Possible differential diagnosis of various chronic nonbacterial prostatites

Department of Urology and Surgical Nephrology, Nicolae Testemitanu State University of Medicine and Pharmacy, Chisinau, the Republic of MoldovaAbstract. Background: The purpose of the study was to diagnose possible chronic nonbacterial prostatitis (CNP) and chronic pelvic pain syndrome (CPPS) among patients, as well as differentiate between the inflammatory (category IIIA) or non-inflammatory (category IIIB) types in selecting and optimizing differential drug treatment of this category of patients. Material and methods: The study was conducted on 43 patients diagnosed with CNP/CPPS. The control group included 10 healthy men. Both the production of nitric oxides (NO) by phagocytes, as well as prostate secretion and ejaculate were determined according to the procedure described by Metelyskaya B.A., which was modified by Gudumac V, et al. Results: There was a 39.0% (p <0. 05) decrease in NO production by induced NO-synthase (iNOS), determined in the blood of 11 patients (from the main group – 2) with CNP/CPPS and a 115% (p <0.05) increase was determined in 32 patients (from the main group 1) if compared to the same indices in the control group. The prostatic secretion and ejaculate showed a higher macrophage iNOS activity by 80% (p <0.05) and 75% (p <0.05) if compared to the same parameters from the control group. The iNOS activity in prostatic fluid and split-ejaculate fractions from the main group – 2 did not differ from that of the control group. Conclusions: The assessment of NO production, prostate secretion and ejaculate allows to somewhat establish the main diagnosis of CNP and category III types (A – inflammatory and B – non-inflammatory prostatitis), which will significantly contribute to the optimization and selection of an appropriate differential treatment based on the drug action mechanisms

Transurethral thulium laser vapoenucleation of prostate – a good alternative for open surgery

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. Treatment of huge benign prostatic hyperplasia (BPH) consists an actual problem for urological community. Nowadays, open surgery is one of the basic surgical methods in treatment of large BPH, but it is less used due to the modern laser techniques. Spreading of laser surgery offers some new opprotunities for its treatment. Safety of Thulium:YAG laser in transurethral vapoenucleation of the prostate in combination with its efficiency assure a good alternative for clasic open surgery in BPH treatment.Aim of the study. Comparative assessment of the efficacy of transurethral Thulium:YAG laser vapoenucleation of prostate (ThuVEP). Materials and methods. 37 patients with average age of 67 years underwent surgical treatment of large BPH at the Department of urology and surgical nephrology, State University of Medicine and Pharmacy “Nicolae Testemițanu”. Patients were divided into two treatment groups: ThuVEP (17 patients) and open simple prostatectomy (Fuller-Freyer procedure) (20 patients) and evaluated postoperatively at 3 months. Hemoglobin drop was also evaluated at the first postoperative day. Preoperative patients were investigated: PSA, IPSS, QoL, TRUS-P with PVR and Qmax. Patients inclusion criteria: Prostate Volume ≥80cm3 , IPSS ≥16 and PVR ≥ 50ml, PSA≤4ng / ml, QoL> 4, Qmax <8ml / s. Results. Average duration of intervention: 79 min vs 63 min. The prostate volume decreased postoperative on average from 82,2 cm3 to 31,3 cm3 vs 83,4 cm3 to 31,9 cm3 , there was an increase of average Qmax from 8,2 to 20.3 ml / s vs 8,4 to 21,1 ml / s, and a decrease in mean IPSS from 19,3 to 5.3 vs 20,1 to 5,4, and PVR diminished from 67.2 ml to 15,4 ml versus 68,1 to 17,4 ml, respectively. The period of transitional macrohematuria was 2,1 days vs 5,3 days respectively. The duration of cateterization was 2,3 days in the first group and 8,3 days in the second group. Mean hemoglobin drop was 2,1g/l in Group 1 vs 3,4g/l in Group 2. Conclusions. ThuVEP is an effective alternative method in the treatment of large BPH. Immediate postoperative results of ThuVEP are similar to the results in open simple prostatectomy (Fuller-Freyer procedure). It is to mention a high safety profile characteristic for ThuVEP and a reduced hemoglobin drop comparatively to clasic open surgery

Early outcomes of transurethral thulium laser vapoenucleation of prostate

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. Surgical treatment of large benign prostatic hyperplasia (BPH) remain an important problem in endourology. Open surgical procedures are still used to treat pacients with BPH. Surgical trauma and numerous contraindications make it useless in many pacients with comorbydities. A small number of endourologic procedures offer the posibility to treat large BPH. Thus, laser surgery seems to be a salvage treatment for pacients with contrindications for classical open surgery. Aim of the study. The efficiency assesment of transurethral Thulium YAG laser vapoenucleation of prostate (ThuVEP). Materials and methods.. 16 patients with average age of 71 years underwent surgical treatment of large BPH. All of them underwent ThuVEP. A 550 micron end fire laser fiber was used during vapoenucleation. 80W power setings were used in all of the pacients. The period of surveillance was of 6 months. Preoperative investigations: PSA, IPSS, QoL, TRUS-P withPVR and Qmax. Patients inclusion criteria: Prostate Volume ≥80cm3, IPSS ≥16 and PVR ≥ 50ml, PSA≤4ng / ml, QoL> 4. Results. Average duration of intervention: 76 min. The prostate volume decreased postoperative on average from 83,2 cm3 to 35,4 cm3, there was an increase of average Qmax from 8,2 to 19.3 ml/s, a decrease in mean IPSS from 21,3 to 7,1, and PVR diminished from 69,1 ml to 16,1 ml. The period of transitional macrohematuria was 2,1 days. The duration of cateterization was 2,5 and mean hemoglobin drop was 2,1 g/l. Conclusions. ThuVEP is an effective method for endourologic treatment of large BPH. Immediate postoperative results of ThuVEP are promising. It is to mention a high haemorrage safe features of ThuVEP

