RESUMEN
We compared efficacy and safety of mono- vs quasibipolar transurethral resection (TUR) for 198 patients treated with TUR. The patients were randomized into two groups by the TUR variant: mono-or quasibipolar. Comparison ofpre- and postoperative examinations data in the above two groups demonstrated: blood sodium decreased more in patients from monopolar TUR group, the absence of TUR-syndrome and less frequent and severe symptoms of obturator nerve irritation after quasibipolar TUR. Use of salt solution in quasibipolar TUR allowed us to avoid such a severe postoperative complication as TUR-syndrome. Thus, transurethral resection in physiological solution is an operation of choice in surgical treatment of prostatic adenoma and superficial cancer of the urinary bladder.
Asunto(s)
Hiperplasia Prostática/cirugía , Resección Transuretral de la Próstata/instrumentación , Resección Transuretral de la Próstata/métodos , Neoplasias de la Vejiga Urinaria/cirugía , Vejiga Urinaria/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Hiperplasia Prostática/sangre , Sodio/sangre , Neoplasias de la Vejiga Urinaria/sangreRESUMEN
Radical cystectomy with creation of orthotopic reservoir from various segments of gastrointestinal tract was made in 120 patients (99 males, 21 females, age 37-74 years) with muscular-invasive cancer of the urinary bladder (UB) in 1996-2004. Replacement of UB was made according to the Studer and Hautmann method in 38 and 27 patients, respectively. S-cystoplasty was performed in 31 patients. The gastric segment was used for creation of the reservoir in 24 patients. Three patients died. Three to twelve month follow-up recorded the best functional results in patients after Studer cystoplasty.
Asunto(s)
Cistectomía , Derivación Urinaria/métodos , Reservorios Urinarios Continentes , Micción/fisiología , Urodinámica/fisiología , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Neoplasias de la Vejiga Urinaria/cirugía , Reservorios Urinarios Continentes/efectos adversosRESUMEN
Repair of long uretheral defects with the appendix (appendi-couretheroplasty--AUP) was made in 5 patients. Stenosis of the lumbar urether was caused by a gunshot wound in one patient. Uretheral strictures developed after iatrogenic injury during extended gynecological operations in 3 women. The strictures arose after radiotherapy in one female. The man has undergone plastic reconstruction of the upper third of the right ureter, while women - replacement of the pelvic urether, including one case on the left. In two cases a modified surgical technique was used for better appendicocystanastomosis--a flap was dissected from the cupola of the cecum. In one case surgery was combined with simultaneous contralateral Boari's operation, in the other case--with transvaginal suturing of the vesicovaginal fistula. Exacerbation of chronic pyelonephritis occurred in one patient. In the other case antegrade pyeloureterography has detected stricture of ureteroappendicoanastomosis. Resection of the stricted place and reanastomosing were performed in this patient. Passability of the urinary tract recovered in all the patients. Thus, replacement of any part of the right and pelvic part of the left ureter with the appendix is feasible with good results.
Asunto(s)
Apéndice/trasplante , Procedimientos de Cirugía Plástica/métodos , Enfermedades Ureterales/cirugía , Procedimientos Quirúrgicos Urológicos/métodos , Adulto , Femenino , Humanos , Enfermedades Ureterales/etiología , Enfermedades Ureterales/fisiopatología , Urodinámica , UrografíaRESUMEN
Orthotopic cystoplasty for various diseases of the urinary bladder was made in 58 females aged 22 to 78 years (mean age 52.5 +/- 5.8 years) in 1996-2005. Surgery was indicated in muscular-invasive cancer of the bladder (n = 35, 60.3%), microcystis (n = 21, 36.3%), bladder atonia (n = 1, 1.7%), vesicovaginal fistula (n = 1, 1.7%). The reservoir was made of iliac segment in 50 (86,2%) patients, of gastric body - in 8 (13.8%) patients. Postoperative complications arose in 7 (12.1%) patients, late complications occurred in 4 (6.8%). Postoperative lethality was not registered, 12 months later 3 (5.2%) patients died of cancer progressiion. Day continence after ileo- and gastrocystoplasty was 93.3 and 87.8%, night - 45.2 and 32.8%, respectively. Urodynamics was satisfactory. Chronic continence occurred in 3 (5.6%) patients. Satisfactory clinical and functional results of artificial reservoir creation in females support advantages of this method of urine derivation. Gastrocystoplasty is a promising method of urinary bladder replacement. It is important to assess function of the lower urinary tract before operation. Reservoir-vaginal fistula is a new kind of urogenital fistulas. It is treated by transvaginal fistuloraphy.