Partial urethral resection in the surgical treatment of vulvar cancer does not have a significant impact on urinary continence. A confirmation of an authority-based opinion

2007 ◽  
Vol 17 (1) ◽  
pp. 294-297 ◽  
Author(s):  
Y De Mooij ◽  
M. P.M. Burger ◽  
M. S. Schilthuis ◽  
M. Buist ◽  
J. Van Der Velden
Keyword(s):  
Urinary Incontinence ◽  
Surgical Treatment ◽  
Vulvar Cancer ◽  
Locally Advanced ◽  
Partial Resection ◽  
Urinary Continence ◽  
Control Group ◽  
Study Group ◽  
Partial Removal ◽  
Radical Vulvectomy

Partial resection of the urethra is sometimes necessary in the surgical treatment of locally advanced vulvar cancer. In this study, the frequency of urinary incontinence after partial urethral resection was compared with that of patients who were treated without partial resection of the urethra. Eighteen patients with vulvar cancer encroaching or infiltrating the urethra, treated by a radical vulvectomy and partial urethrectomy, were compared with 17 patients treated by vulvectomy without partial removal of the urethra. Data on urinary incontinence pre- and postoperatively from both groups were retrospectively collected from the patient files. A questionnaire on urinary incontinence was sent to a subset of patients from both groups in order to get information on the current micturation pattern. In four out of 18 patients (22%) with a partial urethrectomy, incontinence was reported, versus two out of 17 patients (12%) in the control group (P= 0.860). Eight patients in the study group and 12 in the control group are currently alive, and all responded to the questionnaire. Two (25%) in the study group and three (25%) in the control group reported to have current symptoms of urinary incontinence. This retrospective study shows that partial resection of 1–1.5 cm of the distal urethra in addition to a radical local excision for vulvar cancer does not result in a significant increase in the frequency of urinary incontinence, compared with vulvar cancer patients without partial urethrectomy.

scholarly journals Direct effectiveness of adding local hyperthermia to the scheme of neoadjuvant chemoradiotherapy for locally advanced rectal cancer

2020 ◽  
Vol 7 (3) ◽  
pp. 10-20
Author(s):  
S. A. Ivanov ◽  
L. O. Petrov ◽  
D. V. Erygin ◽  
I. A. Gulidov ◽  
A. A. Karpov
Keyword(s):  
Rectal Cancer ◽  
Radiation Therapy ◽  
Surgical Treatment ◽  
Tumor Regression ◽  
Therapy Group ◽  
Locally Advanced ◽  
Neoadjuvant Chemoradiotherapy ◽  
Advanced Rectal Cancer ◽  
Control Group ◽  
Study Group

Purpose of the study. Direct evaluation of the antitumor effectiveness of neoadjuvant chemoradiotherapy for rectal cancer using local electromagnetic hyperthermia. Materials and methods. The analysis of the direct results of treatment of patients with locally advanced rectal cancer in the clinic of the MRRC them. A.F.Tsyba is a branch of the Federal State Budgetary Institution Scientific Research Center for Radiology of the Ministry of Health of Russia from 2015 to 2018. The study included 2 groups of patients: the study group of 54 patients and the control group of 56 people. All patients underwent a comprehensive examination with the aim of staging and morphological verification of the tumor. Patients of the study group in the neoadjuvant mode received conventional radiation therapy with classical dose fractionation in ROD 2 Gy, up to SOD 50 Gy, for 5 weeks with CAPOX chemotherapy, and local electromagnetic hyperthermia on the Yacht 4 unit, in the amount of 6 sessions. Patients in the control group received neoadjuvant treatment in an absolutely identical manner, with the exception of local hyperthermia. After the end of neoadjuvant therapy after 8–10 weeks, a comprehensive examination was again performed to assess the response of the tumor and a decision was made to conduct surgical treatment. During the follow-up examination, the following parameters were evaluated: tumor regression according to clinical and radiological examination. After surgical treatment, a comprehensive evaluation of the removed drug was carried out, including an assessment of the degree of therapeutic tumor pathomorphism according to Lavnikova G. P. Results. When conducting a comparative analysis of the frequency of complete clinical regressions of the tumor in the thermo-chemoradiotherapy group, we more often recorded the full clinical response, 12 patients (22%), compared with the chemoradiotherapy group, 8 patients (14%). In terms of partial response and stabilization in the chemoradiotherapy group, partial regression was observed in 75% of patients, while in the thermochemioradiation group only in 52% of cases. Stabilization in the study and control groups was 14% and 6%, respectively. All patients of the study and control groups with partial tumor regression and stabilization underwent surgical treatment. As a result, the frequency of surgical operations in the control group was slightly higher than 48 (85.7%) versus 42 (77.7%) from the main group (p>0.05). When analyzing the frequency of a complete pathomorphological response, we noted that in the thermochemo-radiation therapy group it was 34% versus 4% in the chemo-radiation therapy group. On the contrary, pathomorphism of the 1st degree was much more common in patients of the control group — 21% versus 2% in the study group. The differences in both cases are statistically highly significant (p<0.001, χ2 15, χ27). Conclusion. The use of thermochemoradiotherapy with high statistical significance (p<0.001) increases the frequency of complete pathomorphological response: 34% in the study group versus 4% in the chemoradiotherapy group.

