scholarly journals Bladder neck sclerosis: alternative methods of treatment and prospects for their development

2021 ◽  
Vol 14 (3) ◽  
pp. 94-99
Author(s):  
S.A. Abbosov ◽  
◽  
N.I. Sorokin ◽  
A.V. Kadrev ◽  
A.B. Shomarufov ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Bladder Neck ◽  
Balloon Dilatation ◽  
Laser Energy ◽  
Treatment Options ◽  
Alternative Methods ◽  
Cochrane Library ◽  
Invasive Treatment ◽  
Prostate Diseases ◽  
Methods Of Treatment

Introduction. Bladder neck sclerosis (BNS) is a widespread complication of the surgical treatment of prostate diseases. Nevertheless, the etiology and pathogenesis of BNC development are not well understood, the frequency and degree of iatrogenic BNS varies depending on what treatment took place before its appearance. Treatment options for BNS can vary from simple dilatation to complex surgical interventions. Clinical variants of BNS, as well as their treatment options, vary in complexity, from simple short annular contractures to obliterating stenosis, which requires a significant expansion of surgical treatment volume. The purpose of this study – is to assess the effectiveness of modern and alternative methods of prevention and treatment of BNS based on the analysis of published studies. Materials and methods. The search and analysis of publications in the databases PubMed, Scopus, Cochrane Library, elibrary, according to the keywords, «bladder neck sclerosis», «benign prostatic hyperplasia», «bladder neck contracture», «bladder neck stenosis», «balloon dilatation», «treatment». As a result, 46 publications were selected and included in this review. Results and discussion. In this review, we highlighted the routine and alternative methods of BNS treatment. Currently, there are quite modern methods for treating prostate diseases (using robotic techniques, electrosurgical resections, and enucleations, laser enucleations, etc.), which are often complicated by secondary BNS. Nowadays, there are a lot of routine and alternative methods of treatment of secondary BNS in the urologist’s armamentarium. Routine methods include TUR and incision of the bladder neck using electric and laser energy, alternative methods include balloon dilatation, installation of a urethral stent, instillation (or intraoperative injection) of the bladder with cytostatics, hormonal drugs, derivatives of hyaluronic acid, and biomedical cell products. Conclusions. According to the literature from the listed alternative treatment methods for BNS, balloon dilatation is the most promising one. Based on the results of the literature analysis, we concluded that the use of balloon dilatation as a method of primary (least invasive) treatment and prevention of the occurrence of BNS is advisable.

scholarly journals Emphysematous pyelonephritis: epidemiology, modern approaches to diagnosis and treatment

2020 ◽  
Vol 13 (5) ◽  
pp. 100-105
Author(s):  
A.A. Novinsky ◽  
◽  
A.F. Zinukhov ◽  
◽  
Keyword(s):  
Surgical Treatment ◽  
Conservative Treatment ◽  
Minimally Invasive ◽  
Bacterial Flora ◽  
Invasive Treatment ◽  
Scientific Publications ◽  
Emphysematous Pyelonephritis ◽  
Methods Of Treatment ◽  
Minimally Invasive Methods ◽  
Clinical Cases

Introduction. Emphysematous pyelonephritis (EPN) is a rare form of acute suppurative pyelonephritis, which is characterized by a rapid and severe course due to the pathogenic effect of the gas-forming bacterial flora. Currently, only a few hundred clinical cases of EPN are described in the literature. Currently, there are no standards for the surgical treatment of patients with EPN, but there is a clear tendency towards a wider use of minimally invasive methods of treatment and limitation of indications for nephrectomy. A risk-based approach based on the proposed radiological classifications of EPN is considered preferable. Purpose. Тo study all literature sources available for the current period on the Internet, describing clinical cases and experience in treating patients with a diagnosis of emphysematous pyelonephritis. Materials and methods. Тhe results of a search in the scientific databases PubMed, MEDLINE, Embase, elibrary were analyzed for the queries «emphysematous pyelonephritis», «classification», «gassing bacterial flora», «diabetes mellitus», «conservative treatment», «nephrectomy», «percutaneous drainage». 754 scientific publications were found, 25 were selected for detailed analysis. Results and discussion. Today, there are no standards for surgical treatment of patients with EP, but there is a clear trend towards wider use of minimally invasive methods of treatment and limiting the indications for nephrectomy. Minimally invasive methods of treating EN allows organ-preserving treatment and reduces the risk of renal failure. The lack of clear indications for the choice of the scope of surgical treatment and the low orientation of specialists towards radiological diagnostic criteria are the main reasons for excessive organ-carrying treatment of patients with PF. A risk-mediated approach based on the proposed clinical and radiological classifications of EP is considered preferable. In controversial cases, it is possible to recommend an attempt at minimally invasive treatment in combination with adequate conservative therapy, and only if it is ineffective, resort to performing nephrectomy. Conclusion. Indications for nephrectomy should be strictly limited and revised taking into account modern approaches. Nephrectomy should be an option of choice only if conservative treatment is impossible or ineffective.

