Vol 25, No 7 (2023): Урология
Articles
Prevention of postoperative pyelonephritis in patients after percutaneous nephrolithotripsy for large and coral kidney stones
Abstract
Background. Improving the results of prevention and treatment of postoperative pyelonephritis, the most frequent complication of percutaneous nephrolithotripsy, is an important task of modern urology.
Aim. To determine the effectiveness of using physiotherapeutic procedures (magnetotherapy and laser therapy) for prevention of pyelonephritis development in the postoperative period.
Materials and methods. The study included 72 patients with kidney stones of large size who underwent percutaneous nephrolithotripsy. The patients were divided into two groups: group 1 – 44 patients with kidney stone over 2.5 cm (including coral), group 2 – 28 patients with kidney stone over 2.5 cm (including coral) who underwent physiotherapeutic procedures in the perioperative period in combination with antibiotic therapy. All patients underwent percutaneous nephrolithotripsy with preoperative administration of antibacterial therapy. All patients underwent urine and stone culture, as well as laboratory and clinical evaluation of pyelonephritis attack development in the postoperative period.
Results. Analysis of histories showed that in group 1, clinical symptoms of pyelonephritis exacerbation were observed more frequently in operated patients than in patients who underwent physical therapy in the perioperative period. The severity and duration of hyperthermia in the group 2 was noted to be not so high and prolonged. The percentage of microflora detection in urine and stone cultures was insignificantly different in both groups. At the same time, the level of leukocytosis in the group 2 in the postoperative period was on average lower, a 3-fold decrease in the frequency of prescribing "reserve" antibacterial drugs was also revealed.
Conclusion. In patients with large and coral kidney stones physiotherapeutic procedures can be used in combination with antibacterial therapy for prevention and treatment of pyelonephritis exacerbation in the postoperative period after percutaneous nephrolithotripsy.
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Fosfomycin: An old antibiotic and new perspectives. A review
Abstract
Urinary tract infection (UTI) is one of the most common urological diseases and presents a problem for rational antibiotic therapy due to the growing antibiotic resistance. Fosfomycin is one of the older low molecular weight, broad-spectrum bactericidal antibiotics with activity against uropathogens, particularly Escherichia coli and others. Fosfomycin is administered as a single dose that achieves very high concentrations of the antibiotic in the urine and bladder, sufficient to eliminate most common uropathogens, including those with multidrug resistance (MDR). Many factors have contributed to the persistence of fosfomycin's antibacterial activity, including the use of a single dose, limited use for UTIs only, and very high and persistent urinary concentrations that rapidly kill bacteria, reducing the possibility of mutant selection. In addition to its antimicrobial properties, fosfomycin has an immunomodulatory effect by altering the function of lymphocytes, monocytes, and neutrophils. It affects the acute inflammatory cytokine response. New data have been obtained on the activity of fosfomycin against biofilms formed by uropathogens and against biofilm-associated bacterial strains with MDR. A new 2020 meta-analysis compared the efficacy of fosfomycin with equivalent antibiotics (β-lactams/cephalosporins, quinolones, sulfonamides, nitrofurantoin) in women in the broad categories of uncomplicated UTI or asymptomatic bacteriuria and found no difference in clinical and microbiological cure rates with comparison groups. A number of other studies in patients with UTIs with MDR or complicated course also showed a high sensitivity of uropathogens to fosfomycin and the effectiveness of treatment with multiple doses (2–3 doses with an interval of 48–72 hrs). Fosfomycin is being considered as a potentially useful antibiotic for the treatment of prostatitis. Current data indicate that sufficient concentrations in prostate tissue are achieved after a single dose of fosfomycin. Recent reviews in 2019 and 2022 present results of studies of fosfomycin for the prevention of infectious complications after transurethral prostate biopsy and in patients with chronic bacterial prostatitis whose pathogens are resistant to other antibiotics. Thus, the accumulation of new scientific data on the mechanisms of action and resistance of fosfomycin reveals more potential advantages of its practical application.
433-438
Endovideoscopic urethra-sparing simple prostatectomy via an extraperitoneal approach as treatment of benign prostatic hyperplasia
Abstract
Aim. To evaluate the efficacy of endovideoscopic urethra-sparing simple prostatectomy via an extraperitoneal approach (EUSP) for patients with benign prostatic hyperplasia.
