PECULIARITIES OF POSTOPERATIVE MANAGEMENT OF PATIENTS IN EARLY PERIOD AFTER CYSTECTOMY

We analyzed the results of treatment of 30 patients who had. cystectomy with different methods of urine diversion. The postoperative course of patients after cystectomy is determined, by the extent of the operation, method of urine derivation, volume of intraoperative hemorrhage, time of recovery of intestinal peristalsis, continuance of lymphorrhea, complications (appeared or not), and patient's condition before the operation

COMPLiCATiONS AFTER CYSTECTOMY AND THEiR TREATMENT

We analyzed the results of treatment of 110 patients who had. cystectomy with, different types of urinary diversion. In the early postoperative period next complications occurred: prolonged intestinal paresis, dynamic ileus, thrombosis of the external iliac artery failure of intestinal anastomosis and the uretero-reservoir anastomosis, lymphocele formation, exacerbation of chronic pyelonephritis. In the late postoperative major complications were: urinary incontinence, stricture of the uretero-reservoir anastomosis, bladder stone formation. Conducted. operational and conservative methods of treatment allowed the arrest caused complications

ORTHOTOPIC INTESTINOPLASTY OF URINARY BLADDER - A COMPLEX APPROACH

We analyzed the results of treatment of 57 patients who had. cystectomy with forming of orthotopic cystoplastte urinary bladder. Cystoplastis was performed by the original method. The approach to the choice of method, for creating orthotopic bladder was complex. Take into account the length of ileum resection, the technique of formation and the shape of the bladder, pre-calculated volume of orthotopic urinary bladder technique was used to create antireflux ureteral-intestinal anastomosis. Such an approach to reduce the risk of postoperative complications and to maintain the high, quality of life for patients

Burst wave lithotripsy – the new evolution stage of extracorporeal shock-wave lithotripsy

Urolithiasis is currently one of the most urgent problems in the world. Every eleventh worldwide inhabitant suffers from this disease. Previously, the only way to get rid of kidney stones and the urinary tract was open surgery, which was characterized by high trauma. Over the past decades, the development of technologies has made a significant contribution to the development of new methods of urolithiasis treatment. One of these methods is extracorporeal shock wave lithotripsy (ESWL). The first lithotripter Dornier HM-1 was produced in 1980. Subsequent models have got many changes, both in terms of ergonomics and power. The researchers noticed that the efficiency of stone crushing in the Dornier HM-1 lithotripter was higher than in newer models since the lower power provided the less intensive formation of cavitation bubbles that prevent the effective transit of subsequent waves through the stone. Nowadays, a new method of remote stone crushing is being developed based on low-amplitude high-frequency technology combined with ultrasonic propulsion, which is the main difference from traditional shock-wave lithotripters. The new technology of stone crushing is called «burst wave lithotripsy» (BWL). Currently, the data have been obtained that this method is more effective in terms of crushing quality and less traumatic

Urinary pH: its regulation and relevance in urolithiasis metaphylaxis

Urolithiasis is a common multifactorial disease characterized by a high recurrence rate. This review is devoted to the urine pH as one of the main factors determining its lithogenic properties. It affects the excretion of lithogenic substances and stone formation inhibitors, the solubility, and the crystallization of substances involved in stone formation. The urine pH significantly affects the solubility of uric acid in urine, which decreases at a pH < 5.5. This explains the high incidence of uric acid concretions in patients with metabolic syndrome. Their insulin resistance leads to a decrease in the excretion of ammonium ions in the proximal tubules, leading to persistent urine acidification. The activity of many transport processes involved in the processing of calcium, citrates and phosphates is sensitive to changes in systemic or local pH. The data on the effect of urine pH on the solubility of calcium oxalate remain contradictory. At the same time, there is no doubt about the determining role of urine pH in the excretion of citrate, the most important stone formation inhibitor. The alkaline urine pH promotes the formation of concretions containing calcium phosphates. In conditions of constantly elevated urine pH in patients with persistent urease-producing urinary tract infection, a rapid growth of "infectious" concretions occurs. The review summarizes information on the causes of the decrease and increase in the urine pH, as well as the possibilities of medicinal and non-medicinal methods of modifying the urine pH during the prevention of stone formation recurrence

