4 research outputs found
ΠΡΠ΅Π΄ΠΈΠΊΡΠΎΡΡ ΠΌΠΎΡΠ±ΠΈΠ΄Π½ΠΎΡΡΠΈ ΡΠ°Π΄ΠΈΠΊΠ°Π»ΡΠ½ΠΎΠΉ ΡΠΈΡΡΡΠΊΡΠΎΠΌΠΈΠΈ ΠΈ ΡΠ°Π·Π»ΠΈΡΠ½ΡΡ Π²Π°ΡΠΈΠ°Π½ΡΠΎΠ² ΡΡΠΎΠ΄Π΅ΡΠΈΠ²Π°ΡΠΈΠΈ: 20-Π»Π΅ΡΠ½ΠΈΠΉ ΠΎΠΏΡΡ ΠΎΠ΄Π½ΠΎΠ³ΠΎ Ρ ΠΈΡΡΡΠ³ΠΈΡΠ΅ΡΠΊΠΎΠ³ΠΎ ΡΠ΅Π½ΡΡΠ°
Background. Most of serious complications of radical cystectomy (RCE) should be associated with the comorbidity of patients and the interintestinal anastomoses designed with urinary reservoirs rather than with RCE. It is relevant to identify and assess the role of predictors for morbidity of RCE and urine derivation.Objective: to search for risk factors for complications after RCE with different types of urine derivation.Subjects and methods. The immediate and late results of RCE and urine derivation were studied in 350 patients with bladder cancer. Sequential postoperative complications were additionally analyzed in chronological order in all the patients, including non-cancer ones (n = 43).Results. 43.9% of the patients had postoperative complications, if a surgeon had sufficient surgical experience; there was a preponderance of patients with mild-to-moderate complications (Clavien-Dindo grade I-II, 37.8%) unassociated with urine derivation. The patients with severe postoperative complications were 16.3%; mortality was 3.1%, which