scholarly journals Evolution of diagnosis and surgical treatment of intra-abdominal infiltrates, abscesses of primary and postoperative origin in patients

2021 ◽  
pp. 15-29
Author(s):  
V.V. Skyba ◽  
◽  
V.F. Rybalchenko ◽  
A.V. Ivanko ◽  
R.М. Borys ◽  
...  
Keyword(s):  
Duodenal Ulcer ◽  
Gastric Ulcer ◽  
Surgical Treatment ◽  
Abdominal Cavity ◽  
Postoperative Mortality ◽  
Multiple Organ ◽  
Long Term Results ◽  
Control Group ◽  
Study Group ◽  
Perforated Gastric Ulcer

Purpose – to improve the results of surgical treatment of patients with intra-abdominal infiltrates and abscesses through the introduction of the latest imaging methods and surgical technologies. Materials and methods. In the clinic of the Department of Surgical Diseases No 1, on the basis of the Surgery Center of the Kyiv City Clinical Hospital No. 1 from 2006 to 2019 218 patients with primary and secondary intra-abdominal infiltrates, abscesses and fluid formations were treated. The patients’ age ranged from 16 to 85 years. There were 107 (49.08%) male patients, 111 (50.92%) female patients. Depending on the time of hospitalization (by years), the patients were divided into two groups: the control group (CG) (2006–2012) 117 (53.67%) patients and the study group (SG) (2013–2019) 101 (46.33%) patients. The SG used the latest imaging technologies and improved methods of surgical treatment. Results. The patients were divided into two groups: primary in 191 (87.61%) and secondary postoperative infiltrates and abscesses in 27 (12.39%). The causes of primary infiltrates and abscesses were: complicated forms of appendicitis in 74 (33.94%), perforated stomach and duodenal ulcer in 48 (22.02%), complicated forms of cholecystitis in 69 (31.65%). Postoperative infiltrates and abscesses were observed in 27 (12.39%) patients who underwent urgent surgery: adgeolysis of adhesive ileus in 14 (6.42%) and complicated hernias of various localization in 13 (5.97%). Postoperative complications were diagnosed in 43 (19.72%) patients, of whom 34 (15.59%) from the surgical wound and 29 (15.18%) of the abdominal cavity, who required relaparotomy or laparoscopy, with destructive appendicitis in 10 (13.51%), perforated gastric ulcer and 12 duodenal ulcer in 6 (12.5%), destructive cholecystitis in 9 (13.04%), adhesive intestinal obstruction in 13 (19.12%) and with strangulated and complicated hernias in 14 (17.28%) of the examined patients. During relaparotomy, incompetence of the intestinal wall and intestinal sutures was established in 11 out of 32 patients, an ileostomy was imposed in 7, and cecostomy in 1 patient. Actually, in the control group, 8 (6.84%) patients died on the background of ongoing peritonitis, thrombosis of mesenteric vessels and multiple organ failure and concomitant ailments and in the study group 4 (3.96%) patients died. Conclusions. Surgical treatment is individualized depending on the disease, so with destructive appendicitis from 74 (38.74%) laparotomic in 42 (21.99%), laparoscopic in 32 (16.75%), and in 12 (6.28%) with conversion; perforated gastric ulcer and duodenal ulcer in 48 (25.13%) open laparotomy; with cholecystitis of 69 (36.13%) patients, 48 (25.13%) had laparotomy and 21 (11.00%) had laparoscopic examination. The use of the latest imaging and treatment technologies: Doppler ultrasonography, hydrojet scalpel and laparoscopy in 64 (33.51%), allowed to have better near and long-term results and to reduce postoperative mortality from 6.84% to 3.96%, with an average of 5.5%. The research was carried out in accordance with the principles of the Helsinki declaration. The study protocol was approved by the Local Ethics Committee of these Institutes. The informed consent of the patient was obtained for conducting the studies. The authors declare no conflicts of interests. Key words: destructive appendicitis, cholecystitis, perforated gastric ulcer and 12-duodenal ulcer, adhesive leakage, strangulated hernias, diagnosis and treatment.