scholarly journals Melanotic neuroectodermal tumor of infancy: a description of the experience of Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology and literature review

2019 ◽  
Vol 6 (3) ◽  
pp. 44-53
Author(s):  
A. M. Suleymanova ◽  
S. S. Ozerov ◽  
V. Yu. Roshchin ◽  
N. S. Grachev ◽  
N. A. Bolshakov ◽  
...  
Keyword(s):  
Treatment Options ◽  
Locally Advanced ◽  
Morphological Characteristics ◽  
Neck Region ◽  
Neuroectodermal Tumor ◽  
Alternative Methods ◽  
Rare Type ◽  
Pediatric Hematology ◽  
National Medical ◽  
Methods Of Treatment

Melanotic neuroectodermal tumor of infancy (MNTI) is a rare type of tumor with uncertain clinical behavior. The tumor commonly occurred in the head and neck region. Radical surgical resection is the standard of treatment, which is often associated with high risks of severe postoperative complications due to tumor localization. Alternative methods of treatment including chemotherapy/radiotherapy are used in metastatic, locally advanced and relapsed cases of MNTI. The aim of this study was to analyze clinical and morphological characteristics of the tumor, evaluate the effectiveness of various treatment options, and to describe two clinical cases of MNTI.

scholarly journals Application of olfactory ensheathing cells in clinical treatment of spinal cord injury: meta-analysis and prospect

2019 ◽  
Vol 7 (2) ◽  
pp. 70-81
Author(s):  
Huijing Chen ◽  
Qijia Tan ◽  
Caijun Xie ◽  
Cong Li ◽  
Yun Chen ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Meta Analysis ◽  
Treatment Options ◽  
Primary Source ◽  
Olfactory Ensheathing Cells ◽  
Cochrane Library ◽  
Invasive Treatment ◽  
Cord Injury ◽  
Ensheathing Cells

Background:A number of clinical trials of olfactory ensheathing cells (OECs) for the treatment of chronic spinal cord injury (SCI) have been carried out all over the world. However, their safety and efficacy have not been basically evaluated. Moreover, there are no uniform standards laid out for the use of optimal source, transplantation method and the dosage of OECs.Objective:This study evaluated the source, dose, and route of transplantation of OECs for the treatment of chronic SCI.Methods:PubMed, Cochrane Library, EMBASE, CNKI, and Wanfang Data were searched for the clinical studies of OECs in the treatment of chronic SCI on July 2018.Results:A total of 30 articles on OECs transplantation for chronic SCI were selected for comprehensive evaluation of OECs sources, doses, and transplantation methods. The efficacy of OECs in the treatment of chronic SCI was evaluated using Review Manager 5.3.Conclusion:Fetal OECs are the primary source of cells for the treatment of chronic SCI in OECs, with standardized cell-culture and quality-control processes. Fetal OECs can significantly improve the neurological function of patients with chronic SCI. It is an ideal cell therapy for neurorestoration. However to explore more precise and minimally invasive treatment options are required in the future.

scholarly journals METHODS OF TREATMENT OF POST-NECROCTIC PANCREATIC CYSTS: MODERN LOOK AT THE PROBLEM (LITERATURE REVIEW)

2017 ◽  
Vol 2 (5) ◽  
pp. 147-154
Author(s):  
Igor Noskov ◽  
Igor Noskov
Keyword(s):  
Surgical Treatment ◽  
Minimally Invasive ◽  
Diagnostic Algorithm ◽  
Clinical Results ◽  
Pancreatic Cysts ◽  
Invasive Treatment ◽  
Clear Trend ◽  
Wide Range ◽  
Few Data ◽  
Methods Of Treatment

The problem of choosing the method of surgical treatment of postnecrotic pancreatic cysts remains extremely urgent these days. With the development of technology, recently there has been a clear trend towards improving diagnostic capabilities and the emergence of an increasing number of minimally invasive methods of treatment, while traditional methods of surgical treatment do not lose their relevance, but recent studies optimize the indications for their implementation, which in turn reduces the frequency of the nearest and distant postoperative complications. In the article the questions concerning conservative therapy of postnecrotic cysts, indications and choice of a method of surgical treatment are considered. The methods of minimally invasive surgery are widely covered, the application of which allows achieving excellent clinical results of treatment. Particular attention is paid to the recent tendency of using several methods of minimally invasive treatment, the combination of minimally invasive internal and external drainage has shown its effectiveness, it should be noted that a good clinical result can be achieved by performing intervention data from the position of pathogenetic treatment. There are only a few data on the success of combined drainage of postnecrotic cysts, which requires confirmation by a large number of publications. Thus, the high incidence of acute pancreatitis, the lack of a diagnostic algorithm and clear indications for a wide range of existing methods of surgical treatment of postnecrotic pancreatic cysts leaves a field for subsequent studies and observations.