Materials and methods. In the period from January 2021 until September 2022 8 patients underwent EUSP. Initial clinical datas, perioperative and postoperative outcomes, implications, IPSS questionnaires, IIEF-5 and ejaculatory datas have been evaluated. The technique of the present method was adopted from Ping Wang, Dan Xia, SunYi Ye, DeBo Kong, Jie Qin, TaiLe Jing, YeQing Mao, HongZhou Meng, Shuo Wang (2018).
Results. Seven (87.5%) patients underwent EUSP successfully, 1 (12.5%) patient needed conversion into open simple prostatectomy. Mean time of operation was 171 minutes (150–185), mean blood loss was 232 ml (180–300). In 2 (25%) cases urethral reconstruction after damage was needed. Mean catheterization time was 1.5 days (1–4). According to Clavien–Dindo classification (2004) such complications were found: low degree – 2 (1 or 2 group), 3а group – 1 (severe hematuria, when bladder infusion is needed). Mean management time was 8.4 months (6–11). Results from post-operative questionnaire IPSS (p<0.1) и QoL (p<0.1) significantly improved. Totally 4 patients had secure erectile function: 3 of them had normal erection, the last one (1) – retrograde ejaculation.
Conclusion. EUSP is technically applicable for patients with benign prostatic hyperplasia. Patients have shorter time of catheterization, risk profile, significant improvement of urination и support of antegrade ejaculation.
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The effectiveness of preventive use of partially hydrolyzed dietary fibers of cyamopsis tetrahedral (OptiFibre®) in patients with benign prostatic hyperplasia and chronic functional constipation
Abstract
Anatomical proximity of the prostate gland and colon, common innervation, blood and lymph circulation create prerequisites for the involvement of the intestine in the pathological process in prostate diseases.
Aim To evaluate the effectiveness of preventive treatment of chronic constipation (CC) with the use of partially hydrolyzed dietary fibers of cyamopsis tetrahedral (OptiFiber®) in patients with benign prostatic hyperplasia (BPH) who are shown to have a prostate tour and its effect on the course of the postoperative period.
Materials and methods. We examined 60 patients with BPH who were referred for surgical treatment (transurethral resection of the prostate), who had chronic functional constipation. By random sampling, the patients were divided into two groups of 30 people. In group 1, standard preparation for surgical treatment was carried out for 1 month. In group 2, patients, in combination with standard preparation for surgical treatment, took partially hydrolyzed dietary fibers of cyamopsis tetrahedral (OptiFiber®) with food for the first 3 days – 1 sachet (5 g) per day, from the 4th to the 6th day – 2 sachets per day. From day 7, patients in group 2 were divided into two subgroups. In subgroup 2a, patients whose bowel function returned to normal continued taking the drug at a dose of 2 sachets per day. Those patients in whom the effect of restoring the regularity of bowel function was not satisfactory, took 3 sachets a day from the 7th day and were assigned to subgroup 2b. In the preoperative period, patients were examined on the 1st day (visit 1), 15th day (visit 2) and 30th day (visit 3) of observation. The average number of acts of defecation during the previous week, the severity and dynamics of clinical manifestations of constipation were evaluated on the basis of the Patient Assessment of Constipation Symptoms (PAC-SYM questionnaire), according to the totality of symptoms in points, as well as for each criterion separately. Evaluation of the effectiveness of treatment in the postoperative period was carried out on the basis of dynamic observation for 5–7 days.
Results. Initially, all patients in the two groups had signs characteristic of BPH and chronic functional constipation, the groups were homogeneous. According to the results obtained in group 1 for 30 days of follow-up before surgery, none of the studied parameters significantly changed (p>0.05). In group 2, after 15 days of follow-up, a significant (p<0.05) positive dynamics was revealed for all the studied indicators, both in comparison with group 1 and in comparison with the results obtained at visit 1. By visit 3, despite the absence of statistically significant dynamics in the indicators of both group 1 and group 2, in comparison with visit 2, significant (p<0.05) differences remained between the groups. During the study, subgroup 2a included 19 patients who took 2 sachets of OptiFiber® per day, and subgroup 2b included 11 men who took 3 sachets per day from the 7th day of observation. Restoration of intestinal motility in patients taking dietary fiber occurred at an earlier time, while the differences were also statistically significant (p<0.05). In group 1, 14 cases of early postoperative complications were registered, and in group 2–9 cases, which is 35.7% less. The number of cases of antibiotic-associated diarrhea in group 1 was 3, while in group 2 there was 1 such case, which is 66.7% less. When analyzing the results obtained, there were no significant differences in the studied parameters in the postoperative period between subgroups 2a and 2b. All 30 (100%) patients of group 2 gave a positive review of partially hydrolyzed dietary fibers of cyamopsis tetrahedral (OptiFiber®), and plan to continue taking them after completing participation in the study.
