta Treime, Conferinţa consacrată aniversării celor 40 de ani de la fondarea SCM Sfânta Treime 17 iunie 2016 Chișinău, Republica MoldovaThe mechanisms by which lysosomal disorders affecting prostate functions in prostate adenoma News. The mechanisms by which lysosomal disorders affecting prostate functions in prostate adenoma bulky (APV), including the Lodge of adenomectomy are poorly understood, and the effectiveness of current therapeutic measures are limited and uncertain. The research is based on two study groups: Lb – patients with a mean age of 68.6±1.05 and bulky AP definite diagnosis (≥ 80 cm3) repair surgery using drainage endouretralnye and Lm – 20 men of the same age, basically healthy. Lysosomal enzyme activity determination (Cat G rnd CatD; FA; NAG; β -gal, β-gul, and β-glucuronidase, arylsulfatase A and B, total protein was performed by standard techniques, adapted for application to multi-modal hybrid rider microplate Synergy H1 (Reader Hydride). As a result it was determined that AP ≥ 80 m3 bulky significantly induce the growth of all lysosomal enzymes studied, reaching values of 2-3 times higher compared with controls, with the prevalence of high values of 4-6 times, β –gal, ß-gluc and CatG fact catgut as coexistent inflammatory process caused by the presence of biological membranes and destabilization celulare. Sa direct interdependencies found the presence of liposomal enzymes in their blood serum and deletions to the lodge postoperative which can serve as a biomarker of evolution postoperative period, with predictive role in assessing the effectiveness of the treatment strategy and local general medical and surgical, monitoring and optimization of rehabilitation of patients with AP and adenomectomy.Механизмы расстройств лизосомальных энзимов, влияющие на функции простаты при аденоме предстательной железы (АПЖ), в том числе в ложе после аденомэктомии недостаточно изучены, а эффективность лечебных мероприятий ограничены и неопределенны. Исследование проводилось в двух группах: основная группа – 49 пациентов возрастом в среднем 68,6±1,05, оперированные по поводу АП с дренированием ложе [3], и контрольная – 20 мужчин того же возраста, в основном здоровые. Определение активности лизосомальных энзим (Cat G rnd CatD; FA; NAG; β -gal, β-gul, и β-glucuronidase, arylsulfatase A и B), общего белка проводили с помощью стандартных методов используя микропланшеты Synergy H1 (гидрид Reader). В результате было установлено, что при АПЖ происходит значительный рост всех лизосомальных энзимов, включенных в исследование, достигая цифры в 2-3 раза выше по сравнению с контрольной группой и в 4-6 раз значений β-галактозидазы (β-gal), бетаглюкозидазы (β-glu) и катепсина (Cat) G, обусловленные воспалительными существующими процессами приводящие к дестабилизации биологических клеточных мембран. Установлено наличие прямой зависимости между активностью лизосомных энзимов в сыворотке и послеоперационной ложе, что может служить биомаркером эволюции послеоперационного периода, с предсказательной ролью в оценке эффективности медицинской и хирургической тактики лечения, общего и локального мониторинга и оптимизации реабилитации больных с АПЖ до и после аденомэктомии

The peculiarities of clinical evolution and diagnosis of acute pyelonephritis in patients with diabetes mellitus

Catedra Urologie şi Nefrologie Chirurgicală, USMF „N.Testemiţanu”, Secţia Urologie IMSP Spitalul Clinic Municipal „Sfînta Treime”, Secţia Urologie IMSP Spitalul Clinic Republican, Al V-lea Congres de Urologie, Dializă şi Transplant Renal din Republica Moldova cu participare internaţională (1-13 iunie 2011)Summary. Kidney involvement in diabetes mellitus represents a serious problem both in therapy, endocrinology and urology. It is due to this fact that inflammatory renal and urinary diseases in patients with diabetes mellitus are four times more frequent, that in patients without diabetes mellitus. It is characterized by severe evolution associated with complication of renal failure and urosepsis, being conditioned by postoperative lethality. Development of the severe forms of acute pyelonephritis is caused by late hospital admission, inexact clinical picture, late diagnosis and inappropriate treatment in this group of patients. The combination of these two severe diseases endangers patients’ life. This has made us carry out a retrospective analysis of the collected data and give practical recommendations. The algorithm of the emergent examinations comprises the ultrasound scan, radiologic and radionuclear methods. Ultrasound scan accompanied by use of doplerography and computed tomography has an essential role. Nowadays the most effective method of examination used in diagnosis of acute pyelonephritis in patients with diabetes mellitus is considered to be computed tomography