significantly correlated with surgical experience. Late (3-18 month) postoperative complications were detected in 21.4% of the patients with a preponderance of those with urine derivation-related complications (19.4). The frequency of complications due to extraintestinal versus intestinal urine derivations was significantly higher (68.1 and 49.8% (p < 0.05). During two-step surgical treatment, the patients demonstrated higher morbidity and worse survival. Extraintestinal urine derivations, continuous urinary intestinal diversion determine a less favorable prognosis compared with one-stage ortho- and heterotopic procedures. The type of urine derivation and the experience of a surgeon performing RCE are valid predictors for postoperative morbidity and independent prognostic factors of overall and cancer-specific survival, respectively. 150 operations are needed for achieving optimal surgical experience. Discussion. It is appropriate to increase the time of research reports on the results of urine derivation up to 12-18 months of a postoperative follow-up.In practice, the routine use of two-step RCE and final urine derivation and internal and/or external urine ones should be abandoned; preference should be, when possible, given to single-stage ortho- and/or heterotopic urine derivations rather than to the former.Conclusion. Extraintestinal (percutaneous puncture nephrostomy, ureterocutaneostomy), and internal (ureterosigmoanastomosis, ureterosigmorectoanastomosis, Mainz pouch II) urine derivations, two-step surgical treatment, and a surgeonβs insufficient experience are predictors for high morbidity and poor prognostic factors for survival after RCE and urine derivation.ΠΠ²Π΅Π΄Π΅Π½ΠΈΠ΅. ΠΓ³Π»ΡΡΡΡ ΡΠ°ΡΡΡ ΡΠ΅ΡΡΠ΅Π·Π½ΡΡ
ΠΎΡΠ»ΠΎΠΆΠ½Π΅Π½ΠΈΠΉ ΡΠ°Π΄ΠΈΠΊΠ°Π»ΡΠ½ΠΎΠΉ ΡΠΈΡΡΡΠΊΡΠΎΠΌΠΈΠΈ (Π Π¦Π) ΡΠ»Π΅Π΄ΡΠ΅Ρ ΡΠ²ΡΠ·ΡΠ²Π°ΡΡ Ρ ΠΊΠΎΠΌΠΎΡΠ±ΠΈΠ΄Π½ΠΎΡΡΡΡ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ², ΠΌΠ΅ΠΆΠΊΠΈΡΠ΅ΡΠ½ΡΠΌΠΈ Π°Π½Π°ΡΡΠΎΠΌΠΎΠ·Π°ΠΌΠΈ, ΠΊΠΎΠ½ΡΡΡΡΠΈΡΡΠ΅ΠΌΡΠΌΠΈ ΠΌΠΎΡΠ΅Π²ΡΠΌΠΈ ΡΠ΅Π·Π΅ΡΠ²ΡΠ°ΡΠ°ΠΌΠΈ, Π° Π½Π΅ Ρ Π Π¦Π. ΠΠΊΡΡΠ°Π»ΡΠ½ΠΎ Π²ΡΡΠ²Π»Π΅Π½ΠΈΠ΅ ΠΈ ΠΎΡΠ΅Π½ΠΊΠ° ΡΠΎΠ»ΠΈ ΠΏΡΠΎΠ³Π½ΠΎΡΡΠΈΡΠ΅ΡΠΊΠΈΡ
ΡΠ°ΠΊΡΠΎΡΠΎΠ² ΠΌΠΎΡΠ±ΠΈΠ΄Π½ΠΎΡΡΠΈ Π Π¦Π ΠΈ ΡΡΠΎΠ΄Π΅ΡΠΈΠ²Π°ΡΠΈΠΈ.ΠΠ°ΡΠ΅ΡΠΈΠ°Π»Ρ ΠΈ ΠΌΠ΅ΡΠΎΠ΄Ρ. ΠΠ·ΡΡΠ΅Π½Ρ Π½Π΅ΠΏΠΎΡΡΠ΅Π΄ΡΡΠ²Π΅Π½Π½ΡΠ΅ ΠΈ ΠΎΡΠ΄Π°Π»Π΅Π½Π½ΡΠ΅ ΡΠ΅Π·ΡΠ»ΡΡΠ°ΡΡ Π Π¦Π ΠΈ ΡΡΠΎΠ΄Π΅ΡΠΈΠ²Π°ΡΠΈΠΈ ΠΏΡΠΈ Π ΠΠ (n = 350). ΠΡΠΏΠΎΠ»Π½Π΅Π½ Π΄ΠΎΠΏΠΎΠ»Π½ΠΈΡΠ΅Π»ΡΠ½ΡΠΉ Π°Π½Π°Π»ΠΈΠ· ΠΏΠΎΡΠ»Π΅Π΄ΠΎΠ²Π°ΡΠ΅Π»ΡΠ½ΠΎ Π²ΠΎΠ·Π½ΠΈΠΊΡΠΈΡ
ΠΏΠΎΡΠ»Π΅ΠΎΠΏΠ΅ΡΠ°ΡΠΈΠΎΠ½Π½ΡΡ
ΠΎΡΠ»ΠΎΠΆΠ½Π΅Π½ΠΈΠΉ Π² Ρ
ΡΠΎΠ½ΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΎΠΌ ΠΏΠΎΡΡΠ΄ΠΊΠ΅ Ρ Π²ΡΠ΅Ρ
ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ², Π²ΠΊΠ»ΡΡΠ°Ρ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ Π½Π΅ΠΎΠ½ΠΊΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΎΠΉ ΠΏΠ°ΡΠΎΠ»ΠΎΠ³ΠΈΠ΅ΠΉ (n = 43).Π¦Π΅Π»Ρ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΡ β ΠΏΠΎΠΈΡΠΊ ΡΠ°ΠΊΡΠΎΡΠΎΠ² ΡΠΈΡΠΊΠ° ΡΠ°Π·Π²ΠΈΡΠΈΡ ΠΎΡΠ»ΠΎΠΆΠ½Π΅Π½ΠΈΠΉ ΠΏΠΎΡΠ»Π΅ Π Π¦Π Ρ ΡΠ°Π·Π»ΠΈΡΠ½ΡΠΌΠΈ Π²Π°ΡΠΈΠ°Π½ΡΠ°ΠΌΠΈ ΠΎΡΠ²Π΅Π΄Π΅Π½ΠΈΡ ΠΌΠΎΡΠΈ.Π Π΅Π·ΡΠ»ΡΡΠ°ΡΡ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΡ. ΠΠΎΡΠ»Π΅ΠΎΠΏΠ΅ΡΠ°ΡΠΈΠΎΠ½Π½ΡΠ΅ ΠΎΡΠ»ΠΎΠΆΠ½Π΅Π½ΠΈΡ ΠΏΡΠΈ Π΄ΠΎΡΡΠ°ΡΠΎΡΠ½ΠΎΠΌ Ρ
ΠΈΡΡΡΠ³ΠΈΡΠ΅ΡΠΊΠΎΠΌ ΠΎΠΏΡΡΠ΅ ΠΈΠΌΠ΅ΡΡ 43,9 % Π±ΠΎΠ»ΡΠ½ΡΡ
, ΠΏΡΠ΅ΠΎΠ±Π»Π°Π΄Π°ΡΡ ΠΏΠ°ΡΠΈΠ΅Π½ΡΡ Ρ Π»Π΅Π³ΠΊΠΈΠΌΠΈ ΠΈ ΡΠΌΠ΅ΡΠ΅Π½Π½ΡΠΌΠΈ (IβII ΡΡΠ΅ΠΏΠ΅Π½ΠΈ ΠΏΠΎ Clavien β Dindo) ΠΎΡΠ»ΠΎΠΆΠ½Π΅Π½ΠΈΡΠΌΠΈ Π½Π΅ ΡΠ²ΡΠ·Π°Π½Π½ΡΠΌΠΈ Ρ ΡΡΠΎΠ΄Π΅ΡΠΈΠ²Π°ΡΠΈΠ΅ΠΉ β 37,8 %. ΠΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ ΡΡΠΆΠ΅Π»ΡΠΌΠΈ ΠΏΠΎΡΠ»Π΅ΠΎΠΏΠ΅ΡΠ°ΡΠΈΠΎΠ½Π½ΡΠΌΠΈ ΠΎΡΠ»ΠΎΠΆΠ½Π΅Π½ΠΈΡΠΌΠΈ β 16,3 %, Π»Π΅ΡΠ°Π»ΡΠ½ΠΎΡΡΡ ΡΠΎΡΡΠ°Π²ΠΈΠ»Π° 3,1 %, ΡΡΠΎ Π΄ΠΎΡΡΠΎΠ²Π΅ΡΠ½ΠΎ ΠΊΠΎΡΡΠ΅Π»ΠΈΡΡΠ΅Ρ Ρ Ρ
ΠΈΡΡΡΠ³ΠΈΡΠ΅ΡΠΊΠΈΠΌ ΠΎΠΏΡΡΠΎΠΌ. ΠΡΡΡΠΎΡΠ΅Π½Π½ΡΠ΅ ΠΏΠΎΡΠ»Π΅ΠΎΠΏΠ΅ΡΠ°ΡΠΈΠΎΠ½Π½ΡΠ΅ ΠΎΡΠ»ΠΎΠΆΠ½Π΅Π½ΠΈΡ (3β18 ΠΌΠ΅Ρ) Π²ΡΡΠ²Π»Π΅Π½Ρ Ρ 21,4 % Π±ΠΎΠ»ΡΠ½ΡΡ
, ΡΡΠ΅Π΄ΠΈ ΠΊΠΎΡΠΎΡΡΡ
