Benign prostatic hyperplasia (BPH) is one of the most common benign diseases in men, as it leads to an enlarged prostate, the development of lower urinary tract symptoms, and worsens the quality of patient’s life. Surgical treatment is indicated to patients after non-effective drug treatment. Most often, transurethral resection of the prostate (TURP) is used. The objective: to improve the results of TURP in patients with BPH and acute urinary retention by optimizing antibacterial prophylaxis of postoperative complications in the early postoperative period. Materials and methods. An analysis of the surgical treatment of 179 patients with BPH with acute urinary retention after TURP was performed. The age of the patients varied from 51 to 84 years old, the average age was 64.9±5.1 years. All patients had a complex urological examination in the preoperative period. The patients were divided into two groups: I group – 85 patients after operation who were prescribed ceftriaxone in the early postoperative period; II group – 94 patients who received levofloxacin in the early postoperative period. Results. It was determined that complications occurred in 43 (24.1%) patients in the early postoperative period. Long-term macrohematuria was found in 23 (12.9%) patients, exacerbation of chronic pyelonephritis was in 13 (7.3%) patients after operation, acute urethritis developed in 7 (3.9%) patients, acute orchiepididymitis – in 9 (5, 0%) patients. It has been proven that the total frequency of complications in patients with BPH who received levofloxacin in the early postoperative period was statistically significantly lower than in the patients who were prescribed ceftriaxone. Conclusions. The use of levofloxacin for the prevention of early postoperative complications after TURP in patients with BPH complicated by acute urinary retention improves the results of surgical treatment by reducing the frequency of postoperative complications by 60%.
The objective: to analyze the diagnostic capabilities and various methods of treatment of overactive bladder in young patients with lower urinary tract symptoms (LUTS). Materials and methods. The study involved 40 men who were divided into two groups. The main group included 24 patients with urodynamic diagnosis of overactive bladder (OAB) who were treated for LUTS. The age of patients ranged from 21-37 years old (mean age – 28.5±2.4 years). The control group included 16 men 21-48 years old (mean age – 36.32±2.34 years) without LUTS. The patients had complex urodynamic testing (UDT) for the diagnosis, the treatment management, and to determine the degree of functional disorders of the urination. The clinical task of treatment of OAB was to control the involuntary contractions of the bladder to normalize the quality of patient’s life. In 14 (58.3 %) patients of the main group solifenacin at a dose of 10 mg was used, in 10 (41.7 %) men – mirabegron at a dose of 50 mg. Results. The results of the first line therapy were studied in 1 month and then a decision was made to continue treatment or to change the medical approach. During the evaluation of the effectiveness of therapy, it was determined that the first line therapy was effective in 11 (45.8 %) patients, and in 13 (54.2 %) patients there was effect. In the absence of the results of medication treatment of OAB in 1 month in 8 out of 13 patients the treatment with the second line drug was prescribed – intradetruce injections of Botox. During the analysis of complex UDT after 12-18 months of the first injection of Botox, positive dynamics of therapy was estabslihed. Conclusions. Complex urodynamic testing is a reliable method of diagnosis and control of therapy. It is performed in the presence of overactive bladder (OAB). It is proved that if initially first-line drug therapy in young men is effective, it remained efficacy in longer period. If the first line therapy by botulotoxin injection in young men with OAB is not effective this led to some reduction in the tone of the detrusor. However, clinically this type of therapy has contributed to a significant improvement in the patient’s quality of life and the normalization of urodynamic.
Today the lower urinary tract symptoms (LUTS) in men are the actual problem. LUTS is an extremely polyetiological problem, but benign prostate hyperplasia (BPH) is the most often reason for its development. The problem of chronic prostatitis (CP) in patient of the older age with BPH is of great importance. These patients have the most pronounced symptoms of the lower urinary tract dysfunction. The therapy of patients with BPH and CP must lead to reducing of LUTS and improvement of quality of life, as well as to complications prevention associated with prostate enlargement and intravesical obstruction, such as acute urinary retention, recurrent urinary tract infection. The modern researches have presented that the combinations of herbal preparation with tamsulosin were more effective than monotherapy with α-adrenoblockers. That is why phytotherapy is considered an alternative option in the treatment of CP as first-line therapy and for the BPH initial stages in the complex treatment with other drugs. In contrast to “traditional” measures with one component, today multicomponent herbal preparations are popular. A natural complex preparation which contains saw palmetto extract (S. Repens), 3.3’ diindolylmethane, pumpkin seed extract, resveratrol, lycopene for hormonal balance normalization for men with BPH was analyzed. The advantage of the natural complex hormonal balance normalization for men with BPH is that it can be prescribed for the first LUTS signs that can prevent the symptoms progression and development of complications. Urologist received the preparation for effective LUTS treatment in patients with BPH and CP, as well for removal of postoperative dysuria.
Despite the fact that urinary incontinence (UI) occurs after radical prostatectomy (RP) quite often, it is currently not completely understood which factors really increase the risk of UI development. The results of a systematic review of patient- and tumor-related prognostic factors that cause post-prostatectomy urinary incontinence (PPI) are presented. The primary results evaluated the presence of UI within 3 months after the RP. Secondary outcomes included the presence of UI in 3–12 months and >12 months after RP. The study of databases including Medline, EMBASE and CENTRAL was conducted between January 1990 and June 2022. The articles about patient- and tumor-related prognostic factors with univariate and multivariate analysis were included. Surgical influencing factors were excluded. Risk of bias (RoB) was assessed using Quality In Prognosis Studies (QUIPS) indicators. A random-effects metaanalysis was performed for all prognostic factors where it was possible. 83 studies (5 randomized controlled trials, 15 prospective, 61 retrospective and 2 case-control studies) which included 55,302 patients were analyzed. The significant prognostic factors for postoperative UI within 3 months after RP were age, membranous urethral length (MUL), prostate gland volume (PGR), and Charlson Comorbidity Index (CCI). The results of the literature analysis indicate that increased age, shorter MUL, greater PGR and higher CCI are the independent prognostic factors for urinary incontinence within 3 months after RP. At the same time, all of them, except CCI, are the prognostically significant factors for the period 3–12 months after surgery. Increased age, increased prostate volume, shorter membranous urethral length, and lower physical fitness were found to be associated with worse urinary incontinence during the first 3 months after surgery. During the next 3–12 postoperative months, all of these factors except the physical fitness remained the prognostic ones.
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