Epidemiological aspects of postoperativelumbar incisional hernias

Department of Urology and Surgical Nephrology, Nicolae Testemitanu State University of Medicine and Pharmacy, Chisinau, Republic of Moldova, The 8th International Medical Congress for Students and Young Doctors, September 24-26, 2020Introduction. Incisional lumbar hernia is a complication of 17.1% of the surgery on the kidneys and ureter and constitutes 8% of the total hernias of the antero-lateral abdominal wall. Aim of the study. Evaluation of incidence of lumbar incisional hernias following urological surgery and establishment of epidemiological data for a period of 1 year. Materials and methods.. The study developed 32 care patients who underwent surgery on the kidneys with dynamic surveillance up to 12 months. In the case of studies or evaluation of indices such as serum glycemia, the diagnosis of obesity has been established, through the use (BMI) and anthropometric indices of patients. Results. Results. The study shows that in 94% of patients the risk of developing postoperative hernias is increased in the first year after the surgery, considering a significant exceedance of BMI standards, positive uroculture, the presence of diabetes or high blood sugar levels. Thus, the study shows that the lombotomy failure rate represents 11% of the cases. Conclusions. The incidence of incisional hernias at 6 months was 10%, at 12 months the incidence of 18%. The postoperative evolution of patients at increased risk of herniation is uncertain and depends on the presence of risk factors such as diabetes, obesity, anthropometric indices. Diabetes has a significant value in the diagnosis and prophylaxis of incisional hernias

Clinical and morphological aspects of the postoperative lumbar herniation

Catedra Urologie şi Nefrologie Chirurgicală, USMF„N. Testemiţanu", Al VI-lea Congres de Urologie, Dializă şi Transplant Renal din Republica Moldova cu participare internaţională (21-23 octombrie 2015)Rezumat. Scopul studiului a fost de a stabili grupul de pacienţi cu risc înalt de herniere postlombotomică. în studiu au fost incluse două loturi: primul lot de 10 cadavre, prin metoda disecţiei s-au apreciat indicii antropometrici ai regiunii lombare. în al doilea lot au fost incluşi 15 pacienţi cărora li s-a efectuat „plastia herniei lombare postlombotomice". Patologiile asociate (discolagenoze, obezitate,etc) determină dezvoltarea hernilor lombare postintervenţionale.Summary. The aim of the study was to establish the group of patients with a high risk of postoperative lumbar herniation. The study includes two groups. The first group includes 10 cadavers in which by dissection method were appreciated the anthropometric indices of the anatomical structures of the lumbar region. The second group includes 15 patients that underwent „ Postoperative lumbar hernia plasty". Associated pathologies (collagen disorders, obesity, etc.) determine the development of the postinterventional lumbar hernias

Исследование клеточного и гуморального иммунитета у больных с осложненным уролитиазом

Catedra de urologie şi nefrologie chirurgicală, IP USMF „Nicolae Testimiţanu”, Secția Urologie, IMSP Spitalul Clinic RepublicanSummary. The treatment of complicated nephrolithiasis, especially surgical, is closely related to drug therapy of urinary infection, one of the reasons being reduction of immune status. In the same time, prolonged persistence of kidney stone cause the development of general inflammatory syndrome affecting the functioning of the unspecific humoral and cellular immune system. The work is performed evaluating the immunological status preoperatively in 58 patients with complicated lithiasis. Analysis of immune status in these patients demonstrated that complicated urolithiasis resulting in signifi cant changes in the immune system, these changes being expressed at the cellular and humoral level of immunity.Rezumat. Litiaza renală, în special cea complicată, coraliformă și infectată, contribuie la dezvoltarea sindromului inflamator general care afectează funcţionarea sistemului imun nespecific, umoral şi celular. Tratamentul chirurgical al nefrolitiazei este în strânsă corelație cu terapia medicamentoasă a infecţiei urinare, una din cauze fiind micşorarea statusului imun. În lucrare este efectuată evaluarea preoperatorie a statusului imunologic la 58 pacienţi cu litiază renală, preponderent litiază coraliformă. Analiza statusului imunologic la această categorie de pacienţi a demonstrat că litiaza urinară complicată decurge cu schimbări semnificative din partea sistemului imun al organismului, aceste modificări fiind mai exprimate la nivelul celular și umoral al imunităţii.Резюме. Мочекаменная болезнь, особенно осложненная, коралловидная и инфицированная, как правило, способствует развитию воспалительного синдрома, влияющего на функционирование гуморального и клеточного компонентов неспецифической иммунной системы. Хирургическое лечение нефролитиаза требует одновременной лекарственной терапии инфекции мочевыводящих путей, одной из причин снижения иммунного статуса. В данной работе была выполнена предоперационная оценка иммунного статуса у 58 пациентов с мочекаменной болезнью, в основном с коралловидной. Анализ иммунного статуса у этих больных показал, что осложненная мочекаменная болезнь протекает с значительными изменениями в иммунной системе организма, выраженные в клеточном и гуморальном иммунитете