ΠΏΡΠ΅ΠΎΠ±Π»Π°Π΄Π°ΡΡ ΠΏΠ°ΡΠΈΠ΅Π½ΡΡ ΡΠΎ ΡΠ²ΡΠ·Π°Π½Π½ΡΠΌΠΈ Ρ ΡΡΠΎΠ΄Π΅ΡΠΈΠ²Π°ΡΠΈΠ΅ΠΉ ΠΎΡΠ»ΠΎΠΆΠ½Π΅Π½ΠΈΡΠΌΠΈ β 19,4 %. Π§Π°ΡΡΠΎΡΠ° ΠΎΡΠ»ΠΎΠΆΠ½Π΅Π½ΠΈΠΉ ΠΏΡΠΈ Π²Π½Π΅ΠΊΠΈΡΠ΅ΡΠ½ΡΡ
ΡΠΎΡΠΌΠ°Ρ
ΡΡΠΎΠ΄Π΅ΡΠΈΠ²Π°ΡΠΈΠΈ Π΄ΠΎΡΡΠΎΠ²Π΅ΡΠ½ΠΎ Π²ΡΡΠ΅ Π² ΡΡΠ°Π²Π½Π΅Π½ΠΈΠΈ ΠΊΠΈΡΠ΅ΡΠ½ΡΠΌΠΈ ΡΡΠΎΠ΄Π΅ΡΠΈΠ²Π°ΡΠΈΡΠΌΠΈ β 68,1 % ΠΏΡΠΎΡΠΈΠ² 49,8 % (p < 0,05). ΠΡΠΈ Π΄Π²ΡΡ
ΡΡΠ°ΠΏΠ½ΠΎΠΌ Ρ
ΠΈΡΡΡΠ³ΠΈΡΠ΅ΡΠΊΠΎΠΌ Π»Π΅ΡΠ΅Π½ΠΈΠΈ ΠΏΠ°ΡΠΈΠ΅Π½ΡΡ Π΄Π΅ΠΌΠΎΠ½ΡΡΡΠΈΡΡΡΡ Π±ΠΎΠ»Π΅Π΅ Π²ΡΡΠΎΠΊΡΡ ΠΌΠΎΡΠ±ΠΈΠ΄Π½ΠΎΡΡΡ ΠΈ Ρ
ΡΠ΄ΡΡΡ Π²ΡΠΆΠΈΠ²Π°Π΅ΠΌΠΎΡΡΡ. ΠΠ½Π΅ΠΊΠΈΡΠ΅ΡΠ½ΡΠ΅ ΡΠΎΡΠΌΡ ΡΡΠΎΠ΄Π΅ΡΠΈΠ²Π°ΡΠΈΠΈ ΠΈ ΠΎΡΠ²Π΅Π΄Π΅Π½ΠΈΠ΅ ΠΌΠΎΡΠΈ Π² Π½Π΅ΠΏΡΠ΅ΡΡΠ²Π½ΡΠΉ ΠΊΠΈΡΠ΅ΡΠ½ΠΈΠΊ ΠΎΠ±ΡΡΠ»ΠΎΠ²Π»ΠΈΠ²Π°ΡΡ ΠΌΠ΅Π½Π΅Π΅ Π±Π»Π°Π³ΠΎΠΏΡΠΈΡΡΠ½ΡΠΉ ΠΏΡΠΎΠ³Π½ΠΎΠ· Π² ΡΡΠ°Π²Π½Π΅Π½ΠΈΠΈ Ρ ΠΎΠ΄Π½ΠΎΠΌΠΎΠΌΠ΅Π½ΡΠ½ΡΠΌΠΈ ΠΎΡΡΠΎ- ΠΈ Π³Π΅ΡΠ΅ΡΠΎΡΠΎΠΏΠΈΡΠ΅ΡΠΊΠΈΠΌΠΈ ΠΌΠ΅ΡΠΎΠ΄ΠΈΠΊΠ°ΠΌΠΈ. Π’ΠΈΠΏ ΡΡΠΎΠ΄Π΅ΡΠΈΠ²Π°ΡΠΈΠΈ ΠΈ ΠΎΠΏΡΡ Ρ
ΠΈΡΡΡΠ³Π°, Π²ΡΠΏΠΎΠ»Π½ΡΡΡΠ΅Π³ΠΎ Π Π¦Π, ΡΠ²Π»ΡΡΡΡΡ Π΄ΠΎΡΡΠΎΠ²Π΅ΡΠ½ΡΠΌΠΈ ΠΏΡΠ΅Π΄ΠΈΠΊΡΠΎΡΠ°ΠΌΠΈ ΠΏΠΎΡΠ»Π΅ΠΎΠΏΠ΅ΡΠ°ΡΠΈΠΎΠ½Π½ΠΎΠΉ ΠΌΠΎΡΠ±ΠΈΠ΄Π½ΠΎΡΡΠΈ ΠΈ Π½Π΅Π·Π°Π²ΠΈΡΠΈΠΌΡΠΌΠΈ ΡΠ°ΠΊΡΠΎΡΠ°ΠΌΠΈ ΠΏΡΠΎΠ³Π½ΠΎΠ·Π° ΠΎΠ±ΡΠ΅ΠΉ ΠΈ ΠΊΠ°Π½ΡΠ΅ΡΡΠΏΠ΅ΡΠΈΡΠΈΡΠ΅ΡΠΊΠΎΠΉ Π²ΡΠΆΠΈΠ²Π°Π΅ΠΌΠΎΡΡΠΈ ΡΠΎΠΎΡΠ²Π΅ΡΡΡΠ²Π΅Π½Π½ΠΎ. ΠΠΏΡΠΈΠΌΠ°Π»ΡΠ½ΡΠΉ Ρ
ΠΈΡΡΡΠ³ΠΈΡΠ΅ΡΠΊΠΈΠΉ ΠΎΠΏΡΡ Π΄ΠΎΡΡΠΈΠ³Π°Π΅ΡΡΡ ΠΏΠΎΡΠ»Π΅ Π²ΡΠΏΠΎΠ»Π½Π΅Π½ΠΈΡ 150 ΠΎΠΏΠ΅ΡΠ°ΡΠΈΠΉ.ΠΠ±ΡΡΠΆΠ΄Π΅Π½ΠΈΠ΅. Π¦Π΅Π»Π΅ΡΠΎΠΎΠ±ΡΠ°Π·Π½ΠΎ ΡΠ²Π΅Π»ΠΈΡΠ΅Π½ΠΈΠ΅ ΡΡΠΎΠΊΠΎΠ² ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°ΡΠ΅Π»ΡΡΠΊΠΈΡ
