[Ejaculatory disorders after surgical treatment of benign prostatic hyperplasia].

INTRODUCTION: Ejaculation disorders occur in 62-75% of patients after surgical treatment for benign prostatic hyperplasia (BPH). Despite the development and widespread introduction into clinical practice of laser procedures, which have reduced the overall incidence of complications, the frequency of ejaculatory disorders is still high. This complication negatively affects the quality of life of patients. AIM: To study the nature of ejaculation disorders in patients with BPH after surgical treatment. In this work, we did not compare the effect of various surgical methods and techniques in patients with BPH on ejaculation. At the same time, we selected the most widely used procedures in routine urological practice and assessed the presence and development of ejaculatory dysfunction prior to and after surgery. It should be emphasized that we determined the disorders that occurred in the same patients in whom ejaculatory function was evaluated prior to surgery. MATERIALS AND METHODS: A prospective study of the ejaculatory function of 224 sexually active men aged 49 to 84 years with LUTS/ BPH before and after surgical treatment was performed. From 2018 to 2021, thulium laser enucleation of prostatic hyperplasia (ThuLep) was done in 72 patients, conventional TURP in 136 patients, and 16 patients underwent open transvesical simple prostatectomy. Surgical treatment was carried out by certified urologists with extensive experience. ThuLep and conventional TURP were not ejaculatory-sparing. All patients underwent a standard examination for LUTS/ BPH pre- and postoperatively, including IPSS score, uroflowmetry to determine the maximum urine flow rate (Qmax), PSA, urinalysis, transrectal ultrasound examination with a calculation of prostate volume, postvoid residual. The erectile function was assessed according to the IIEF-5 score. Ejaculation function was evaluated according to the Male Sexual Health Questionnaire (MSHQ-EjD) preoperatively and at 3- and 6-months follow-up. For the diagnosis of premature ejaculation, CriPS questionnaire was used. For the differential diagnosis of retrograde ejaculation and anejaculation after surgical treatment, patients underwent an analysis of post-orgasmic urine for the presence and quantity of spermatozoa. RESULTS: The average age of patients was 64 years. At baseline, various ejaculatory disorders were detected in 61.6% of cases. In 48.2% of patients (n=108) a decrease in the ejaculate volume was found, while 47.3% (n=106) noted a decrease in the intensity of ejaculation. In 15.2% of cases (n=34), acquired premature ejaculation was detected, and 17% (n=38) men reported pain or discomfort during ejaculation. In addition, 11.6% (n=26) had delayed ejaculation during intercourse. There were no patients with anejaculation at baseline. The average score on the IIEF-5 scale was 17.9, and on the IPSS scale 21.5 points. Three months after surgical treatment, the following disorders of ejaculation were documented: retrograde ejaculation in 78 (34.8%), anejaculation in 90 (40.2%) patients. In the remaining 56 (25%) men, antegrade ejaculation was preserved. Among those with antegrade ejaculation, an additional survey was carried out, which showed a decrease in ejaculate volume and in the intensity of ejaculation in 46 (20.5%) and 36 (16.1%) cases, respectively. Pain during ejaculation was noted by 4 (1.8%) men, however, there was neither premature nor delayed ejaculation after surgical treatment. CONCLUSION: In patients with BPH, the predominate types of ejaculation disorders before surgical treatment were as following: a decrease in ejaculate volume (48.2%), a decrease in the speed (intensity) of ejaculation (47.3%), painful ejaculation (17%), premature ejaculation (15.2%), and delayed ejaculation (11.6%). After surgical treatment, retrograde ejaculation (34.8%, n=78) and anejaculation (40.2%, n=90) prevailed.

[15-year experience with PTFE-grafts "Ecoflon" in Leriche s syndrome].

Analyzed herein are the outcomes of 1,079 reconstructions of the aortofemoral segment, performed for Leriche s syndrome using polytetrafluoroethylene grafts "Ecoflon" during the period from 1997 to 2012. Hospital lethality amounted to 3.1%, frequency of thromboses was 0.53% and that of amputations equalled 0.53%. The patients were followed up at terms varying from 6 to 180 months. Cumulative patency of the bypass grafts at 1 year amounted to 99.3±0.2%, at 5 years to 97.3±0.6%, at 10 year to 91.9±1.9%, and to 90.0±2.7% after 15 years. Primary patency amounted to 97.6±0.4%, 90.9±1.1%, 75.9±2.7% and 71.4±4.1%, respectively. Grafts infection occurred in 1.3% of cases (0.2% in the early, and 0.83% in the remote postoperative periods). False aneurysms of distal anastomoses were registered in 0.5% of cases. A total of 137 reoperations were performed (104 for graft thromboses, 9 for pseudoaneurysms of anastomoses, and 7 for graft infection). Seventeen operations were carried out for ischaemia relapse due to progression of the occluding process in patent grafts. The amputation rate amounted to 6.6%. Based on the obtained findings a conclusion is drawn that polytetrafluoroethylene grafts "Ecoflon" comply with the current standards of quality.

