[CLASSICAL RADICAL EXTRAURETHRAL METHOD OF ADENOMECTOMY--BEYOND 30 YEARS].

Introduction of transvesical extraurethral adenomectomy into clinical practice was preceded by the clinical and morphological study of the prostate, prostatic urethra, bladder, upper urinary tract and renal function. It was found that at any volume of adenomatous (hyperplastic) tissue in the prostate, front semicircle around the prostatic urethra remains intact, and changes occur only in the proximal part of its back semicircle. Front semicircle adherent to the anterior commissure of the prostate has no adenomatous tissue. Extraurethral method enables you to perform a prostatectomy at any size of adenomatous tissue (fragmentarily) with preservation of the prostatic urethra, urethral vascular plexus and, if necessary, to carry out the vesico-urethral segment correction without blood loss. Free independent urination is recovered at days 10-12 after the healing of the suprapubic surgical wound and removal of drainage tube. Since the introduction of transvesical extraurethral prostatectomy into clinical practice, more than 3,000 radical adenomectomies at different stages in patients with co-morbidities were performed only at Burdenko Central Military Clinical Hospital and the 2nd Mandryka CMCH.

[On the question of the so-called gold standard of surgical treatment of benign prostatic hyperplasia].

The article presents the comparative analysis of results of surgical methods used for the treatment of patients with BPH. The standardization of surgical TURP interventions as the "gold standard" in comparison with transvesical extraurethral adenomectomy is estimated. After TURP, according to the data from domestic and foreign authors, taking into account own author's data, complications develop in 28.7 to 100% cases after non-radical removal of adenomatous (hyperplastic) tissue, and only in 5.6% of cases after radical extraurethral prostatectomy. Thus, open transvesical or retropubic extraurethral adenomectomy is considerably superior to "closed" transurethral resection of the prostate as consistent with immediate and long-term results.

[Splenic cyst].

True non-parasitic splenic cysts are a rare pathology represented by some 800 cases recorded worldwide. The method of choice for the treatment of this condition is surgical intervention. To-day, open surgery is substituted by low-invasive methods, such as laparoscopic splenectomy. A clinical case is described illustrating approaches to diagnostics and stages of surgical management of this pathology.

[Experience of performing the extraurethral transvesical adenomectomy in patients with BPH].

Despite the development of endourology, issues of open surgical treatment of prostate adenoma remain relevant. It is not always possible to perform transurethral electro-resection of prostate or other minimally invasive surgery. Urologists performing the transvesical adenomectomy still often face serious complications in both early and late in the postoperative period. This article presents a 15-year experience of performing the extraurethral transvesical adenomectomy according to N.F. Sergienko procedure in 308 patients with BPH. Assessment of functional results was performed using uroflowmetry and IPSS score. The effectiveness of extraurethral transvesical adenomectomy (EUTA) was statistically confirmed. The use of EUTA technique allows minimizing intraoperative injury, maintaining the integrity of the front semicircumference and lateral sides of the vesico-urethral segment, which provides early rehabilitation of damaged tissues and contributes to a significant reduction in the number of early and late postoperative complications.

[High-technology extraurethral adenomectomy].

The article presents a method of organ-sparing radical transvesical extraurethral adenomectomy in which adenomatous prostate tissue are removed as individual fragments from semi-oval or wedge-shaped incision of the bladder neck and initial part of the prostatic urethra. Preservation ofprostatic urethra and its vascular plexus provides minimal intraoperative blood loss and less traumatic treatment. Correction of vesico-urethral segment is carried out with full preservation ofthe closing apparatus of the bladder. More than 2,000 patients were followed-up for postoperative immediate and long-term results. Mortality after this type of intervention was 0.89%. Urinary incontinence and urethral stricture were not reported in any patients.

[Retropubic urethro- and vessel-preserving extraurethral adenomectomy].

The article presents the results of an advanced method for retropubic removal of adenomatous prostate tissue. Retropubic extraurethral adenomectomy (REUA) was performed in 29 patients with benign prostatic hyperplasia. Distinctive features of REUA from Lidsky-Millin surgery consist in the fact that the new method of prostatectomy preserve dorsal and urethral vascular plexus and the integrity of the prostatic urethra. Adenomatous tissues fragments are removed through a parallel longitudinally incisions made on the front surface of the fibrous capsule to adenoma. Surgical intervention is accompanied by minimal blood loss and minimal postoperative complications. Hemodynamics of the prostate and external genitalia is not disturbed.

[Erectile dysfunction: choice of the treatment method].

The 15-year clinical experience with falloendoprosthetic operations (FEPO) in patients with erectile dysfunction is reviewed including algorithm of diagnostic examination, prostheses of different generations, indications and contraindications for falloendoprosthetic surgery. The results of 117 FEPO are outlined with special emphasis on 19 cases of postoperative complications. The conclusion is made that FEPO is most effective in erectile dysfunction by the presented criteria of the erectile dysfunction treatment efficacy.

[Current views on surgical treatment of patients with prostatic adenoma].

The article focused on the urgent problem of surgical treatment of patients with BPH. Drug therapy is ineffective in some cases and is mainly used for the initial stages of the disease. Therefore, in urological practice using methods of surgical treatment. The authors are on personal material (more than 2000 patients) comparing the results of surgical treatment of patients with prostatic adenoma after adenomectomy made in ekstraurethral, endourethral, transurethral and retropubic ways.

[Iliac neobladder - 10-year experience].