ΠΎΡΡΠ΅ΡΠΎΠ² ΠΏΡΠΈΠΌΠ΅Π½ΠΈΡΠ΅Π»ΡΠ½ΠΎ ΠΊ ΡΠ΅Π·ΡΠ»ΡΡΠ°ΡΠ°ΠΌ ΡΡΠΎΠ΄Π΅ΡΠΈΠ²Π°ΡΠΈΠΈ Π΄ΠΎ 12β 18 ΠΌΠ΅Ρ ΠΏΠΎΡΠ»Π΅ΠΎΠΏΠ΅ΡΠ°ΡΠΈΠΎΠ½Π½ΠΎΠ³ΠΎ Π½Π°Π±Π»ΡΠ΄Π΅Π½ΠΈΡ. Π ΠΏΡΠ°ΠΊΡΠΈΡΠ΅ΡΠΊΠΎΠΉ ΡΠ°Π±ΠΎΡΠ΅ ΡΠ»Π΅Π΄ΡΠ΅Ρ ΠΎΡΠΊΠ°Π·Π°ΡΡΡΡ ΠΎΡ ΡΡΡΠΈΠ½Π½ΠΎΠ³ΠΎ ΠΏΡΠΈΠΌΠ΅Π½Π΅Π½ΠΈΡ Π΄Π²ΡΡ
ΡΡΠ°ΠΏΠ½ΠΎΠ³ΠΎ Π²ΡΠΏΠΎΠ»Π½Π΅Π½ΠΈΡ Π Π¦Π ΠΈ ΠΎΠΊΠΎΠ½ΡΠ°ΡΠ΅Π»ΡΠ½ΠΎΠΉ ΡΡΠΎΠ΄Π΅ΡΠΈΠ²Π°ΡΠΈΠΈ, ΠΎΡ Π²Π°ΡΠΈΠ°Π½ΡΠΎΠ² Π²Π½ΡΡΡΠ΅Π½Π½Π΅ΠΉ ΠΈ / ΠΈΠ»ΠΈ Π½Π°ΡΡΠΆΠ½ΠΎΠΉ ΡΡΠΎΠ΄Π΅ΡΠΈΠ²Π°ΡΠΈΠΈ, Π° ΠΈΡ
ΠΈΡΠΏΠΎΠ»ΡΠ·ΠΎΠ²Π°Π½ΠΈΡ ΠΏΡΠ΅Π΄ΠΏΠΎΡΠ΅ΡΡΡ, ΠΊΠΎΠ³Π΄Π° ΡΡΠΎ Π²ΠΎΠ·ΠΌΠΎΠΆΠ½ΠΎ, ΠΎΠ΄Π½ΠΎΠΌΠΎΠΌΠ΅Π½ΡΠ½ΡΠ΅ ΠΎΡΡΠΎ- ΠΈ / ΠΈΠ»ΠΈ Π³Π΅ΡΠ΅ΡΠΎΡΠΈΠΏΠΈΡΠ΅ΡΠΊΠΈΠ΅ ΡΡΠΎΠ΄Π΅ΡΠΈΠ²Π°ΡΠΈΠΈ.ΠΠ°ΠΊΠ»ΡΡΠ΅Π½ΠΈΠ΅. ΠΡΠ΅Π΄ΠΈΠΊΡΠΎΡΠ°ΠΌΠΈ Π²ΡΡΠΎΠΊΠΎΠΉ ΠΌΠΎΡΠ±ΠΈΠ΄Π½ΠΎΡΡΠΈ ΠΈ ΡΠ°ΠΊΡΠΎΡΠ°ΠΌΠΈ Π½Π΅Π±Π»Π°Π³ΠΎΠΏΡΠΈΡΡΠ½ΠΎΠ³ΠΎ ΠΏΡΠΎΠ³Π½ΠΎΠ·Π° Π²ΡΠΆΠΈΠ²Π°Π΅ΠΌΠΎΡΡΠΈ ΠΏΠΎΡΠ»Π΅ Π Π¦Π ΠΈ ΡΡΠΎΠ΄Π΅ΡΠΈΠ²Π°ΡΠΈΠΈ ΡΠ²Π»ΡΡΡΡΡ Π²Π½Π΅ΠΊΠΈΡΠ΅ΡΠ½ΡΠ΅ ΡΠΎΡΠΌΡ ΡΡΠΎΠ΄Π΅ΡΠΈΠ²Π°ΡΠΈΠΈ (ΡΡΠ΅ΡΠΊΠΎΠΆΠ½Π°Ρ ΠΏΡΠ½ΠΊΡΠΈΠΎΠ½Π½Π°Ρ Π½Π΅ΡΡΠΎΡΡΠΎΠΌΠΈΡ, ΡΡΠ΅ΡΠ΅ΡΠΎΠΊΡΡΠ°Π½Π΅ΠΎΡΡΠΎΠΌΡ), Π²Π½ΡΡΡΠ΅Π½Π½ΡΡ ΡΡΠΎΠ΄Π΅ΡΠΈΠ²Π°ΡΠΈΡ (ΡΡΠ΅ΡΠ΅ΡΠΎΡΠΈΠ³ΠΌΠΎΠ°Π½Π°ΡΡΠΎΠΌΠΎΠ·, ΡΡΠ΅ΡΠ΅ΡΠΎΡΠΈΠ³ΠΌΠΎΡΠ΅ΠΊΡΠΎΠ°Π½Π°ΡΡΠΎΠΌΠΎΠ·, Mainz pouch II), Π΄Π²ΡΡ
ΡΡΠ°ΠΏΠ½ΠΎΠ΅ Ρ
ΠΈΡΡΡΠ³ΠΈΡΠ΅ΡΠΊΠΎΠ΅ Π»Π΅ΡΠ΅Π½ΠΈΠ΅ ΠΈ Π½Π΅Π΄ΠΎΡΡΠ°ΡΠΎΡΠ½ΡΠΉ ΠΎΠΏΡΡ Ρ
ΠΈΡΡΡΠ³Π°.
