[Estimation of the risk and prevention of postoperative esophagogastroduodenal hemorrhage in elderly urological patients].

Open transvesical adenomectomy was made in 853 old males with prostatic adenoma in Samara Hospital for Veterans from 1995 to 2010. The age of the patients ranged from 60 to 89 years, of them 389 (45.6%) were from 60 to 75 years of age, 464 (54.4%) - 75 to 89 years. Elective simultaneous operations were conducted in 104 (12.2%) of the above patients. It is shown that early postoperative esophagogastroduodenal hemorrhage after adenomectomy occurs in 7% old patients. Endoscopic parietal pH-metry is "a gold standard" in selective sensitive diagnosis of acid-dependent conditions in presenile and senile patients with prostatic adenoma. The proposed method of prediction of the risk of early postoperative esophagogastroduodenal hemorrhage provides realization of the principle of a differential approach to effective prevention of the hemorrhage in old patients with prostatic adenoma. Complex preoperative preparation using adequate antisecretory therapy in old patients with prostatic adenoma with the risk of early postoperative esophagogastroduodenal hemorrhage decreases hemorrhage rate from 7 to 0.4%. Prevention of early postoperative esophagogastroduodenal hemorrhage in old patients with prostatic adenoma should become as obligatory as prevention of cardiovascular, thromboembolic, pulmonary and pyoseptic complications.

[Elective simultaneous operations in elderly and senile urological patients].

Surgeons of Samara Regional Veterans' Hospital made elective-simultaneous operations in 229 presenile and senile patients. Surgery was performed in the urological department in 1995-2010. It is shown that over 12% patients of urological geriatric departments need elective situltaneous operations, of them 8.7% are mild, 78.6%--moderate and 12.7%--severe. The results of simultaneous operations in 133 patients and staged operations in 60 control patients (adenomectomy and Vinkelman) differed insignificantly (p > 0.05). Such achievement was realized due to advanced prophessional education of all medical personnel of the department, introduction of new techniques in examination and treatment: accurate definition of absolute and relative contraindications for simultaneous surgery, effective preoperative preparation, low-invasive operations, different variants of non-endotracheal anesthesia. In addition to a positive clinical effect, new technology of simultaneous operations reduces 2.3-fold economic costs vs staged surgery, improves significantly quality of life of the above patients.