Laser Но-YAG versus transurethral incision of prostate (ITUP) in treatment of prostate sclerosis areas after chronic prostatitis

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. Nowadays, patients suffering from the sclerosis of prostate became a global health problem. The main trigger factor is the presence of chronic prostatitis. This is a consequence of the inflammatory process in prostate, with structure damage tissue. Finally the damaged areas are substituted with fibrous tissue, causing developing of sclerosis in prostate. The surgical treatment of prostate sclerosis should have maximal excision of prostate tissue and minimally temperature impact on surrounding tissue. Aim of the study. Evaluation of the efficiency Но-YAG laser versus ITUP incision in treatment of prostate sclerosis after chronic prostatitis. Materials and methods.. The 46 of patients were selected with the defined diagnosis with sclerosis of prostate after chronic prostatitis during the period from 2018 till 2019. The study was conducted in the Department of urology and surgical nephrology of the State University of Medicine and Pharmacy "Nicolae Testemitanu", within the Republican Clinical Hospital "Timofei Mosneaga". The patients were divided into 2 groups depending on the method of treatment: a control group consisted of 23 patients who underwent ITUP incision and a main group 23 patients were conducted using incision with Но-YAG laser . Results. Surgical treatment was successfully performed for all cases. There were no major intra- or after surgery complications. During all procedures, blood loss was insignificant and no patient required blood transfusions. Also, there were no cases of urinary tract infection, sepsis, bleeding or urinary retention. All patients were able to void spontaneously and was no detected urinary retention or incontinence after catheter removal. Four patients were presenting moderate irritative symptoms (dysuria, hesitance and frequency) and were treated conservatively, with no further complications. In all prostate cancer cases, the pathological specimens were negative for malignancy. The mean operating time was 20 minutes (range 15 to 35 minutes), the duration of catheterization period was 48 hours (range 24 to 72 hours) and the mean hospital stay was 72 hours. Preoperative and at 1, 3 and 6 months after surgery, the mean values for Qmax, were 6.2 ml/s, 15.9 ml/s, 15.8 ml/s and 15.4 ml/s, respectively. Conclusions. The results clearly demonstrate the advantages of using laser energy for treatment of prostate sclerosis compared to ITUP, with significant increase in scores on the IPSS and QoL, maximum urinary flow rate, and a decrease in residual urine volume and frequency of relapses in the group carried out the laser dissection of prostate sclerosis

Diagnostic markers of urinary bladder tumors

Department of Urology and Surgical Nephrology, Nicolae Testemitanu State University of Medicine and Pharmacy, Chisinau, the Republic of MoldovaAbstract. Background: The perfect method for laboratory diagnosis of bladder cancer should have high sensitivity and specificity, should be easily reproducible, inexpensive, be suitable for primary diagnosis, screening, and follow-up of patients, for timely detection of recurrence. In clinical practice, for bladder cancer diagnostics have been used the following markers: UBC, BTA, “ImmunoCyt”, NMP22, “UroVision», and others. Each method has relative advantages and disadvantages. The study has demonstrated an influence on the test result of the histological structure and grade of the tumor, presence of hematuria, urolithiasis, chronic inflammatory malignancies, recent surgical procedures on the urinary tract. Apparently, the use of a palette of markers in connection with imaging techniques will increase the diagnostic capabilities, but it is still not clear which elements should be present in such a palette. Conclusions: At present, basic diagnostic methods for bladder cancer remain: USG, MRI, CT, and endoscopic methods. The laboratory methods that exist are not informative enough. Each marker has serious restrictions, but possibly the complex application will allow increasing the diagnostic value in the future, therefore it is necessary to develop new markers of bladder cancer or to study the results of the complex application of several known markers to increase the value of the laboratory diagnosis of primary bladder cancer and recurrent

Technique de la résection transurétrale „en-bloc“ du cancer de la vessie sans envahissement du muscle

Republican Clinical Hospital „Timofei Mosneaga“, Department of Urology and Surgical Nephrology, State University of Medicine and Pharmacy „Nicolae Testemitanu“, Chisinau, Republic of MoldovaABSTRACT. Introduction. Transurethral resection of the bladder tumours (TURBT) is the standard approach to bladder tumour removal; however, it has several disadvantages. The objective of the study was to evaluate the safety and efficacy of „en bloc“ resection of non-muscle invasive bladder tumours (ERBT) by using the conventional monopolar „Hook“ resection electrode. Material and methods. ERBT and TURBT procedures were conducted in 67 and in 85 patients respectively, diagnosed with superficial bladder tumours. In the ERBT group, the tumours were removed retrograde en bloc, under direct vision, via a conventional monopolar „Hook“ electrode. Clinical pathological, intra-operative and post-operative patients’ data were compared retrospectively between both groups (ERBT and TURBT). Results. Of the 152 patients, 67 underwent ERBT and 85 were treated with TURBT. Both groups were comparable in clinical characteristics. ERBT has been performed as safely and effectively as TURBT. There were no significant differences in the operative time and intraoperative or postoperative surgical complications. The comparative recurrence rates were similar for both groups during up to 24-month follow-up. The detrusor muscle fibers were histologically identified in 100% of ERBT tumour samples and marginal tumour bases, and only in 80% of post-TURBT samples. Conclusions. ERBT is a feasible and safe technique for removing superficial bladder tumours using a monopolar „Hook“ resection, with the same advantages of a proper tumour resection, as well as possibility to collect good quality tumour samples and bladder tumour base specimen for pathological diagnosis and staging compared to standard TURBT