MICROBIOTA URINE AND ANTIBIOTIC PROPHYLAXIS FOR LITHOTRIPSY SIMPLE JUNCTION STONES
Extracorporeal shock wave lithotripsy (ESWL) may be associated with infectious and inflammatory complications. The dynamics of the microbial spectrum of urine and the need for antibiotic prophylaxis are still poorly understood. The study included 40 patients with simple pelvicΒ stones, which one session was held ESWL. Bacteriological examination were taken midstream urine to ESWL, when the first urination after ESWL, 1, 3, 7 days. Patients were divided into 2 groups. Group I consisted of patients (60%) with antibiotic prophylaxis. Patients of group II (40%) of antibiotic prophylaxis was not performed. The pattern of isolated microorganisms were as follows: NAB - 92.5%, Gram-positive microorganisms - 70.0%, urease-producing microorganisms - 60,0%, E.coli - 12,5%. Dynamic study of the microbial spectrum of urine Group found that the prophylactic use of antibiotics after ESWL simple junction stones accompanied by increased frequency of occurrence and levels of contamination of urine urease-producing bacteria, Candida, Gram-positive microorganisms and increases the risk of infectious and inflammatory complications in connection with the question of the need for antibiotic prophylaxis to be decided individually
Predictors for morbidity of radical cystectomy and different types of urine derivation: 20-year experience of a surgery center
Background. Most of serious complications of radical cystectomy (RCE) should be associated with the comorbidity of patients and the interintestinal anastomoses designed with urinary reservoirs rather than with RCE. It is relevant to identify and assess the role of predictors for morbidity of RCE and urine derivation. Objective: to search for risk factors for complications after RCE with different types of urine derivation. Subjects and methods. The immediate and late results of RCE and urine derivation were studied in 350 patients with bladder cancer. Sequential postoperative complications were additionally analyzed in chronological order in all the patients, including non-cancer ones (n = 43). Results. 43.9% of the patients had postoperative complications, if a surgeon had sufficient surgical experience; there was a preponderance of patients with mild-to-moderate complications (Clavien-Dindo grade I-II, 37.8%) unassociated with urine derivation. The patients with severe postoperative complications were 16.3%; mortality was 3.1%, which significantly correlated with surgical experience. Late (3-18 month) postoperative complications were detected in 21.4% of the patients with a preponderance of those with urine derivation-related complications (19.4). The frequency of complications due to extraintestinal versus intestinal urine derivations was significantly higher (68.1 and 49.8% (p \u3c 0.05). During two-step surgical treatment, the patients demonstrated higher morbidity and worse survival. Extraintestinal urine derivations, continuous urinary intestinal diversion determine a less favorable prognosis compared with one-stage ortho- and heterotopic procedures. The type of urine derivation and the experience of a surgeon performing RCE are valid predictors for postoperative morbidity and independent prognostic factors of overall and cancer-specific survival, respectively. 150 operations are needed for achieving optimal surgical experience. Discussion. It is appropriate to increase the time of research reports on the results of urine derivation up to 12-18 months of a postoperative follow-up. In practice, the routine use of two-step RCE and final urine derivation and internal and/or external urine ones should be abandoned; preference should be, when possible, given to single-stage ortho-and/or heterotopic urine derivations rather than to the former. Conclusion. Extraintestinal (percutaneous puncture nephrostomy, ureterocutaneostomy), and internal (ureterosigmoanastomosis, ureterosigmorectoanastomosis, Mainz pouch II) urine derivations, two-step surgical treatment, and a surgeon\u27s insufficient experience are predictors for high morbidity and poor prognostic factors for survival after RCE and urine derivation