Surgeons of the clinic of P.V. Mandryka Central Military Hospital have rich 10-year experience in creation of neobladders after cystectomy. So, from 2000 to 2009 a total of 90 cystectomies were made for different diseases of the urinary bladder and prostatic gland as well as in cancer of the other pelvic organs. Vesicoplasty, both heterotopic and orthotopic, was performed from an iliac segment by an original technique with creation of antireflux bypass with the ureters. The examination of the patients in different terms after operation (up to 10 years later) provided information about changes in the neobladder under the influence of urine and systemic changes in the body. The analysis of the results show that creation of the iliac neobladder in our modification is perspective, while side effects are rare. Further long-term follow-up will give new arguments for and against this procedure.

[Gender differences of acute pyelonephritis in the North].

To investigate results of treatment in patients with acute pyelonephritis (AP) among the population of giving age in the North of Russia for prognostication of the disease and decision on further therapy, we studied 1109 case histories of patients treated for urinary infections (UI) including 794 patients with pyelonephritis (119 with AP). Age of both males and females with AP was younger than of UI patients. AP among female inpatients with UI occurred twice more frequently than in males. Ascending AP was characterized by dysuria, mild lumbar pain, symptoms of general intoxication, leukocyturia, bacteriuria, moderate leukocytosis, elevated leukocytic intoxication index (LII) both in males and females. Hematogenic AP in young males presented with lumbar pain, symptoms of general intoxication, leukocytosis, LII elevation in the absent or mild leukocyturia. The main route of renal infection in population of giving age in the North in AP - ascending. Hematogenic route of infection occurs in young males and is typical for pyodestructive AP.

[Comparative characteristics of operative treatment of growth of urocyst].

The authors effectuated a retrospective analyze of operative treatment of 108 patients with carcinoma of urocyst in urological unit of the 2nd CMCH by Mandryka P. V. for the period of 1995-2007.

[Transvesical extraurethral adenomectomy and transurethral prostatic resection in adenoma: specific features].

The procedure of transvesical extraurethral adenomectomy (EUA) and the results of its application were characterized in comparison with transurethral resection (TUR) of the prostate in adenoma. EUA is made via the approach through the extraperitoneal cut of the soft tissues of the anterior abdominal wall, anterior wall of the urinary bladder, semioval or sphenoid incision of the vesicourethral segment. Dissection is conducted of the affected posterior half-round of only proximal prostatic part of the urethra in unaffected anterior and lateral urethral surface. Adenomatous tissues are removed in fragments and radically. Enucleation of the adenomatous nodes is followed by correction of the vesicourethral segment and hemostasis. TUR of the prostate is made without incision of the soft tissues of the anterior abdominal wall, but with removal of the prostatic portion of the urethra, sphincter mechanism of the bladder. After TUR the prostate contains residual adenomatous tissue, inner wound cavity in adenoma bed. The wound of the anterior abdominal wall, anterior wall of the bladder and vesicourethral segment healed by primary intention for 10-14 days, while adenoma bed heals for 6-18 months. EUA does not cause such complication as "adenoma bed", urethral stricture, scar deformation of the bladder neck, urinary incontinence. Radical EUA produces complications 5 times less frequently than TUR of the prostate.

[Characteristics of urinary tract infections in military personnel in military service in Far North].

For the purpose of improvement of the effectiveness of the treatment of urinary tract infections in military personnel in condition of High North were studied 505 clinical records of military personnel took the treatment from 1998 till 2009. It is established that the part of urinary tract infections from the urologic pathology in contract military personnel is higher than in draft military personnel. Among urinary tract infections prevails pyelonephritis associated with urolithiasis and abnormal development of kidneys. The main type of contamination under the acute pyelonephritis in military personnel is ascending. For this type dysuria, leukocyturia and bacteriuria are characteristic. For the hematogenous contamination pain in lumbar region, imperceptible leukocyturia, proteinuria are characteristic. Kidney carbuncles are higher in 2.5 times in draft military personnel. The main pathogen is aurococcus. "Gates" of this infection are furunculuses of different localization.

[Poorly differentiated stomach adenocarcinoma combined with jejunal stromal tumour. Clinical study].

Gastrointestinal stromal tumours (GIST) first described in 1983 are the commonest mesenchymal neoplsams of the digestive tract. The main pathogenetic mechanism is hypersecretion of tyrosin kinase receptor c-kit (CD-117) by GIST cells and its hyperactivation. A rare clinical case of GIST measuring 1.2 CM with concomitant stomach cancer (poorly differentiated carcinoma) is reported. The tumours were discovered intraoperatively. To our knowledge, data on such cases are practically lacking in the literature.

[Transabdominal ultrasonic scanning in evaluation of liver parenchyma: new opportunities].

On suspicion of the diffusive liver lesions 117 patients have been performed a transabdominal ultrasound investigation with a visual estimate of the echogenicity of the structure of the liver's parenchyma in comparison with the echogenicity of the cortical substance of the kidney and with the determination of the homogeneity of the liver's structure on its different areas. For the purpose of the elevation of the self-descriptiveness and precision of diagnostics as well as for the reduction of the subjective estimation the authors carried out the evaluation of the structure of the liver's parenchyma and the cortical substance of the kidneys using the histography on the marked area. The elaboration of the efficient quantitative assessment of the changes of the liver's parenchyma allowed to relieve complications in differential diagnostics and to estimate the damage level of the organ's parenchyma objectively during the investigation.

[Delayed results of proximal gastrectomy in patients with esophageal and gastric varices].

An original method of proximal gastrectomy was used to eliminate hemorrhage from gastric and oesophagal varicose veins in 27 patients with portal hypertension. The follow up period varied from 1 to 23 years. The risk of hemorrhage and the degree of vein dilatation were assessed by endoscopy and endoscopic ultrasonography. It is concluded that the method used in the study may be recommended as the first-line surgery for the management of hemorrhage from gastric and oesophagal varicose veins with good functional results in the late postoperative period and rare complications.