Studiul imunității celulare și umorale la pacienți cu urolitiază complicată

Litiaza renală, în special cea complicată, coraliformă și infectată, contribuie la dezvoltarea sindromului infl amator general care afectează funcţionarea sistemului imun nespecifi c, umoral şi celular. Tratamentul chirurgical al nefrolitiazei este în strânsă corelație cu terapia medicamentoasă a infecţiei urinare, una din cauze fiind micşorarea statusului imun. În lucrare este efectuată evaluarea preoperatorie a statusului imunologic la 58 pacienţi cu litiază renală, preponderent litiază coraliformă. Analiza statusului imunologic la această categorie de pacienţi a demonstrat că litiaza urinară complicată decurge cu schimbări semnifi cative din partea sistemului imun al organismului, aceste modificări fiind mai exprimate la nivelul celular și umoral al imunităţii

Studiul imunității celulare și umorale la pacienți cu urolitiază complicată

Universitatea de Stat de Medicină şi Farmacie „Nicolae Testemiţanu“, IMSP Spitalul Clinic RepublicanLitiaza renală, în special cea complicată, coraliformă și infectată, contribuie la dezvoltarea sindromului infl amator general care afectează funcţionarea sistemului imun nespecifi c, umoral şi celular. Tratamentul chirurgical al nefrolitiazei este în strânsă corelație cu terapia medicamentoasă a infecţiei urinare, una din cauze fiind micşorarea statusului imun. În lucrare este efectuată evaluarea preoperatorie a statusului imunologic la 58 pacienţi cu litiază renală, preponderent litiază coraliformă. Analiza statusului imunologic la această categorie de pacienţi a demonstrat că litiaza urinară complicată decurge cu schimbări semnifi cative din partea sistemului imun al organismului, aceste modificări fiind mai exprimate la nivelul celular și umoral al imunităţii. The treatment of complicated nephrolithiasis, especially surgical, is closely related to drug therapy of urinary infection, one of the reasons being reduction of immune status. In the same time, prolonged persistence of kidney stone cause the development of general inflammatory syndrome affecting the functioning of the unspecific humoral and cellular immune system. The work is performed evaluating the immunological status preoperatively in 58 patients with complicated lithiasis. Analysis of immune status in these patients demonstrated that complicated urolithiasis resulting in significant changes in the immune system, these changes being expressed at the cellular and humoral level of immunity Мочекаменная болезнь, особенно осложненная, коралловидная и инфицированная, как правило, способствует развитию воспалительного синдрома, влияющего на функционирование гуморального и клеточного компонентов неспецифической иммунной системы. Хирургическое лечение нефролитиаза требует одновременной лекарственной терапии инфекции мочевыводящих путей, одной из причин снижения иммунного статуса. В данной работе была выполнена предоперационная оценка иммунного статуса у 58 пациентов с мочекаменной болезнью, в основном с коралловидной. Анализ иммунного статуса у этих больных показал, что осложненная мочекаменная болезнь протекает с значительными изменениями в иммунной системе организма, выраженные в клеточном и гуморальном иммунитете

Transurethral en bloc resection of urinary bladder tumors vs conventional transurethral resection of bladder tumors. Early postoperative outcomes

Department of Urology and Surgical Nephrology, Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of MoldovaIntroduction. Treatment of urinary bladder tumors (UBT) remains an important problem in oncourology. Currently, transurethral resection of urinary bladder (TUR-V) remains the gold standard in the endourologic treatment of UBT. In the last decade many alternative endourologic techniques have been proposed for the treatment of UBT. Aim of the study. Comparative assessment of the efficacy of transurethral En Bloc resection of urinary bladder tumors. Materials and methods. In the period between 08.2017 – 12.2017, 25 patients with average age of 57 years underwent endourological treatment of UBT at the Department of Urology and Surgical Nephrology, Nicolae Testemitanu State University of Medicine and Pharmacy. Patients were divided into two treatment groups: first group - transurethral En Bloc resection of UBT (8 patients), second group – TUR-V of UBT (17 patients). All patients were evaluated after 3 months by cystoscopy whit narrow band imaging (NBI). Results. Average duration of intervention: 39 min vs 33 min. The rate of transitional haematuria and postoperative infections was similar. During NBI cystoscopy tumor recurrence was determined in 3 cases in TUR-V group, and no recurrences in En Bloc resection group. In the En Bloc resection group additional tumors with different localization were found during NBI cystoscopy. Conclusions. Transurethral En Bloc resection of UBT is an effective method in the treatment of UBT. Results of treatment using En Bloc resection are better that conventional TUR-V of bladder tumor. Another advantage of transurethral En Bloc resection of UBT is a better staging of tumor process due to the resection of all urinary bladder wall layers which is very important to determine postoperative tactics