Conclusion. Thus, according to the results of the study, we consider it appropriate to use partially hydrolyzed dietary fibers of cyamopsis tetrahedral (OptiFiber®) in the treatment of CC in patients with BPH who are shown to have a prostate tour as a means to effectively eliminate the manifestations of CC, improve the results of surgical treatment and improve the quality of life of this category of patients.
443-449
Endovideoscopic simple prostatectomy via extraperitoneal research as treatment of benign prostatic hyperplasia
Abstract
Aim. To estimate the efficacy of endovideoscopic simple prostatectomy via extraperitoneal research as treatment of benign prostatic hyperplasia.
Materials and methods. In the period since January 2021 until May 2022 45 males with prostatic volume >60 g have underwent extraperitoneal endovideoscopic retropubic prostatectomy was. Endovideoscopic research consisted of standard technical steps: the creation of preperitoneal workspace, hemostasis control in the area of lateral peduncles and dorsal venous complex, anterior transverse incision of prostatic capsule, simple prostatectomy and organ extraction.
Results. Mean weight of resected prostatic tissue was 79.3±17.4 g. Mean operation time was 104.3±25.4 min. No conversion into open prostatectomy was needed. Blood transfusion was provided in 3 patients. After 6 months 40 patients demonstrated decrease of mean IPSS (International Prostate Symptom Score) from 25.5±2.4 to 6.2±2.1, increase of Qmax from 6.1±2.8 to 18.7±3.4 ml/s. No patients had urinary incontinence.
Conclusion. Endovideoscopic retropubic simple prostatectomy via extraperitoneal research (Millin’s method) is workable and technically simple surgical method.
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The role of ultrasound and dopplerography in the assessment of lower urinary tract dysfunction (literature review)
Abstract
This review is devoted to the study of the prevalence of symptoms of the lower urinary tract and the justification of the use of non-invasive and accessible methods of their diagnosis with an assessment of not only structural, but functional indicators. These include ultrasound examination of the bladder with the determination of functional and maximum volumes and the calculation of the sensitivity index, quantitative and speed indicators of ureteral emissions using color flow mapping, as well as assessment of the blood flow of detzurosis by means of vascular dopplerography.
453-455
Laparoscopic nephrectomy for polycystic kidney disease: Benefit or necessity?
Abstract
Background. According to foreign and domestic authors, autosomal dominant polycystic kidney disease (ADPKD) is a disease accompanied by a progressive deterioration in the functional state of the kidneys and occupies a significant contribution to the structure of all causes leading to the end stage of chronic renal failure (ESRD). An increase in the volume of the kidneys and the development of complications significantly worsen the quality of life of these patients. Open surgical interventions are accompanied by a more severe course. In this connection, the question of choosing the timing and method of surgical intervention in this group of patients remains relevant.
Aim. To evaluate the results of nephrectomy in patients with ADPKD for the period from 2016 to 2022, performed at the Krasnoyarsk Regional Clinical Hospital.
Materials and methods. Within 6 years, 22 nephrectomies were performed in 20 patients with ADPKD. Monolateral nephrectomy was performed in 12 cases, simultaneous bilateral surgery was performed in eight patients. The mean age of the patients was 51.3±7.9 years. Mostly nephrectomy was performed by laparoscopic approach (17 patients), lumbotomy operation was performed in three patients. The need for conversion during laparoscopic operations was not noted.
Results. Open surgical treatment was performed only because of uncontrolled gross hematuria and suppuration of cysts. All patients were transferred to the intensive care unit after surgery. Repeated surgery due to the development of bleeding was required in 33.3% of cases. The need for an inpatient stage of treatment was 15.1±2.8 days. In one case, a fatal outcome was recorded. Laparoscopic nephrectomy was performed in 17 patients, monolateral in seven patients, staged bilateral in two, and simultaneous bilateral in eight patients. In 41% of cases, in addition to pain and hypertension, nephrectomy was due to the upcoming kidney transplantation. The average volume of removed kidneys was 3138.74±356.30 ml. The average bed-day was 8.86±2.4 days.
Conclusion. The increase in the number of patients with ADPKD and ESRD raises the question of the improvement in their quality of life that can be achieved by unilateral or bilateral nephrectomy. However, there are no clearly regulated criteria that determine the indications for these types of surgery. Despite certain difficulties, we believe that laparoscopic nephrectomy in patients with ADPKD and ESRD is the most optimal.
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