Search

Background. Minimally invasive partial nephrectomy is the gold standard in the treatment of stage I malignant tumors. To date, there are a large number of techniques for performing partial nephrectomy. The desire to develop a technique that included all the positive characteristics and had no restrictions on use led to the creation of a normotonic zero ischaemia partial nephrectomy. Materials and methods . A retrospective analysis of 45 patients was performed. 1st group included 24 (53.3 %) patients after laparoscopic normotonic zero ischaemia partial nephrectomy. 2ndgroup included 21 (46.7 %) patients who underwent laparoscopic hypotonic zero ischaemia partial nephrectomy. All patients evaluated such surgical parameters as the surgery time, the blood loss, and the duration of hospitalization. To assess pre-operative renal function, the CKD-EPI equation was used to calculate estimate glomerular filtration rate. Results. All patients were demographically comparable. Patients were also evenly distributed in terms of resection complexity according to the RENAL nephrometric scale. Acute kidney injury rate was significantly higher in the hypotension group: relative risk 5.4 (95 % confidence interval 1.59—20.55), odds ratio 11.3 (95 % confidence interval2.04—59.2);p = 0.007. In 1stgroup, the average operation time was 130min (Q1-Q3 110—140), and in 2ndgroup, 150min (Q1—Q3 115—227.5);p = 0.0159. The average volume of blood loss during laparoscopic zero ischaemia partial nephrectomy was significantly less than during hypotonic partial nephrectomy: 125 ml (Q1—Q3 50—200) and 450 ml (Q1— Q3200— 750) respectively, p

Objective. To evaluate the effect of preserving proximal and distal segments of the prostatic urethra on functional and oncological outcomes retropubic prostatectomy.Patients and methods. 97 men who underwent radical prostatectomy were divided into two groups. The first group (n = 49) included patients with complete retention of the bladder neck and prostatic urethra segments followed urethro- urethral anastomosis. The control group (n = 48) included patients who have not been saved the bladder neck. Continence control produced by the method of monitoring the daily amount of urine in the pad.Social aspects and quality of life was assessed using conventional questionnaire. Radical surgery was evaluated by «negative surgical margin».Results. Within 1, 3, 6 and 12 months after surgery the average loss of urine control patients with respect to patients of the study group was 741.3 g vs. 218.3 g, 56.9 g and 16.5 g, 48.7 g, against 8.5 g and 35.6 g from 3.3 g, respectively (for each comparison, p < 0.05). The indicator of the quality of life of the patients of the first group on all end points was significantly higher than those of the second group. There were no significant differences betweenthe frequency of «positive margins» in patients in the control group and the group with a fully preserved bladder neck (5.8 % vs. 5.4 %, p = 0.65).Conclusions. Preservation of the bladder neck and proximal and distal segments of the prostatic urethra during radical prostatectomy significantly improved urinary function, and can achieve full satisfaction of quality of life in these patients compared with patients in the control group, subject to the necessary oncologic outcomes.

Results of treatment of 143 patients who underwent cystprostatectomy or anterior pelvic exenteration. A comparative analysis of two groups of patients whose operation ended with the traditional drainage through the anterior abdominal wall (n = 71), and bilateral perineal drainage (n = 72). Bilateral perineal drainage after operations on the pelvic organs, accompanied by cystectomy and extended lymphadenectomy in conjunction with the restoration of the peritoneum lateral pelvic walls, improves postoperative recovery of intestinal peristalsis, promotes an earlier reduction in the intensity of pain and morbidity in the early postoperative period. Installation is simple perineal drainage performed and safe procedure. We recommend bilateral perineal drainage after operations on the pelvic organs, accompanied by cystectomy and extended lymphadenectomy.

Analyzed the surgical treatment of 154 patients with locally advanced pelvic tumors that required resection of the bladder or its complete removal. 67 (43.5 %) patients had colorectal cancer. In 53 (34.4 %) cases of cervical cancer in 21 (13.7 %) – ovarian cancer, 8 (5.2 %) – uterine cancer, in 5 (3.2 %) – a cancer of the vagina. In 41 (26.6 %) patients operation was accompanied by resection of the bladder, 113 (73.4 %) cases, the volume of surgery was pelvic exenteration.Proposed surgical classification of locally advanced pelvic tumors and secondary destruction of the bladder with locally advanced tumors. Describes the criteria of choosing the optimal amount of intervention at different propagation of the tumor and the degree of involvement of the bladder. The perspective of large interventions to improve the results of treatment of patients with tumors of the pelvic localization.

Background. How to derive urine is stemmed from removal of the bladder and from the necessity of its disengaging from the process of urination. Most surgeons prefer to do incontinent urine derivation in elderly and senile patients.Subjects and methods. In 2007 to 2009, the Leningrad Regional Oncology Dispensary treated 103 patients with diseases requiring the bladder be removed. All these patients underwent cystectomy as an independent operation or one of the surgical stages, followed by incontinent urine derivation described by Bricker. The patients were divided into 2 groups: 1) Bricker-type end-to-side ureteroileal anastomosis; 2) Wallace-type one. Group 1 comprised 50 patients: 37 (74 %) women and 13 (26 %) men; Group 2 included 53 patients: 48 (90.6 %) women and 5 (9.6 %) men. These were elderly and senile patients aged 60 to 79 years (mean age 65 ± 3.71).Results. In Group 1, 36 (72 %) patients were preoperatively diagnosed as having hydroureteronephrosis (HUN). Of them, 23 (64%) patients underwent preoperative percutaneous puncture nephrostomy (PPN). In Group 2, HUN was diagnosed in 43 (81 %) patients; of them 27 (63 %) had PPN. Complications and resurgeries were more common in Group 1 (p < 0.001). In Group 2, there were a larger number of cases of incompetence of the ureteroileal anastomosis. This complication required no surgical correction, but a longer drainage standing.Conclusion. The Bricker operation is the safest urine derivation in elderly and senile patients after surgery involving cystectomy. Wallacetype ureteroileal anastomosis during the Bricker operation is accompanied by a considerable reduction in the number of early and late postoperative complications and resurgeries. Wallace-type ureteroileal anastomosis is considered the method of choice in cancer patients.