[An improved method of risk prediction and prevention of esophagogastroduodenal bleeding in geriatric urology].

With the aim of prediction and prevention of early postoperative esophagogastroduodenal bleeding (EPEGDB), 1296 elderly patients with BPH were examined during the preoperative period before isolated or simultaneous operations. Patients in group 1 (n=357) with a history of gastric or duodenal ulcer underwent esophagogastroduodenoscopy (EGDS). In group 2 (n=522) EGDS was performed and gastric acidity was determined using AGM-03 acid-gastrometer. Patients of group 3 (n=417) underwent EGDS and gastric acidity was determined by hromogastroscopy. The differentiated approach to treating patients of group 3 on the basis of preoperative comprehensive examination resulted in preventing severe complications such as EPEGDB. Prevention of EPEGDB in this category of geriatric patients should be as mandatory as preventing thromboembolic, respiratory, cardiovascular and septic complications.

[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.

[Prognosis and prophylactics of early postoperative esophagogastroduodenal bleedings in geriatric practice].

Results of examination and surgical treatment of 488 elderly patients (mean age from 60 to 89 years) with benign hyperplasia of the prostate (BHP) who underwent planned prostatectomy were analyzed. It was shown that early postoperative esophagogastroduodenal bleedings (EPEGDB) occurred in 7% of clinical observations of elderly and senile patients with BHP after prostatectomy. These patients become urgent surgical patients. The endoscopic parietal pH-metry was considered the method of "gold standard" in the selective precision determination of acid-dependent conditions in elderly and senile patients with BHP. The developed method of prognosis of EPEGDB risk allows the principle of differentiated approach to the effective preoperative prophylactics to be realized in elderly and senile patients with BHP. A complex preoperative management using adequate anti-sectetory therapy in elderly and senile patients with BHP and risk of the development of EPEGDB contributes to their considerable reduction (from 7 to 0.6%).