Laparoscopic retropubic extraurethral adenomectomy

Introduction. Existing methods of surgical treatment of benign prostatic hyperplasia are accompanied by the frequent development of postoperative complications, such as urinary incontinence, retrograde ejaculation, and urethral strictures. The method of preserving the prostatic urethra has been developed for a long time. At present, it is possible to use the operation technique and perform laparoscopic urethral-sparing adenomectomy.Objective. To assess the possibility of performing extraurethral adenomectomy with prostatic urethral preservation using the laparoscopic approach, its advantages and disadvantages.Materials and methods. Based on St. Luke’s Simferopol сlinical Multidisciplinary Medical Center, 35 successful laparoscopic operations were performed to remove benign prostate hyperplasia with the prostatic urethra preservation. The features of the operation are laparoscopic access, a transverse section of the capsule, alternate isolation of adenomatous nodes while preserving the prostatic urethra on the catheter without replacing it during the operation, suturing the capsule with a decrease in space from the removed adenomatous nodes. Urethral preservation provided accelerated epithelialization of the defect, in the absence of the formation of a “prevesical” space.Results. After the operation, it is possible to turn off the urinary bladder irrigation system earlier (up to 4 – 6 hours after the operation) and early removal of the catheter after surgery (2 – 3 days). The hospital stay averaged 5.7 days. Urination was restored immediately after catheter removal in 92% of the patients. There were no elements of dysuria, particularly urinary incontinence. Prostate volume measured throughout transrectal ultrasound after operation was 20 – 24 cm³.Conclusion. The technique of retropubic extraurethral adenomectomy with prostatic urethral preservation can be performed in laparoscopic technique. The advantages are early activation of the patient and discharge from the hospital, early removal of the catheter with restoration of independent urination, absence of dysuria, urinary incontinence, and postoperative complications. The results of our study demonstrate the effectiveness of the laparoscopic extraurethral adenomectomy technique, the further development of this technique, and the possibility of its application in practice

Aspects of the surgical treatment of secondary hyperparathyroidism in patients with chronic renal failure are on dialysis replacement therapy program

The article is devoted to study of efficacy of surgical methods of treatment of secondary hyperparathyroidism which is refractory to therapy using active metabolites of D vitamin in patients with stage V chronic renal disease receiving treatment with program hemodialysis. In some cases the surgical treatment of the advanced stage of secondary hyperparathyroidism, PTH reduction was not observed, but patients reported clearly the disappearance or reduction of the pain in the bones and joints and also the normalization of calcium phosphorus metabolism. We are adhere to surgical treatment method consisting in removing of enlarged parathyroid glands with further conservative therapy that helps to avoid postoperative hypoparathyroidism, normalize the levels of parathyroid hormone and improves the quality of life of patients

"FAST-TRACK" IN SIMULTANEOUS OPERATIONS AGAINST THE BACKGROUND OF WIDESPREAD PERITONITIS

Aim. This research was conducted to study the possibility and effectiveness of the "Fast-track" fast recovery program application when performing simultaneous operations against the background of widespread peritonitis.Materials and methods. In the course of the study were examined 66 patients, the ratio of woman/man was 45:21. The main group – 32 (48,5%) patients with the major disease of constricted postoperative hernia complicated by the widespread peritonitis and chronic calculous cholecystitis (a prospective analysis of surgical treatment). The comparison group – 34 (51,5%) patients with the identical pathology – the retrospective analysis of surgical treatment. The treatment of patients of the main group was supplemented with the application of the elements of the «Fast-track» program. Whereas, the treatment of patients of the comparison group was performed exclusively according to the standard scheme of the patient management with widespread peritonitis.Results. Clinical, laboratory and instrumental data indicate the positive effect of the "Fast-track" program on the process of rehabilitation of patients in the postoperative period. There was a significant acceleration in the recovery of motorevacuation function of the intestine in patients of the main group in relation to the comparison group and a smaller number of complications in the main group in relation to the comparison group against the background of the application of this technique. As a result, the average duration of hospitalization of patients from the comparison group was 10- 5 days (average 12±2,4 days). While the average duration of hospitalization of patients from the comparison group was 17-20 days (on average 18±1,2 days).Conclusion. The use of the "Fast-track" program in simultaneous operations does not increase the effectiveness of surgical treatment, thereby accelerating the process of rehabilitation of patients in the postoperative period

PATHOPHYSIOLOGICAL REASONING OF THE EFFICIENCY OF ANTI-ANGIOGENIC THERAPY IN THE RETINAL VEIN OCCLUSION BY THE COHERENT EYE TOMOGRAPHY

Aim. The main aim of our research is to study the effectiveness of anti-VEGF therapy in the treatment of retinal vein occlusions.Materials and methods. The study included 124 patients aged between 23 to 66, an average of 54.3±8.9 years old who were on an outpatient and inpatient treatment in the ophthalmologic department of the V.K. Gusak Institute of Emergency and Reconstructive Surgery from 2011 to 2016. We have formed two groups. The comparison group included 66 patients who received standard therapy in the form of local anticoagulant and anti-edematous therapy, disaggregants. To improve microcirculation and with a decongestant purpose, rheopolyglucin was administered intravenously, and intramuscular injections of actovegin were prescribed with an antihypoxic purpose. With edema of the macula and the development of newly formed vessels – laser coagulation, intravitreal or subtenon introduction of trimacionolone. The main group included 58 patients who, in addition to standard therapy, were given the drug Eilia (aflibercept) intravitreally 2 mg in 0.05 ml. Treatment with aflibercept for intravitreal injections started with one injection once a month for the next five months, with a further transition to one injection every two months, with no monitoring required between the injections.Results. When post-thrombotic neovascular glaucoma occurred, the concentration of TGFα in the lacrimal fluid increased by 1.7, and TGFβ by 28-fold. When the branch of the central vein of the retina is occluded according to the ischemic type, the systolic and diastolic blood flow velocity in the retina decreases. With coherent optical tomography with the function of angiography, admission in both groups showed significant macular edema, non-perfusion zones of the retina, a decrease in the density of the capillary network in the inner layers of the retina in angio-OCT, and 3 patients with angio-OCT visualized newly formed vessels in the nonperfusion zone.Conclusion. In the group with the use of anti-angiogenic drugs, earlier restoration of the visual fields and reduction of neoangiogenesis were noted