Objective. The objective of the study was to investigate the results of operative endoscopic treatment of patients with urological profile depending on the duration of hospitalization.. Patients and methods. The study examined the treatment results of 1647 urological patients aged from 41 to 69 years (mean age 57.1 years), including 791 (48.03 %) males and 856 (51.97 %) females. A comparative analysis of the results of operative endoscopic treatment of patients in two groups was conducted. The interventions were comparable in volume. The first group consisted of patients who were observed in a hospital setting for 3-4 days; the second group consisted of patients who were discharged home within the first day. The visual analog scale (VAS) was used to assess pain. Quality of life was determined using the SF-36 questionnaire. Results. The average pain score on the VAS scale in the first day after surgery in both patient groups was 5.45±0.3 and 5.16±0.2 points, respectively, which was considered «tolerable» pain. The quality of life of patients in the two groups during the first day of the postoperative period indicated comparability of data on the PR, PF, BP, and GH scales. Better parameters were recorded in the second group of patients, compared to the first, on the SF, RE, and MH scales. Analysis of the quality of life questionnaire three days after surgery showed improvement in all scales; better results were achieved in the second group of patients, compared to the first, on the VT, SF, RE, and MH scales, which characterized better social functioning and higher vitality. Conclusion. Endoscopic interventions in urology allow for better pain tolerance, especially in the first day after surgery, which has a positive impact on the quality of life of patients. Shortening the length of hospital stay to one day without increasing the pain syndrome increases the socio-economic significance of endoscopic techniques and emphasizes the prospects for further research.
Introduction. The three-dimensional (3D) imaging during laparoscopic procedures can improve the quality of that surgeries. There is a shortage of publications about the potential benefits of 3D navigation in laparoscopic surgery with urological diseases. Radical prostatectomy (RPE) is known as the gold standard of treatment of localized prostate cancer (PC), and investigation of imaging technologies in laparoscopic surgery in PC patients is a hot topic. Aim. To compare the perioperative outcomes of laparoscopic RPE performed with 3D and two-dimensional (2D) imaging. Materials and methods. We performed retrospective analysis of perioperative outcomes in 146 patients who had undergone radical surgery with localized PC. All the patients were divided into 4 groups by the surgery features: 1) 2D imaging with the technique for neurovascular bundles preservation (TNVBP) (n=52); 2) 2D without TNVBP (n=46); 3) 3D with TNVBP (n=23); 4) 3D without TNVBP (n=25). We assessed operative time, intraoperative blood loss volume (IBLV), duration of the bladder drainage, positive surgical margin (PSM) detection rate, duration of the postoperative inpatient period, urinary continence recovery rate, erectile function recovery (EFR) rate. Results and discussion. In groups 1, 2, 3, 4 the operative time was 171,4±21,1, 168,3±23,2, 98,7±17,3, 92,2±22,2 min, and the IBLV was 294,2±62,1, 281,2±53,2, 144,2±31,7, 148,5±33,0 mL, respectively. PSM detection rate was 1,92±0,11%, 2,17±0,04% in groups 1, 2, while PSM had not been detected in groups 3, 4. In all the participants, duration of the bladder drainage was 5–7 days, and the full recovery of urinary continence was detected at both 6 and 12 months after the surgery. The postoperative inpatient period was 8–10 days in groups 1, 2, and 8–9 days in groups 3, 4. The EFR at 3 months after the surgery was detected in 38,4%, 28,3%, 34.8%, 28.0% of patients, while at 12 months it was detected in 59,6%, 41,3%, 82,6%, 56,0% of patients in groups 1, 2, 3, 4, respectively. Conclusion. We revealed the following features of perioperative period of laparoscopic RPE performed with 3D imaging compared to 2D: 1) the operative time was reduced by 42–45% (р<0,05); 2) the IBLV was reduced by 47–51% (р<0,05); 3) the PSM had not been detected; 4) there was the tendency to the shorter postoperative inpatient period; 5) the EFR rate was increased by 1,3–1,4 times (р<0,05), and the best EFR outcomes were obtained via 3D imaging together with TNVBP. Thus, our study demonstrates the advisability of usage of both 3D imaging and TNVBP during the laparoscopic RPE.
BACKGROUND: The number of older patients with kidney tumors is steadily increasing. Surgical methods are the main ones in the treatment of patients with localized forms of renal cell carcinoma, including the elderly. AIM: to conduct a comparative analysis of perioperative data and functional results of surgical interventions for renal cell carcinoma in patients of different age groups. MATERIALS AND METHODS: The study included 256 patients with kidney tumors (mean age 65.2 8.6 years). 146 (57.0%) patients aged 56 to 64 years made up group I, and 110 (43.0%) patients aged 65 to 75 years group II. In 210 (82.0%) patients, the tumor diameter did not exceed 4 cm (T1a), in 46 (18.0%) patients it ranged from 4 to 6.2 cm (T1b). Radical nephrectomy and partial nephrectomy were performed respectively in 44 (30.1%) and 102 (69.9%) patients of group I and 58 (52.7%) and 52 (47.3%) patients of group II. All operations were performed laparoscopically. RESULTS: In patients of group I, the duration of radical nephrectomy was 115.0 18.0 min, and partial nephrectomy 135.5 25.0 min (p 0.0001), in patients of group II, 120.0 20.5 and 138.0 25.5 min (p 0.0001), respectively. Warm ischemia time during partial nephrectomy was 17.6 1.2 min in patients of group I and 18.2 1.5 min in patients of group II (p = 0.25). The volume of blood loss in patients of both groups I and II was significantly higher during partial nephrectomy. The average volume of blood loss in patients of group I was 130.0 20.0 ml when performing radical nephrectomy and 236.5 20.0 ml when performing partial nephrectomy (p 0.0001), and in group II 125.0 18.5 ml for radical nephrectomy and 246.0 22.0 ml for partial nephrectomy (p 0.0001). The frequency of significant complications did not differ in patients of groups I and II. Grade IIIa complications according to the ClavienDindo classification of surgical complications were observed in 5 (3.4%) patients of group I and 4 (3.9%) patients of group II (p 0.05), and grade IIIb in 3 (2.1%) and 2 (1.8%) patients (p 0.05). Intraoperative bleeding developed in 19 (7.4%) patients: in 13 (8.4%) of 154 patients with partial nephrectomy, and in 6 (5.9%) of 102 patients with radical nephrectomy. In the early postoperative period in patients of group I after radical nephrectomy and partial nephrectomy, normal glomerular filtration rates was observed in 34.0% and 54.0% of patients, respectively, and in group II in 31.0% and 52.0% of patients, respectively. Renal function significantly decreased in patients of both groups after radical nephrectomy compared with partial nephrectomy (p 0.05). The results of GFR 3 months after surgery improved in patients after partial nephrectomy, and did not change significantly in the radical nephrectomy group. CONCLUSIONS: The results of the study showed no differences in perioperative parameters (volume of intraoperative blood loss, warm ischemia time) during radical nephrectomy and partial nephrectomy in patients aged 5664 and 6575 years. The functional results of partial nephrectomy in patients of both groups were better compared to patients after radical nephrectomy. Thus, our data indicate the justification for performing organ-preserving operations, including in elderly patients.
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