Медико-хирургическая тактика решения вопроса аденомы и локального гемостаза простаты при трансвезикальной аденомэктомии престательной железы путем дренирования ложa

IMSP SCM Sfânta Treime, Conferinţa consacrată aniversării celor 40 de ani de la fondarea SCM Sfânta Treime 17 iunie 2016 Chișinău, Republica MoldovaThe current work aimed at increasing the efficiency of surgical tactics in adenomectomy transvezicală prostate based on the development of a new process used in prostate adenoma voluminous developed and applied in the urology service of Municipal Clinical Hospital “Trinity” in surgical and therapeutic management optimization intraoperatively and postoperatively at the lodge adenoma. Summary of the process developed is to install a tube in the lodge adenoma transurethral drainage / irrigation facilitates monitoring lodge adenoma, administration of appropriate therapy after surgery and postoperative behavior. The advantage of the new developed version provides effective improvement of haemostasis Zia-bed reduce the postoperative period from 25.3±2.11 days in using the classical method to 9.3 ± 0.26 days, accelerates restoration of having a desinestătătoare micţiei quite relevant economic effect.В данной работе освещены результаты эффективности хирургической тактики с использованием нового метода одномоментного дренирования мочевого пузыря и остаточной ложе аденомы простаты при аденомэктомии аденом больших размеров. Данный метод разработан и внедрен на базе урологического отделения Городской клинической больницы «Сф. Троицы» на протяжении многих лет. Сущность разработанного метода заключается в создании системного дренажа путем одномоментного трансуретрального введения дополнительного дренажа в ложе аденомы в целях оптимизации локального гемостаза на уровне ложе. Результаты показали, что трансуретральное дренирование ложи после аденомэктомии способствует не только дренажу и ирригации, но также эффективной ее мониторизации в послеоперационном периоде, возможность контроля за процессами заживления. Преимущество нового способа заключается в обеспечении эффективности и улучшении локального гемостаза, восстановлении самостоятельного мочеиспускания, укорочении койко-дней, и сокращении послеоперационного периода от 25,3±2,11 дней при классической методики до 9,3±0,26 дней, имеющей значительный экономический эффект

Current considerations on morphological peculiarities of voluminous prostate adenoma associated with prostatitis

Efectuarea unei cercetări complexe macro-microscopice în estimarea activităţii proceselor inflamatorii și populațiilor de celule în HBP. Materiale de studiu au servit segmente și noduli în integritatea prostatei eliminate prin prostatectomie deschisă la 30 de pacienți cu vârsta cuprinsă între 45-68 ani. Hematoxilină-Eozină a fost utilizată în 280 de blocuri de parafină, s-au folosit, de asemenea, colorarea van Gieson și histiobacterioscopia cu azur-eozină. Analiza statistică a fost realizată utilizând metode variaționale și corelaționale, construirea de histograme și scanarea multidimensională. Pentru analiza statistică comparativă a gradului de activitate a proceselor patologice în funcție de componentele structurale ale țesutului, s-a dezvoltat o scală de apreciere a evoluției: 0 - fără modificări, 1 - activitate scăzută, 2 - activitate moderată, 3 - activitate pronunțată. În conformitate cu caracteristicile histopatologice detectate, caracterul lezional principal este HBP concomitent cu procese inflamatorii cronice în remisiune sau focare acute cu zone frecvente sau difuze de manifestare și alternând cu zone relativ normale.Performing a complex macro-microscopic research in the estimation of inflammatory process activity and cell populations in BPH. Material of study served segments and nodules in integrity of the prostate removed by open prostatectomy in 30 patients aged between 45-68 years. Hematoxylin-eosin stain was used in 280 paraffin blocks, also van Gieson staining and histiobacterioscopia with azure-eosin were used. Statistical analysis was performed using variational and correlational methods, building histograms and multidimensional scanning. For comparative statistical analysis of the degree of activity of pathological processes depending on tissue structural components it was developed a scale for assessing changes in the 0 - no changes, 1 - low activity, 2 - moderate activity, 3 - pronounced activity. According to histopathological features detected, the main lesional character is BPH concomitent with chronic inflammatory processes in remission or acute outbreaks with frequently or diffuse areas of manifestation and alternating with relatively normal areas.Проведение целого комплекса макро-микроскопических исследований для оценки активности воспалительных процессов и популяций клеток при ДГПЖ. В качестве материала для исследований выступили сегменты и узелки в целостности простаты, удаленной в ходе открытой простатэктомии у 30 пациентов в возрасте от 45 до 68 лет. Краситель гематоксилин-эозин был использован на 280 парафиновых срезах, кроме того, использовалось окрашивание по Ван Гизону и проводилась гистио-бактериоскопия с применением Азурэозина. Статистический анализ проводился с использованием вариационных и корреляционных методов, построением гистограмм, а также многомерным сканированием. Для сравнительного статистического анализа степени активности патологических процессов в зависимости от структурных компонентов тканей была разработана шкала оценки изменений: 0 – без изменений, 1 – низкая активность, 2 – умеренная активность, 3 – выраженная активность. В соответствии с выявленными гистопатологическими признаками основным поражающим фактором является ДГПЖ одновременно с хроническими воспалительными процессами в стадии ремиссии или острые очаги с частыми или диффузными областями проявления и чередующиеся с относительно нормальными областями

