[Bipolar and laser endoscopic enucleation for large benign prostatic hyperplasia].

BACKGROUND: endoscopic enucleation is a conventional minimally invasive method of surgical treatment for large prostates. AIM: The aim of the study was to analyze preoperative, intraoperative, immediate postoperative outcomes and 12-month functional results of endoscopic enucleation of the prostate. MATERIALS AND METHODS: a total of 120 endoscopic enucleations were performed in the Department of Urology, City Clinical Hospital named after D.D. Pletnev in 2016-2017. Bipolar electroenucleation was performed in 63 cases, while laser enucleation was done in 57 patients (28 holmium and 29 thulium). Three-lobe, two-lobe and en-block electroenucleation was performed in 23, 24 and 16 patients, respectively. The technical advantages of laser enucleation included lesser need for mechanical traction during enucleation of the adenoma from the prostatic capsule and the predominant use of two-lobe technique (33 cases). En-block laser enucleation was done in 7 patients, while three-lobe technique was used in 17 patients. Both groups were comparable in terms of I-PSS, QoL, prostate volume, maximum urination rate, and residual urine volume. RESULTS: weight of the removed adenoma after electroenucleation was 105+/-24 g and 98+/-18 g after laser enucleation; the operation time was 118+/-10 and 132+/-25 min, duration of the catheterization 48+/-16 and 51+/-10 h, length of stay 3.6+/-1.2 and 3.8+/-1.3 days, respectively. Closed prostate perforation more often occurred after electrosurgical enucleation (6 vs. 1). There were no significant differences in the outcomes in both groups one year after the surgery. After removal of the urethral catheter, incontinence developed in 9% (6/63 and 5/57, respectively) of cases. During the period from 6 to 12 months, urinary incontinence persisted only in one patient, who subsequently was underwent to injection therapy with a partially positive effect. All 22 patients with urinary disturbances that occurred after enucleation had a short distance from the top of the verumontanum to the external sphincter (less than 1.5 cm; risk ratio (RR) = 3.5) and intravesical protrusion of more than 1 cm (RR=2.1). CONCLUSION: endoscopic bipolar and laser enucleation is an effective and safe treatment method for large BPH. It should be noted that postoperatively there was an increased frequency of irritative symptoms, which disappeared by 6 months.

[Lower urinary tract symptoms after transurethral resection of the prostate].

An analysis of the frequency of residual lower urinary tract symptoms after surgical treatment is presented in this literature review. A special attention is paid to prognostic criteria for persistence of irritative symptoms after the surgery. The analysis of modern approaches to the treatment of urinary disturbances has been performed. The possibility of the combined use of various classes of drugs to improve the efficiency of the treatment is highlighted.

[Use of cytomedins in case of prostatic involvement in chronic prostatitis according to UPOINT classification].

BACKGROUND: chronic prostatitis is a common disease that significantly influence on the quality of life. AIM: Our aim was to assess the prevalence of particular domains of UPOINT classification and determine the efficiency of prostate-selective cytomedins in complex therapy of chronic prostatitis with the predominance of organic component. MATERIALS AND METHODS: a total of 96 patients aged from 24 to 48 years were treated in City clinical hospital named after D.D. Pletnev in 2017-2018 yy. with a previously diagnosed chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). The mean duration of the disease was 18.0+/-6.2 months. The total NIH-CPSI score was 24+/-7.3 (pain score 9+/-4.9, urinary score 7+/-2,7, quality of life 8+/-2.3), Qmax was 16+/-4.2 ml/s, prostate volume - 34+/-12 cc. Leukocyturia in post-massage urine was found in 52 patients (54%). Positive urine culture after prostate massage or positive bacterial semen study were found in 22 patients (23%). Prostate-specific therapy consisted of 20 days of rectal suppositories Vitaprost-forte followed by oral therapy by Vitaprost tablet of the same duration. RESULTS: Follow-up examination of 72 patients (75%) was performed after 3 months of therapy. The total NIH-CSPI score decreased to 15.6+/-5.1 (pain score 6.3+/-3.8, urinary score 4.6+/-2.2, quality of life 4.7+/-2), Qmax was 16+/-3.8 ml/s and mean prostate volume was 24+/-6 cc. The normalization of laboratory parameters was achieved in all cases. CONCLUSION: using the UPOINT classification allows to optimize the treatment of patients with chronic prostatitis. Use of prostate-specific cytomedins (Vitaprost) is highly effective in case of prostatic involvement according to the UPOINT classification.