scholarly journals Personalized reconstructive and plastic approach in the surgical treatment of vulvar cancer

2021 ◽  
Vol 20 (2) ◽  
pp. 12-16
Author(s):  
A. A. Mukhin ◽  
A. V. Taratonov
Keyword(s):  
Surgical Treatment ◽  
Squamous Cell ◽  
Vulvar Cancer ◽  
Locally Advanced ◽  
Defect Closure ◽  
Anatomical Structures ◽  
Clinical Center ◽  
Vulvar Reconstruction ◽  
Medial Surfaces ◽  
Treatment Volume

Introduction. The choice of a rational method of treatment in vulvar cancer is one of the most actual and difficult problems of modern clinical oncology. In the majority of cases vulvar cancer occurs in elderly and senile patients, as well as in some patients with locally advanced form. The aim of the investigation was to assess the possibility of reconstruction after surgical treatment of vulvar cancer.Materials and Methods. A study was conducted involving 151 patients with squamous cell vulvar cancer in whom the gynecological oncology department of Chelyabinsk regional clinical center of oncology and nuclear medicine performed surgical treatment by various methods in the following volume: dilated vulvectomy with the resection of adjacent anatomical structures with reconstructive and plastic component.Results. The original ways of plasty of the postoperative wound after vulvectomy were evaluated, the minimum risk of  complications was revealed. The presented technologies permit to use additional variants of the wound defect reconstruction and have a number of advantages in comparison with two dermalfascial flaps from the medial surfaces of the femur used earlier. Discussion. Studies have shown that vulvar reconstruction using skin flaps can avoid complications and improve patients' quality of life. Reconstruction with flaps is not currently an accepted standard of treatment for vulvar cancer. Conclusion. The methods of the wound defect closure are possible after radical vulvectomy in patients with squamous cell vulvar cancer and resection of adjacent anatomical structures without reduction of surgical treatment volume. These methods of wound defect closure contribute to the reduction of postoperative complications and significantly reduce postoperative stay in a medical institution.

scholarly journals Abdominal complex muscle in women with stress urinary incontinence – prospective case-control study

2021 ◽  
Author(s):  
Bartlomiej Burzynski ◽  
Tomasz Jurys ◽  
Michalina Knapik ◽  
Kamil Burzynski ◽  
Paweł Rzymski ◽  
...  
Keyword(s):  
Urinary Incontinence ◽  
Stress Urinary Incontinence ◽  
Muscle Thickness ◽  
Isometric Tension ◽  
Transversus Abdominis ◽  
Control Group ◽  
Abdominal Muscles ◽  
Study Group ◽  
Significant Difference ◽  
And Control