Inflammation and immunohistochemical profile of the lymphocyte population in the prostate adenoma and the limit of residual prosthetic surgical capsule after adenomectomy

Catedra de morfopatologie USMF ”Nicolae Testimițanu”, Catedra de urologie și nefrologie chirurgicală USMF ”Nicolae Testimițanu”, Catedra de histologie, citologie și embriologie, Universitatea din Oradea, România, Facultatea de Medicină, IMSP Spitalul Clinic Municipal „Sf.Treime”, Secția de urologie, Al VII-lea Congres de Urologie, Dializă și Transplant Renal din Republica Moldova cu participare internațională 19-21 iunie 2019Studiul constă în: evaluarea inflamației în adenomul prostatic, rolului inflamației și profilului limfocitar ca factor predictiv în evoluția adenomului prostatic; evaluarea particularităților capsulei chirurgicale reziduale și a importanței acesteia în aplicarea hemostazei locale după adenomectomie. Studiul actual este de tip prospectiv și include un eșantion din 118 cazuri (98 cu adenom de prostată rezolvat chirurgical la vârsta medie de 68,6 ±1,05 ani și 20 de prostate de la decedați incidental la vârsta cuprinsă între 21-67 de ani în lipsa intravitală a statutului morbid urogenital stabilit. S-a stabilit prezența corelațiilor prostatitei cronice și a adenomului prostatic, pe un fundal patologic preexistent la nivelul capsulei chirurgicale fiind o prostatită marginală pozitivă cronică activă reziduală după adenomectomie. Frecvența majoră a limfocitelor-T poate rezulta din răspunsul imunologic la diverse leziuni, fiind și un marker al rolului autoimun în evoluția adenomului. Prostatita marginală pozitivă este un impact semnificativ în hemostaza locală și în evoluția perioadei intra- și post-operatorii, servind ca factor predictiv pentru necesitatea monitorizării lojei adenomului și utilizarea unui tratament complementar adecvat.The study consists of evaluation of inflammation in the prostatic adenoma, the role of inflammation and lymphocytic infiltrate as a predictive factor in the evolution of the prostatic adenoma, evaluation of the particularities of the residual surgical capsule and its importance in the application of local hemostasis after adenomectomy. The current study is a prospective study of a sample of 118 cases (98 with prostate adenoma resolved surgically at medium age of 68.6 ± 1.05 years and 20 prostates from incidental deaths at the age of 21-67 years in the absence intravital status of the established urogenital morbidity status. It has been established the presence of correlations of chronic prostatitis and prostate adenoma and the real pathological background preexisting in the surgical capsule, being a chronic active positive marginal prostatitis residual after adenomectomy. Major T-lymphocytes frequency can result from the response immunologically to various lesions as well as a marker of the autoimmune role in evolution of adenoma. Positive marginal prostatitis is a significant impact on local haemostasis and the evolution of the intra- and postoperative period, serving as a predictive factor for necessity of monitoring the adenoma lodge and using appropriate complementary therapy

Traumatismul obstetrical în sarcinile multiple obținute prin reproducerea asistată

Universitatea de Stat de Medicină și Farmacie „Nicolae Testemiţanu”, IMSP Institutul Mamei și Copilulu