[Early urethral catheter removal after robot-assisted radical prostatectomy].

BACKGROUND: Robot-assisted radical prostatectomy (RARP) is a widely used treatment method for patients with clinically localized prostate cancer. Posterior reconstruction of urethrovesical anastomosis (UVA) is one of the techniques that provides early recovery of urinary continence after surgery. Changes in the technique of performing posterior reconstruction of UVA may contribute to further improvement of functional results. AIM: To evaluate the functional results of early removal of the urethral catheter (after 3 days) after RARP using a modified surgical technique of performing posterior reconstruction of UVA compared with the standard catheterization time (7 days after surgery). MATERIALS AND METHODS: Patients who underwent RARP were randomly assigned to early catheter removal (3 days after surgery, main group, n=15) and standard catheterization time (7 days after surgery, control group, n=15). RARP was performed using the Da Vinci Si system. The primary end point was the rate of spontaneous voiding after catheter removal. Secondary endpoints were the incidence of urine leakage into the paravesical tissue during retrograde cystography, as well as complications according to the Clavien-Dindo system. The frequency and severity of stress urinary incontinence after catheter removal was assessed using the International Consultation on Incontinence Questionnaire - Urinary Incontinence Short Form (ICIQ-UI SF). RESULTS: There were no significant differences between groups in terms of baseline and perioperative parameters. After removal of the catheter, no acute urinary retention was observed in both groups. Also, there were no cases of urine leakage into the paravesical tissue during retrograde cystography. The ICIQ-UI SF questionnaire showed no significant differences between the groups at 1, 3, 6, and 12 months after surgery. CONCLUSIONS: The method of modified posterior reconstruction allows to remove the urethral catheter 3 days after RARP. Early removal of the urethral catheter did not adversely affect the early recovery of urinary continence, the quality of UVA, and did not increase the incidence of acute urinary retention. Further studies with longer follow-up periods are needed.

[Kidney carboxycryoablation. Pilot study].

AIM: The aim of this experimental study was to evaluate the effect of low temperatures of carbon dioxide on a "living" blood-supplying organ (pig kidney), to determine the possibility of performing cryoablation of kidney tissue with carbon dioxide (carboxycryoablation), as well as to establish experimentally modes of carboxycryoablation of the kidney. MATERIALS AND METHODS: To carry out this experimental study, a female of the mini-pig line was used. We performed laparoscopic access to the kidney for carboxycryoablation. During the freezing of the kidney, three modes were compared: 60, 90, and 120 s on one kidney of one animal. Immediately after the completion of cryoablation, nephrectomy was performed, and the removed kidney was sent for histological examination. According to the histological study, the results of the use of carbon dioxide during cryoablation of porcine kidney tissue were evaluated. RESULTS: Cryoablation based on carbon dioxide (carboxycryoablation) leads to irreversible death (necrosis) and destruction of the affected tissue. A direct relationship between the exposure mode and the size of the cryonecrosis zone was noted. Thus, the most extensive zone of necrosis with a diameter of 10 mm was achieved when performing cryoablation in the exposure mode of 120 s. CONCLUSION: This experiment showed that carbon dioxide-based cryoablation remains a feasible procedure that leads to irreversible death (necrosis) and destruction of the affected tissue. However, further studies on the safety and efficacy of cryoablation of kidney tissue with carbon dioxide are required.

[Surgical treatment of congenital aortic arch disease]. / Vrozhdennaya anomaliya dugi aorty: kogda operirovat' i kak.

OBJECTIVE: To report treatment outcomes in patients with congenital aortic arch disease. MATERIAL AND METHODS: There were 65 patients (45 boys and 20 girls) for the period from 2005 to 2019. Mean age of patients was 53±12 days (range 1-98), weight - 3,3±1,3 kg (range 2.2-4.6). All patients were divided into 2 groups depending on the method of surgical repair. The 1st group included 33 patients who underwent patch repair, the 2nd group (n=32) - anastomosis in end-to-side fashion. RESULTS: In group I, recurrent aortic arch coarctation was observed in 16.8% of cases, in group II - only in 4% of cases (p=0.02). Analysis of systolic pressure in both groups revealed that arterial hypertension was detected in 39% of cases in group I and only in 9,1% of cases in group II (p=0,0025). CONCLUSION: Surgical treatment of aortic arch disease using anastomosis in end-to-side fashion is associated with reduced risk of recurrent aortic arch coarctation and residual arterial hypertension in long-term postoperative period.

[Fatal renal and neurological complications after aortic arch repair in newborns]. / Fatal'nye pochechnye i nevrologicheskie oslozhneniia posle rekonstruktsii dugi aorty u novorozhdennykh.

AIM: To evaluate effectiveness and safety of various methods of cerebral and visceral protection during aortic arch surgery in infants. MATERIAL AND METHODS: Retrospective analysis included 60 patients after aortic arch repair followed by different cerebral protection technique who have been assessed for neurological status and visceral injury in early and long-term postoperative period. Aortic arch surgery with deep hypothermic circulatory arrest for congenital diseases was performed in 26 patients (group 1) and antegrade unilateral selective cerebral perfusion in 34 patients (group 2). RESULTS: Cerebral complications occurred in 28.5% of patients of the 1st group and in 7.9% of patients of the 2nd group. CONCLUSION: Odds ratio for neurological event is significantly lower in group 2: 0.17 (0.06-0.69; p=0.02). However, there were more patients with renal dysfunction in this group compared with group 1: 58.7% vs. 23.7% (p=0.02).