IntroductionThis study is designed to assess the percentage share of musculus obliquus externus abdominis, musculus obliquus internus abdominis and musculus transversus abdominis activity among women with stress urinary incontinence using ultrasonography.Material and methodsMaterial and methods: The study is a retrospective analysis of prospective collected data of 84 women aged 23-62 years old. In the study group are women suffering from grade 1 or 2 stress urinary incontinence according to the Stamey classification, the control group consists of women with no micturition disorders. The abdominal muscles activity was measured by using the ultrasound imaging with assessment of muscle thickness.ResultsThe analysis of musculus obliquus externus abdominis in anterolateral abdominal wall activity shows a statistically significant difference between study and control group concerning isometric tension of abdominal muscles (p=0,012) and lower part of abdomen tension (p=0,004). Women with stress urinary incontinence present a higher activity of the musculus obliquus externus abdominis than controls. In the case of the musculus obliquus internus abdominis, statistically significant differences were shown during tension of the lower part of the abdomen (p=0,024). Comparison of activity of the musculus transversus abdominis between study and control groups shows a statistically significant difference during isometric tension of abdominal muscles (p=0,018).ConclusionsThe pattern of activity of the assessed muscles differs between the study group and the control group. In the study group, the activity pattern is concerning the higher activity of the musculus obliquus externus abdominis and the lower activity of the musculus obliquus internus abdominis and musculus transversus abdominis.

scholarly journals Surgical treatment of multi-valve heart disease of infective endocarditis

2021 ◽  
pp. 40-49
Author(s):  
Khamidulla ABDUMADJIDOV ◽  
Hijran BURANOV ◽  
Iskender BAYBEKOV ◽  
Bois SAIDKHANOV ◽  
Abdulla ALIMDJANOV
Keyword(s):  
Heart Disease ◽  
Surgical Treatment ◽  
Infective Endocarditis ◽  
Preventive Measures ◽  
Clinical Results ◽  
Control Group ◽  
Study Group ◽  
X Rays ◽  
Infected Area ◽  
Valve Heart Disease

Peculiarities of diagnosis and results of surgical treatment of multi-valve heart disease in infective endocarditis. Analyze data and clinical results operated 156 patients with infective endocarditis, of which 85 were men (56.5%), and women -71 (45.5%). Age Our patients ranged from 12 to 68 (mean 32.76 ± 1.6) years. Diagnosis was based on the classiϐication and criteria Durack D.T. The patients were divided into 2 groups: group 1, 89 (57.4%) patients who underwent a complex developed by the authors of antibiotic therapy, treatment and preventive measures. 2-group 67 (42.6%) patients who underwent the traditional surgical treatment scheme. The diagnosis used: electrocardiography (ECG), X-rays from Skopje, transthoracic echocardiography (TTEHOKG) - all patients, transesophageal echocardiography (TEHOKG) - at 40.5%; coronaroventriculography (CVG) and angiocardiography (ACG) - at 12.65%; blood culture study in 38.6% of patients, with light gistrology electron microscopy (LEM) - in 47.5% of patients.Intraoperative treatment - preventive measures (TPM) were as follows; mechanical and chemical sanitation of the infected area of the heart; valve implantation antibakteriyalnymi properties; hyperthermic perfusion; anti microbial therapy, including anti-fungal agents. Application of the above measures could reduce mortality in the study group and 5.1% in the control group - 9.3%. In dynamics, declined to 3.9% in the last Godi mortality in the study group.

scholarly journals Comparison of methods of automatic bipolar sealing and monopolar coagulation in the surgical treatment of hemorrhoids in patients with diabetes

2021 ◽  
pp. 47-52
Author(s):  
О. V. Ivanko ◽  
S. V. Skiba ◽  
Hassan Al-Lami Saad Humud ◽  
A. V. Goman ◽  
V. V. Lysytsia
Keyword(s):  
Diabetes Mellitus ◽  
Surgical Treatment ◽  
Daily Activity ◽  
Control Group ◽  
Study Group ◽  
Narcotic Analgesics ◽  
Traditional Methods ◽  
Normal Daily Activity ◽  
Patients With Diabetes ◽  
Surgery Duration

