In order to study the possibilities of non-drainage management of the postoperative period in patients with uncomplicated ureteral stones, we analyzed the results of treatment of 198 patients with uncomplicated ureterolithiasis, in whom it was decided to refuse stenting of the upper urinary tract. In the uncomplicated course of ureterolithiasis, in most cases (68.2% of patients) in the postoperative period, there is no need for drainage of the upper urinary tract with stent. At the same time, in 31.8% of patients when a stent was not installed in the postoperative period, complications occurred that significantly affected the duration and cost of treatment. In the future a more rigorous consideration of risk criteria is needed to make a decision on non-drainage management of the postoperative period in patients with uncomplicated ureteral stones.
Urinary stone disease (USD) is a common pathology with the formation of calculi in the kidneys, ureter, and bladder. Besides the family history, hyperparathyroidism, hypo- and hypervitaminosis of vitamin D, hypercalciuria, and hyperoxaluria are the high risk factors for USD development. This is due primarily to the activation of bone resorption with increased hypercalciuria. It is known that in the urine of every person there is a small amount of urea, inorganic salts, uric acid, creatinine and other substances. The main reason for the formation of calculi is a certain metabolic disorder, which leads to the formation of insoluble salts from which stones are formed – urates, phosphates, oxalates, etc. One of the unsolved problems in the metaphylaxis of USD is the treatment and prevention of osteoporosis which is comorbid with it, since calcium and vitamin D preparations are widely used for the prevention and treatment of osteoporosis. Osteoporosis and arterial calcification often coincide in the nature of the manifestation, which indicates an imbalance in the redistribution of calcium with a predominant direction in the vascular the wall. Vitamin K2 deficiency is closely related to the process of vascular calcification. In the cardiovascular system, with the use of vitamin K antagonists or vitamin K deficiency, calcification of the endothelium of blood vessels occurs. The effect of osteocalcin protein on stone formation processes is controversial. For example, some researchers have found that high serum level of Glaprotein is associated with a lower risk of kidney stones. Based on the results of a daily urinalysis study, the EAU Guidelines (2022) updated the recommendations on metaphylactic USD regarding the benefit/harm of additional calcium and vitamin D use in patients with nephrolithiasis depending on the type of crystalluria. The absence of recommendations for the management of patients with combined pathologies (USD, osteoporosis, cardiovascular diseases) prompts a comprehensive assessment of common risk factors, as well as the formation of programs and algorithms for early diagnosis and the development of recommendations for the prevention and avoidance of complications. Based on the literature analysis, it was established that today the issue of choosing the optimal management for diagnosis and treatment of USD and osteoporosis is still very controversial and ambiguous. There is a necessity for detailed study of this problem, the development of a complex differentiated approach to diagnosis and treatment of patients.
Treatment of prostate diseases remains one of the priorities in modern medicine. The patients with chronic inflammation and benign prostate hyperplasia (BPH) have a larger volume of the gland, more pronounced clinical manifestations of the disease and a higher probability of acute urinary retention development. The choice of the medication treatment of BPH and chronic prostatitis (CP) is under the influence of many factors, namely: the nature of clinical manifestations of the disease, the volume of adenomatous tissue, the severity and features of urinary disorders and disorders of the functional state of the bladder. Plant medications are very popular in many countries of the world, primarily due to the minimal severity of side effects. The objective: to analyze the efficacy and tolerability of dietary supplements in the treatment of patients with BPH and CP. Materials and methods. 90 patients with BPH stage I-II were involved in the study, the average age and the duration of the disease were practically similar. Patients were divided into two groups depending on the treatment. The main group included 56 men who received a medication produced by company “BEHEALTH” for condition improvement of CP and BPH. This drug includes all the components listed in the “Phytotherapy” section of Recommendations of the Treatment of the European Association of Urology (2019). The comparison group included 34 patients who received a monocomponent medication. The tolerance of the product in patients of the main group was evaluated on the basis of subjective sensations and objective data during the treatment. Results. After the treatment the patients in both groups had an improvement in the clinical condition, taking into account the main complaints (intermittent and weakening of a jet of urine, feeling of incomplete emptying of the bladder, polakiuria, imperative urges). After 3 months of treatment in the main group the maximum rate of urination increased significantly, dysuria symptoms decreased. In 7 patients of the main group (30±10%) with the output volume of up to 80 ml and the volume of residual urine up to 150 ml after the treatment, the largest and significant decrease in the volume of residual urine on average up to 40±6 ml (p<0.05) was established. QOL decreased by 9.13 % (p>0.05), prostate volume – by 13.3 % (p>0.05), maximum and average urination rate increased (9.1 % and 14.6 % respectively; p>0.05). Treatment has ensured effective elimination of symptoms of lower urinary tract caused by BPH, which is confirmed by clinical improvement in 94.1 % of patients in the main group. Conclusions. As a result of the study, the effectiveness of the medication produced by company “BEHEALTH” for condition improvement by CP and BPH in the treatment of patients with benign prostate hyperplasia (BPH) and chronic prostatitis (CP) both objective and subjective indicators was determined (IPSS and QOL). Phytotherapy has demonstrated its high efficiency and safety in the treatment of BPH, in particular in relieving the symptoms of CP, preventing the progression of the disease, improving the patient’s quality of life and the minimum level of side effects, which allows it to be used for a long time.
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