[The experience of 500 vascular reconstructions of the aorticfemoral segment using a miniaccess].

The immediate and long-term results of 500 reconstructive operations on the aorticfemoral segment using a miniaccess were analyzed. 443 patients suffered from the obliterative atherosclerosis and 57 were operated on the infrarenal aortic aneurism. The size of the surgical access was 5-12 sm (418 through laparotomy, 82 through the retroperitoneal access). The access enlargement was necessary in 5.0% of cases. The mean time of the operation was 166.6±7.8 min (90-255 min). Time of the aortic clamping was 26.2±1.5 min by the aortic by-pass and 32.3±4.5 min by the aortic resection. The postoperative leathality rate was 1.6%, the morbidity rate was 20.0% (local vascular complications 7.2%; local non-vascular complications 7.2%, systemic complication 7.6%). 5-year by-pass patency was 91.9±2.8%, the limb was preserved in 93.6±2.4%.

[Remote results of using "ECOFLON" prostheses in management of patients with Leriche's syndrome].

The authors analysed the outcomes of 476 reconstructions performed on the aortofemoral segment for Leriche's syndrome using polytetrafluoroethylene grafts "ECOFLON" within the time frame from 1997 to 2007. The in-hospital mortality rate amounted to 2.7%, thrombosis rate to 0.46%, and amputation rate to 0.69%. The remote results were assessed at follow-up terms varying from 6 to 108 months, with the mean follow-up time thus amounting to 34.6 +/- 1.3 months. Secondary graft patency by the first postoperative year amounted to 98.0 +/- 0.62%, by 5 years to 92.5 +/-1.9%, and by 9 years to 91.4 +/- 1.9%, with primary graft patency being 97.3 < or =0.23%, 84.9 +/- 2.9%, and 82.9 +/- 3.5%, respectively. The limb salvage rate amounted to 97 +/-0.6% after 1 year, equalling 91.2< or =2.2% after 5 years, and 80.9 +/- 5.2% after 9 years. Infection of prosthetic grafts occurred in 1.04% of cases (0.42% in the short-, and 1.05 % in the long-term periods). Pseudoaneurysms of distal anastomoses were observed in 0.34% of cases. Analysing two time intervals (i. e., 1997-2002 and 2003-2007) howed a statistically significant betterment of the patency rates (with primary graft patency having increased by 5.3% and secondary graft patency by 5.8%, (P < 0.01), thus apparently suggesting improved quality of explants. It was concluded that polytetrafluoroethylene grafts "ECOFLON" comply with the present-day standards of quality.

[Remote results of aortofemoral reconstructions performed through miniaccess].

Analysed herein are long-term outcomes of 250 reconstructions of the infrarenal aorta for occlusive disease with the use of transperitoneal miniapproach (median minilaparotomy 5-10 cm long). The patients' average age amounted to 58.2±0.64 years. 60.4% of patients had critical ischaemia. Bilateral reconstruction was performed in 216 patients, and unilateral--in 34 subjects (with revascularization performed on a total of 466 limbs). Hospital lethality rate amounted to 0.8% (2 patients). There were 2 bypass-graft thromboses (in one case with successful thrombectomy). The incidence rate of amputations was 0.86% from the number of revascularized extremities. Remote outcomes were assessed in 145 patients within terms varying from 6 months to 84 months (mean follow-up duration--30.8±1.4 months). Primary patency after 1 year amounted to 97.0±0.1%, after 5 years--81.8±3.9%, after 84 months--67. ±9.8%, with the corresponding figures for secondary patency amounting to 98.0±0.83%, 91.9±2.8% and 91.9±2.8%, respectively. The limb preservation rate after one year equalled 97.0±0.9%, after 5 years--93.6±2.4%, after 84 months--93.6±2.4%. Five-year survival amounted to 73.5±6.2%. Postoperative ventral hernias were revealed in 6.9% of patients. Hence, the long-term outcomes of aortofemoral reconstructions thorough the miniapproach correspond to the commonly accepted criteria for quality of operations for occlusive pathology of the aortofemoral segment.