Comparison of LigaSure and traditional methods of surgical treatment of III and IV degree hemorrhoids in patients with diabetes mellitusHemorrhoids are submucosal nodules in the anal canal that contain venules, arterioles, and smooth muscle fibers. Hemorrhoidal disease is registered in approximately 5 % of the total population, especially after 40 years. Treatment is indicated only in symptomatic cases. These symptoms include pain, itching, bleeding, thrombosis and hemorrhoidal prolapse.Aim — to compare the clinical results of he­­mor­rhoidectomy using the electrocoagulation he­mostatic device LigaSure and the traditional Milligan—Morgan method in patients with diabetes mellitus. Materials and methods. The study included 65 patients of both genders aged 18—78 years with stage 3 and 4 hemorrhoids, who underwent hemor­rhoidec­tomy: from them, 33 subject were operated with LigaSure (the main group), and 32 patients with traditional Milligan—Morgan method (control group). The following patients’ data were analyzedretrospec­tively:gender, age, pre- and postoperative hemoglobin and hematocritlevels, surgery duration, the presence of thrombosis, the number of removed and residual hemorrhoids, hospitalization duration, early and late postoperative complications, the need for narcotic analgesics, the observationalperiod, and the time to return to normal daily activity. Results. The mean surgery duration was 16 (6—45) min in the study group and 21 (7—43) min in the control group. Narcotic analgesics in the postoperative period were used in 17 (53.1 %) patients in the control group and were not used in the study group. The timerequired for return to the normal daily activity was 6 (2—15) days in the study group and 8 (2—30) days in the control group. Conclusions. It has been shown that LigaSure gave betterresults of hemorrhoidectomy versus traditional methods in patients with diabetes mellitus in terms of surgery duration, hospitalizationperiod, postoperative pain relief needs, risk of postoperative bleeding, and time required to return to normal daily activity.

Bladder neck sparing radical prostatectomy. Impact on continence and local recurrence

1996 ◽  
Vol 63 (1_suppl) ◽  
pp. 112-115
Author(s):  
G. Fiaccavento ◽  
P. Belmonte ◽  
G. Di Meglio ◽  
R. Zucconelli
Keyword(s):  
Surgical Treatment ◽  
Radical Prostatectomy ◽  
Local Recurrence ◽  
Sexual Function ◽  
Bladder Neck ◽  
Prostatic Carcinoma ◽  
Locally Advanced ◽  
Urinary Continence

Radical prostatectomy is the treatment of choice for stage A e B prostatic carcinoma and optional in locally advanced forms. This surgical treatment, however, can lead to various problems such as preservation of sexual function, urinary continence and local recurrence. We present our experience to show how preservation of bladder neck fibres can influence urinary continence without affecting local recurrence. The latter was found in 13.8% of patients, while 90.7% were continent within 24 hours after removal of the catheter.

Three-year outcomes of sandwich therapy in patients with locally advanced cancer of the middle and lower rectum

2021 ◽  
Vol 11 (2) ◽  
pp. 29-35
Author(s):  
A. A. Aniskin ◽  
D. V. Kuzmichev ◽  
Z. Z. Mamedli ◽  
A. V. Polynovskiy
Keyword(s):  
Rectal Cancer ◽  
Locally Advanced ◽  
Neoadjuvant Treatment ◽  
Distant Metastases ◽  
Advanced Rectal Cancer ◽  
Locally Advanced Rectal Cancer ◽  
Chemoradiation Therapy ◽  
Control Group ◽  
Study Group ◽  
Positive Trend