Transurethral Thulium laser resection of prostate vs monopolar transurethral resection – evaluation of postoperative outcomes

Department of Urology and Surgical Nephrology, Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of MoldovaIntroduction. Treatment of benign prostatic hyperplasia (BPH) remains one of the actual problems in endourology. Currently, monopolar TUR-P remains the gold standard in the surgical treatment of BPH. Nowadays laser technologies offer safe and efficient alternatives in BPH endourologic treatment. Aim of the study. Comparative assessment of the efficacy of transurethral Thulium laser resection of prostate. Materials and methods. In the period of 08.2017 – 02.2018, 52 patients with average age of 62 years underwent endourologic treatment of BPH at the Department of Urology and Surgical Nephrology, Nicolae Testemitanu State University of Medicine and Pharmacy. Patients were divided into two treatment groups: transurethral Thulium resection of prostate (24 patients) and monopolar TUR-P (28 patients), and evaluated postoperatively after 1 month. Preoperative patients were investigated: PSA, IPSS, QoL, TRUS-P with PVR and Qmax. Patients inclusion criteria: prostate volume 40 - 70cm3, IPSS ≥16 and PVR ≥ 50ml, PSA≤4ng / ml, QoL> 4, Qmax <8ml/s. Results. Average duration of intervention: 63 min vs 47 min. The prostate volume decreased postoperatively on average from 58.4 cm3 to 26.1 cm3, vs 61.1 cm3 to 24.6 cm3, there was an increase of average Qmax from 7.3 to 20.7 ml/s vs 7,5 to 21.2 ml/s, a decrease in mean IPSS from 20.3 to 4.3 vs 21 to 4.5, and a PVR decrease from 65.2 ml to 15.5 ml vs 68.6 to 16.8 ml, respectively. The period of transitional macrohaematuria was 1.2 days vs 2.3 days respectively. The duration of catheterization was 1.5 days in the first group and 2.6 days in the second group. The complication rate was similar. Conclusions. Transurethral Thulium laser resection of prostate is an effective alternative method in the treatment of BPH. Immediate postoperative results of Thulium laser prostate resection are similar to the results of the “gold standard” – monopolar TUR-P group. The high safety profile characteristic for Thulium laser resection of prostate is also to be mentioned

Computerized tomography in the diagnosis of lumbar incisional hernia

Department of Urology and Surgical Nephrology, Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of MoldovaIntroduction. Incisional lumbar hernia is still a diagnosis problem of the first magnitude. The diagnosis of incisional hernias outside the midline remains a challenging procedure. Lumbar hernias occur in the region of the flank bounded by the 12th rib, the iliac crest, and the erector spinae and external oblique muscles. CT portrays shows the anatomic relationships in this region so well and it may be the only radiographic procedure necessary to make the diagnosis of a lumbar incisional hernia. Aim of the study. Objective evaluation of the alterations in body image and configuration of patients who underwent urological surgery via a flank incision. Materials and methods. Eligible for study were 7 patients who underwent urological surgery via lumbar incision for renal diseases. Preoperative and postoperative abdominal computerized tomography were used for evaluation. We evaluated the objective results using computerized tomography. Results. Over a 12-month period, lumbar hernias were detected with CT in seven patients, all had flank incisions, six of them with detectable flank bulge and one without. In 3 patients diffuse and large hernias were found, in two patients superiorly located hernias, which are immediately palpable below the 12th rib and subsequently thought to originate from the superior lumbar triangle, and in two patients inferiorly located hernias palpable just above the iliac crest and subsequently thought to originate from the inferior lumbar triangle. The mean age was 58 years (range 30-76); five women and two men. Of these, two were asymptomatic and five were symptomatic. All seven lumbar hernias detected on CT were on the left side. Two of them contained extraperitoneal fat and five contained bowel (descending colon or sigmoid colon). Six of the postincisional hernias showed disruption of normal muscle layers. In one case only the external oblique muscles were intact. In a high postincisional hernia there was a disruption of the intercostal muscles. Conclusions. CT can be helpful in the assessment of symptomatic patients after flank incision, to differentiate postincisional muscular weakness and intercostal neuralgia from a lumbar hernia and is able to delineate muscular and fascial layers, a defect in one or more of these layers, and the presence of herniated fat and/or viscera. Computerized tomography is the diagnostic method of choice and is recommended in all patients with a bulge after a flank incision