Introduction Urethral stricture is a partial or complete narrowing of the urethra, caused by damage to the urethral epithelium. This disease leads to a persistent urination dysfunction, the elimination of which is a difficult task. The aim of this study was to perform a comparative analysis of the immediate and long-term narrowing treatment results of the proximal part of the bulbar and membranous urethral parts using the developed magnifying and anastomotic methods. Material and methods A total of 102 patients with a confirmed diagnosis of stricture of the bulbomembranous urethral part of the urethra who underwent treatment in the urological hospital in Irkutsk City Clinical Hospital No. 1 during the period 2012–2018 participated in this prospective study. Urethroplasty operations were performed in two ways, using the anastomotic and intra-urethral substitution techniques. Through the assessment of preoperative parameters, statistical homogeneity of comparison groups was established. Results The final data analysis showed relapse for 4 patients from Group I and for 2 patients in Group II. The absence of relapse during the entire observation period was equal in both groups and after 2 years amounted to 83.0 ±7.9% in Group I and 92.5 ±5.1% in Group II. Conclusions In both groups, the desired result was achieved – adequate independent urination was restored. The anastomotic method of urethroplasty should be used with caution in patients at risk groups, as well as with the presence of predictors of complications: previous transurethral surgeries on the urethra and prostate, anastomotic urethroplasty, radical prostatectomy. The developed minimally invasive substitution technique has a similar effectiveness with a lower risk of complications.
Introduction: There are several options for vessel-sparing anastomotic procedures that allow one to avoid disturbances in the normal blood supply to the spongy body and successfully perform plastic surgery of distal urethral strictures. Aim: To perform a comparative analysis of the effectiveness of reconstructive surgical treatment of strictures of the bulbo-membranous urethra with anastomotic surgery with and without vessel-sparing. Material and methods: A prospective study was carried out on 28 patients with a diagnosis of stricture of the bulbo-membranous urethra who underwent treatment in the period 2012-2018 in the conditions of a urological hospital of Irkutsk City Clinical Hospital No. 1. Anastomotic urethroplasty was performed using one of two methods: with full mobilization of the spongy body bulb and a vessel-sparing method when the spongy body does not intersect. Results: The effectiveness of the classical method of anastomosing EPA-TWW ((excision and primary anastomosis urethroplasty (Turner-Warwick) and excision and Jordan's technique of vessel sparing excision and primary anastomosis)) was comparable with the method of anastomosing without crossing the (spongy body of EPA-J). Postoperative changes in the parameters of the functional status of patients based on the International Prostate Symptom Score (IPSS), International Index of Erectile Function, and Quality of Life were comparable in patients undergoing EPA-TWW and EPA-J. The final data indicate a statistically equivalent risk of developing complications such as urinary incontinence, shortening of the penis, and decreased erectile function. Conclusions: The study did not demonstrate a statistically significant difference in the effectiveness of the treatment and the risks of complications during anastomotic surgery with or without vessel-sparing. However, an unformalized assessment demonstrates the best state of erectile function in patients after vascular-preserving surgery.
Nowadays multiple heterogeneous chemicals affect the human body. They include drugs, household chemicals, dyes, food supplements and others. The human organism can modify, inactivate, and eliminate the chemicals by biotransformation enzymes. But it is well known that biotransformation can lead to toxification phenomenon. Individuals differ from each other by the rate of chemical modification that promotes accumulation of toxins and carcinogens in some patients. An N-acetyltransferase 2 enzyme participates in the aromatic amines second phase metabolism. This work reviews the acetyltransferase gene polymorphism possible role in diseases development including drug-induced organs damage.Gene of acetyltransferase has polymorphisms associated with two haplotypes of fast and slow substrate acetylation. Gene alleles combine in three genotypes: fast, intermediate, and slow acetylators. Acetylation rate plays a significant role in side effects development during tuberculosis treatment and cancer pathogenesis. Recently, new data described the role of enzyme in development of non-infectious diseases in the human. Scientists consider that slow acetylation genotype in combination with high xenobiotic load result in accumulation of toxic substances able to damage cells.Therefore, acetyltransferase genotyping helps to reveal risk groups of cancer and non-infectious disease development and to prescribe more effective and safe doses of drugs.
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