Репозиторий Университета

© Mary Ann Liebert, Inc. Introduction: Endoscopic enucleation of the prostate (EEP) has been recognized as a viable treatment modality for men with benign prostatic hyperplasia (BPH). The aim of our study was to compare the efficacy and functional outcomes of three different techniques of EEP, including monopolar enucleation (MEP), holmium laser enucleation of the prostate (HoLEP), and thulium laser enucleation of the prostate (ThuLEP). Methods: The study consisted of a retrospective comparison of pre- and postoperative parameters in men undergoing three types of EEP: MEP, HoLEP, and ThuLEP. Functional parameters were evaluated before and 6 months after surgery, which included the International Prostate Symptom Score, maximum flow rate, postvoid residual volume, prostate volume, and sodium levels of all patients. Results: A total of 551 men with the mean age of 67.1 years were included in the study. Of these, MEP was performed on 95 patients, HoLEP was performed on 254 patients, and ThuLEP on 202 patients. The mean mass of morcellated tissue obtained during the three techniques did not differ significantly (p > 0.05). Mean procedure times of ThuLEP and HoLEP were shorter than MEP demonstrating 72, 76, and 86 minutes, respectively (p < 0.01). The mean catheterization time following laser EEPs was shorter than MEP as shown by 1.3, 1.3, and 3.8 days, respectively (p < 0.01). Hospital stay times of HoLEP and ThuLEP were shorter than MEP demonstrated by 3.3, 3.4, and 6.9 days, respectively (p < 0.01). Patients after MEP had significant decrease in postoperative hemoglobin and sodium levels. All the groups showed statistically significant improvement in the aforementioned parameters following treatment. Conclusions: Both techniques of laser enucleation proved to be efficacious in the management of BPH. MEP of the prostate seems to be a highly promising addition to the list of enucleation techniques and was determined to be an effective and acceptable procedure, despite a higher complication rate.

© 2018 ABC-press Publishing House. All rights reserved. Background. The high recurrence rate after conventional transurethral resection (cTUR) for bladder cancer (BC) requires search for more effective methods of surgical treatment. Objective: to evaluate the feasibility, safety, and efficacy of cTUR versus thulium laser en bloc resection of bladder tumors using new fiber laser "Urolaz". Materials and methods. 129 patients, who underwent surgical treatment for BC between 2015-2017 in urological department of I.M. Sechenov First Moscow State Medical University were included in the study. The cTUR were performed for 58 patients, 71 patients underwent thulium laser en bloc resection of bladder tumors. Results. The presence of detrusor muscle in specimen was 58.62 % in cTUR group and 91.55 % in thulium laser en bloc resection group respectively. Obturator nerve reflex, bladder perforation, and bleeding in thulium laser en bloc resection group were absent, therefore immediate instillation of chemotherapy was made in all these cases. Recurrence rate after 12 and 18 months after surgery in the group of en bloc resection was statistically lower compared to the cTUR group. Conclusion. The results, obtained in our study shows that thulium en bloc resection using thulium fiber laser "Urolaz" is feasible, effective and safe procedure for patients with BC. Thulium en bloc resection has a number of advantages over the cTUR: Absence of obturator nerve reflex, high quality of specimen for pathological examination (presence of detrusor muscle in specimen was 91.55 %) and low recurrence rate.