Enhanced recovery after retrograde intra-renal surgery (RIRS) in comparison with mini-percutaneous nephrolithotomy (Mini-PCNL) for renal stone treatment.

OBJECTIVES: The study presents a comparative analysis of the mini-percutaneous nephrolithotripsy (mini-PCNL) and retrograde nephrolithotripsy (RIRS) with a logistic analysis of outcomes and complications. MATERIAL AND METHODS: The prospective study included 50 patients diagnosed with urolithiasis from 2018 to 2021 in the urological hospitals in Irkutsk. Patients were divided into two groups: RIRS (group I, n = 23) and Mini-PCNL (group II, n = 27). The comparison groups are statistically homogeneous. RESULTS: Both procedures equally lead to high stone free rates (SFR > 1 mm, 91.3% vs 85.1%; p = 0.867; SFR > 2 mm, 95.6% vs 92.5%; p = 0.936). The intergroup analysis of the total operation time (and lithotripsy) demonstrated similar times (p > 0.05). Postoperative complications of classes II-III (Clavien-Dindo) in the early and late postoperative period developed rarely and were comparable (p > 0.05). Class I complications were predominant in the PCNL group (p = 0.007). Some parameters demonstrated the superiority of RIRS over PCNL: less pronounced pain syndrome (p = 0.002), less drainage time (p < 0.001), no postoperative hematuria (p = 0.002), shorter hospitalization and total treatment period (p < 0.001). CONCLUSIONS: The study highlighted the positive effect of the oneday surgery principle on the risk of developing postoperative hematuria, urinary infection, or severe postoperative pain. RIRS and mini-PCNL have similar effectiveness, but RIRS meets the criteria of the enhanced recovery program more than PCNL.

Fast Track Surgery as the Latest Multimodal Strategy of Enhanced Recovery after Urethroplasty.

Fast track surgery (FTS), as well as ERAS (enhanced recovery after surgery/rapid recovery programs), is the latest multimodal treatment strategy, designed to reduce the disability period and improve the medical care quality. The study aims to analyze the enhanced recovery protocol effectiveness in a comparative study of elective urethral stricture surgery. A prospective study included 54 patients with an established diagnosis of urethral stricture in 2019-2020 in the urological hospital of the Irkutsk City Clinical Hospital No. 1. All 54 patients have completed the study. There were two groups of patients FTS-group (group II, n = 25) and standard group (group I, n = 29). In terms of preoperative parameters, the comparison groups have statistical homogeneity. The comparative intergroup efficacy analysis of the treatment based on the criteria established in the study demonstrated good treatment results for 5 (17.2%) patients of group I and 20 (80%) patients of group II (p=0.004). The overall efficacy of urethroplasty surgeries, regardless of the treatment protocol, was comparable (86.2% vs 92%; p=0.870), as well as the likelihood of relapse within two years (p=0.512). The predictors of recurrence were technical complications and urethral suture failure (OR 4.36; 95% CI 1.6; 7.11; p=0.002). The FTS protocol reduced the treatment period (p < 0.001) and decreased the severity of postoperative pain (p < 0.001). The use of the "fast track surgery" protocol in urethroplasty with generally similar treatment results makes it possible to achieve a better functional and objective condition of patients in the postoperative period due to less pain, shorter catheterization, and hospitalization.

Comparison of efficiency of vascular-preserving urethroplastic methods of the bulbo-membranous part of the urethra.

INTRODUCTION: There are several options for vessel-sparing anastomotic procedures that allow one to avoid disturbances in the normal blood supply to the spongy body and successfully perform plastic surgery of distal urethral strictures. AIM: To perform a comparative analysis of the effectiveness of reconstructive surgical treatment of strictures of the bulbo-membranous urethra with anastomotic surgery with and without vessel-sparing. MATERIAL AND METHODS: A prospective study was carried out on 28 patients with a diagnosis of stricture of the bulbo-membranous urethra who underwent treatment in the period 2012-2018 in the conditions of a urological hospital of Irkutsk City Clinical Hospital No. 1. Anastomotic urethroplasty was performed using one of two methods: with full mobilization of the spongy body bulb and a vessel-sparing method when the spongy body does not intersect. RESULTS: The effectiveness of the classical method of anastomosing EPA-TWW ((excision and primary anastomosis urethroplasty (Turner-Warwick) and excision and Jordan's technique of vessel sparing excision and primary anastomosis)) was comparable with the method of anastomosing without crossing the (spongy body of EPA-J). Postoperative changes in the parameters of the functional status of patients based on the International Prostate Symptom Score (IPSS), International Index of Erectile Function, and Quality of Life were comparable in patients undergoing EPA-TWW and EPA-J. The final data indicate a statistically equivalent risk of developing complications such as urinary incontinence, shortening of the penis, and decreased erectile function. CONCLUSIONS: The study did not demonstrate a statistically significant difference in the effectiveness of the treatment and the risks of complications during anastomotic surgery with or without vessel-sparing. However, an unformalized assessment demonstrates the best state of erectile function in patients after vascular-preserving surgery.

Buccal mucosal graft urethroplasty of the bulbomembranous part of urethra.

INTRODUCTION: Urethral stricture is a partial or complete narrowing of the urethra, caused by damage to the urethral epithelium. This disease leads to a persistent urination dysfunction, the elimination of which is a difficult task. The aim of this study was to perform a comparative analysis of the immediate and long-term narrowing treatment results of the proximal part of the bulbar and membranous urethral parts using the developed magnifying and anastomotic methods. MATERIAL AND METHODS: A total of 102 patients with a confirmed diagnosis of stricture of the bulbomembranous urethral part of the urethra who underwent treatment in the urological hospital in Irkutsk City Clinical Hospital No. 1 during the period 2012-2018 participated in this prospective study. Urethroplasty operations were performed in two ways, using the anastomotic and intra-urethral substitution techniques. Through the assessment of preoperative parameters, statistical homogeneity of comparison groups was established. RESULTS: The final data analysis showed relapse for 4 patients from Group I and for 2 patients in Group II. The absence of relapse during the entire observation period was equal in both groups and after 2 years amounted to 83.0 ±7.9% in Group I and 92.5 ±5.1% in Group II. CONCLUSIONS: In both groups, the desired result was achieved - adequate independent urination was restored. The anastomotic method of urethroplasty should be used with caution in patients at risk groups, as well as with the presence of predictors of complications: previous transurethral surgeries on the urethra and prostate, anastomotic urethroplasty, radical prostatectomy. The developed minimally invasive substitution technique has a similar effectiveness with a lower risk of complications.