Background. The most important criteria for the effectiveness of the treatment of locally advanced rectal cancer are indicators of overall survival (OS) and disease-free survival (DSF). Conducting systemic chemotherapy in addition to chemoradiotherapy at the preoperative stage can increase these indicators.Objective: to study analyze the indicators of 3-year OS and DFS, as well as the frequency of local relapses and distant metastases.Materials and methods. From 2013 to 2020, 72 patients with T≥3(CRM+)N0–2M0 lower and middle ampullar rectal cancer were included in the study using sandwich therapy. At the first stage, 2 courses of induction polychemotherapy were carried out according to the CapOx scheme (capecitabine 2000 mg/m2  orally for 14 days and oxaliplatin 130 mg/m2 intravenously once every 3 weeks). Further, chemoradiation therapy was carried out with a total focal dose of 50–56 Gy while taking capecitabine 1650 mg/m2  per day orally on the days of irradiation. After the end of chemotherapy, the patients underwent 2 courses of consolidating polychemotherapy according to the CapOx scheme (capecitabine 2000 mg/m2  orally for 14 days and oxaliplatin 130 mg/m2  intravenously once every 3 weeks). The control group consisted of 72 patients who underwent neoadjuvant treatment in accordance with current clinical guidelines (chemotherapy course with a total focal dose of 50–56 Gy while taking capecitabine 1650 mg/m2  per day orally on the days of irradiation).Results. In 19 (26.4 %) patients from the study group and in 6 (8.3 %) patients from the control group, the achievement of pCR was recorded (p = 0.006). The overall complication rate was 48 (66.7 %) in the study group and 37 (51.4 %) in the control group (p = 0.072), the frequency of grade III–IV toxicity was 8 (11.1 %) and 7 (9.7 %), respectively (p = 0.072). Sphincter-sparing surgical interventions were performed in 52 (72.2 %) and 40 (55.6 %) patients in the sandwich-therapy group and the control group of chemoradiation therapy, respectively (p = 0.037). Resection in the R0 volume was achieved in 71 (98.6 %) and 72 (100 %) patients, respectively (p = 0.316).Conclusion. The use of sandwich therapy is a promising trend in the treatment of patients with locally advanced rectal cancer. There were no significant differences in the frequency of 3-year OS (96.1 % versus 91.5 %, p = 0.247), DFS (89.8 % versus 84.0 %, p = 0.117) and local relapses (0 % versus 4.2 %, p = 0.997). In our study, statistically significant differences were obtained in the incidence of distant metastases (6.9 % versus 18.1 %, p = 0.05), which may indicate a positive trend towards an increase in OS and DFS rates.

The main criteria for conducting surgical treatment of prolapse of pelvic organs and associated with it stress urinary incontinence

2017 ◽  
pp. 40-43
Author(s):  
A.O. Lulko ◽  
Keyword(s):  
Urinary Incontinence ◽  
Surgical Treatment ◽  
Stress Urinary Incontinence ◽  
Control Group ◽  
Pelvic Organs ◽  
Connective Tissue Dysplasia ◽  
Type 3 ◽  
Degrees Of Severity ◽  
Control Group Group ◽  
Group 1

The objective: is to determine the main criteria for the conduct of surgical treatment of prolapse of pelvic organs (POP) and associated with it stress urinary incontinence (SUI). Patients and methods. 85 women were examined with with prolapse of pelvic organs (POP) and stress urinary incontinence (SUI). They were divided into the following groups: 2nd group – 32 patients with prolapse of pelvic organs 1–2 degrees of severity and incontinence 2a, 2b types, mild and moderate severity; 3rd group (primary) – 53 patients with prolapse of pelvic organs of 3–4 degrees of severity and SUI of type 3, moderate and severe severity. The main group included: 3a group – 28 women with prolapse of pelvic organs 3–4 degrees of severity and with SUI 3 type, moderate and severe severity, without delay with urination; 3b group – 25 women with prolapse of pelvic organs 3–4 degrees of severity and with SUI 3 type, moderate and severe severity, with urinary retention (chronic or acute). The control group (group 1) consisted of 15 women without urologic and gynecological pathology. Methods: clinical-anamnestic, instrumental, radiographic, statistical. Results. It was determined that in patients with SUI there are changes in the posterior urethro-vesic angle (PUVU), bladder vesication, signs of connective tissue dysplasia (CTD), and obesity. Conclusions. The combination of such criteria as an increase in the PUVU greater than 114° and the vesiculation of bladder type 2a and above is the main criterion for conducting an operative intervention. Key words: prolapse of pelvic organs, stress urinary incontinence, diagnostics.

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