Пятнадцатилетний опыт радикальной цистэктомии и кишечной деривации мочи

Objective. Examination of the results of surgical treatment and analysis of the surgical technique and perioperative parameters in a series of radical cystectomy on the basis of its own 15 years of experience in the formation of orthotopic and heterotopic urinary reservoir of the ileum segment by developed and patented techniques in different versions: open radical cystectomy, laparoscopic radical cystectomy and robotassisted radical cystectomy.Materials and methods. A retrospective analysis of 310 radical cystectomy performed from 2000 to 2015, on the occasion of various pathologies of the bladder and prostate, as well as cancers of other organs (uterus, colon) with involvement in the process of bladder tumor. Plastics of the bladder was performed from the segment of the terminal ileum. Formation of orthotopic bladder was performed by the method of M.I. Vasilchenko (RF patent for invention № 2337630 “Method of orthotopic bladder plastics” by M.I. Vasilchenko). The ureters are implanted by antireflux procedure. If unable to perform orthotopic bladder plastics recovery and self-urination, patients underwent the formation of heterotopic enteral reservoir with a holding valve.Results. It assesses the functionality and viability of organic shaped orthotopic and heterotopic urinary neocystis in the early and late postoperative periods in different versions. The proposed techniques have a beneficial effect on the improvement of the functional state and stabilization of the upper urinary tract. Analysis of morbidity and mortality was determined according to the classification of surgical complications on the Clavien–Dindo. This approach allowed to identify most of the complications and prevent an underestimation of the main negative results. Estimated oncologic efficacy of minimally invasive interventions laparoscopic radical cystectomy and robot-assisted radical cystectomy not inferior open radical cystectomy.Conclusions. Formation of heterotopic and orthotopic bladder enteral neocystis (tank), on the proposed contact techniques is a viable alternative to the known intestinal plastics. The introduction of laparoscopic surgery techniques including robot-assisted laparoscopic operations to reduce the number of early and late postoperative complications. Цель исследования – изучение результатов хирургического лечения и анализ техники операций и периоперационных показателей в серии радикальной цистэктомии на основе собственного 15-летнего опыта формирования ортотопического и гетеротопического мочевого резервуара из сегмента подвздошной кишки по разработанным и запатентованным методикам в различных вариантах исполнения: открытой, лапароскопической и робот-ассистированной радикальных цистэктомий.Материалы и методы. Проведен ретроспективный анализ результатов 310 радикальных цистэктомий, выполненных в период с 2000 по 2015 г., по поводу различных патологий мочевого пузыря и предстательной железы, а также при злокачественных опухолях других органов (матки, толстого кишечника) c вовлечением в опухолевый процесс мочевого пузыря. Пластику мочевого пузыря осуществляли из сегмента терминального отдела подвздошной кишки. Формирование ортотопического мочевого пузыря выполняли по методике М.И. Васильченко (патент Российской Федерации на изобретение №2337630 «Способ ортотопической тонкокишечной пластики мочевого пузыря», автор М.И. Васильченко). Мочеточники имплантировались по антирефлюксной методике. При невозможности осуществления ортотопической пластики мочевого пузыря и восстановления самостоятельного мочеиспускания больным выполнялось формирование гетеротопического тонкокишечного резервуара с удерживающим клапаном.Результаты. Оценена функциональная и органическая состоятельность сформированного ортотопического и гетеротопического мочевого неоцистиса в ранние и отдаленные сроки после операции в различных вариантах исполнения. Предложенные методики оказывают благоприятное влияние на улучшение функционального состояния и стабилизацию верхних мочевыводящих путей. Анализ частоты развития осложнений и летальности определяли согласно классификации хирургических осложнений Clavien– Dindo. Данный подход позволил выделить большинство осложнений и предотвратить недооценку главных отрицательных результатов. Была проанализирована онкологическая эффективность малоинвазивных вмешательств – лапароскопической и роботассистированной радикальных цистэктомий, не уступающих открытой радикальной цистэктомии.Выводы. Формирование гетеротопического и ортотопического тонкокишечного мочевого неоцистиса (резервуара) по предложенным нами методикам является достойной альтернативой известным кишечным пластикам. Внедрение лапароскопических техник оперативного лечения, в том числе робот-ассистированных операций, позволяет снизить количество ранних и поздних послеоперационных осложнений.

Conservative therapy of uric acid lithiasis: a review of literature

Urolithiasis (UL) continues to play an important role in the daily practice of urologists and general practitioners. According to various sources, uric acid nephrolithiasis accounts for about 20% of all cases of urolithiasis. Risk factors for uric acid nephrolithiasis include hyperuricemia, hyperuricosuria, decreased urine output and low urine pH. The major risk factor for UL, low urine pH, is managed by different citrate drugs. Citrate mixtures are strong base salts combined with weak acids which alkalize (neutralize) urine pH, whereas the acid component is metabolised. In patients diagnosed with hyperuricemia, uric acid production can be reduced with the help of xanthine oxidase inhibitors which act as suppressors of xanthine oxidase - an enzyme that catalyzes the oxidation of hypoxanthine to xanthine and xanthine to uric acid which is the end-product of purine metabolism in humans. The medical literature confirms the efficacy of citrate mixtures and xanthine oxidase inhibitors for the treatment of patients with uric acid nephrolithiasis

Fifteen years of experience radical cystectomy and intestinal urinary diversion

Objective. Examination of the results of surgical treatment and analysis of the surgical technique and perioperative parameters in a series of radical cystectomy on the basis of its own 15 years of experience in the formation of orthotopic and heterotopic urinary reservoir of the ileum segment by developed and patented techniques in different versions: open radical cystectomy, laparoscopic radical cystectomy and robotassisted radical cystectomy.Materials and methods. A retrospective analysis of 310 radical cystectomy performed from 2000 to 2015, on the occasion of various pathologies of the bladder and prostate, as well as cancers of other organs (uterus, colon) with involvement in the process of bladder tumor. Plastics of the bladder was performed from the segment of the terminal ileum. Formation of orthotopic bladder was performed by the method of M.I. Vasilchenko (RF patent for invention № 2337630 “Method of orthotopic bladder plastics” by M.I. Vasilchenko). The ureters are implanted by antireflux procedure. If unable to perform orthotopic bladder plastics recovery and self-urination, patients underwent the formation of heterotopic enteral reservoir with a holding valve.Results. It assesses the functionality and viability of organic shaped orthotopic and heterotopic urinary neocystis in the early and late postoperative periods in different versions. The proposed techniques have a beneficial effect on the improvement of the functional state and stabilization of the upper urinary tract. Analysis of morbidity and mortality was determined according to the classification of surgical complications on the Clavien–Dindo. This approach allowed to identify most of the complications and prevent an underestimation of the main negative results. Estimated oncologic efficacy of minimally invasive interventions laparoscopic radical cystectomy and robot-assisted radical cystectomy not inferior open radical cystectomy.Conclusions. Formation of heterotopic and orthotopic bladder enteral neocystis (tank), on the proposed contact techniques is a viable alternative to the known intestinal plastics. The introduction of laparoscopic surgery techniques including robot-assisted laparoscopic operations to reduce the number of early and late postoperative complications