Treatments for Periductal Mastitis: Systematic Review and Meta-Analysis

Breast Care ◽  
2021 ◽  
pp. 1-8
Author(s):  
Huiying Xu ◽  
Ruidong Liu ◽  
Yanli Lv ◽  
Zhenhua Fan ◽  
Weimin Mu ◽  
...  
Keyword(s):  
Primary Closure ◽  
Meta Analysis ◽  
Treatment Options ◽  
Breast Disease ◽  
Infected Tissue ◽  
Cochrane Library ◽  
Invasive Treatment ◽  
Incision And Drainage ◽  
Radial Incision ◽  
Periductal Mastitis

Introduction: Periductal mastitis (PDM) is a complex benign breast disease with a prolonged course and a high risk of recurrence after treatment. There are many available treatments for PDM, but none is widely accepted. This study aims to evaluate the various treatment failure rates (TFR) of different invasive treatment measures by looking at recurrence and persistence after treatment. In this way, it sets out to inform better clinical decisions in the treatment of PDM. Methods: We searched PubMed, Embase, and Cochrane Library databases for eligible studies about different treatment regimens provided to PDM patients that had been published before October 1, 2019. We included original studies written in English that reported the recurrence and/or persistence rates of each therapy. Outcomes were presented as pooled TFR and 95% CI for the TFR. Results: We included 27 eligible studies involving 1,066 patients in this study. We summarized 4 groups and 10 subgroups of PDM treatments, according to the published studies. Patients treated minimally invasively (group 1) were subdivided into 3 subgroups and pooled TFR were calculated as follows: incision and drainage (n = 73; TFR = 75.6%; 95% CI 27.3–100%), incision alone (n = 74; TFR = 20.1%; 95% CI 0–59.9%), and breast duct irrigation (n = 123; TFR = 19.4%; 95% CI 0–65.0%). Patients treated with a minor excision (excision of the infected tissue and related duct; group 2) were divided into 4 subgroups and pooled TFR were calculated as follows: wound packing alone (n = 127; TFR = 2.1%; 95% CI 0–5.2%), primary closure alone (n = 66; TFR = 37.1%; 95% CI 9.5–64.8%), primary closure under antibiotic treatment cover (n = 55; TFR = 4.8%; 95% CI 0–11.4%) , and additional nipple part removal (n = 232; TFR = 9.6%; 95% CI 5.8–13.4%). Patients treated with a major excision (excision of the infected tissue and the major duct; group 3) included the following 2 subgroups: patients treated with a circumareolar incision (n = 142; TFR = 7.5%; 95% CI 0.4–14.7%) and patients treated with a radial incision of the breast (n = 78; TFR = 0.6%; 95% CI 0–3.6%). Group 4 contained patients receiving different major plastic surgeries. The pooled TFR of this group (n = 86) was 3.4% (95% CI 0–7.5%). Conclusion: Breast duct irrigation, which is the most minimally invasive of all of the treatment options, seemed to yield good outcomes and may be the first-line treatment for PDM patients. Minor excision methods, except for primary closure alone, might be enough for most PDM patients. Major excision, especially with radial incision, was a highly effective salvage therapy. The major plastic surgery technique was also acceptable as an alternative treatment for patients with large lesions and concerns about breast appearance. Incision and drainage and minor excision with primary closure alone should be avoided for PDM patients. Further research is still needed to better understand the etiology and pathogenesis of PDM and explore more effective treatments for this disease.

scholarly journals Efficacy and safety of gout flare prophylaxis and therapy use in people with chronic kidney disease: a Gout, Hyperuricemia and Crystal-Associated Disease Network (G-CAN)-initiated literature review

2021 ◽  
Vol 23 (1) ◽  
Author(s):  
Huai Leng Pisaniello ◽  
Mark C. Fisher ◽  
Hamish Farquhar ◽  
Ana Beatriz Vargas-Santos ◽  
Catherine L. Hill ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Renal Function ◽  
Kidney Disease ◽  
Literature Review ◽  
Interleukin 1 ◽  
Treatment Options ◽  
Cochrane Library ◽  
Efficacy And Safety ◽  
Clinical Trial Results ◽  
Gout Flare

AbstractGout flare prophylaxis and therapy use in people with underlying chronic kidney disease (CKD) is challenging, given limited treatment options and risk of worsening renal function with inappropriate treatment dosing. This literature review aimed to describe the current literature on the efficacy and safety of gout flare prophylaxis and therapy use in people with CKD stages 3–5. A literature search via PubMed, the Cochrane Library, and EMBASE was performed from 1 January 1959 to 31 January 2018. Inclusion criteria were studies with people with gout and renal impairment (i.e. estimated glomerular filtration rate (eGFR) or creatinine clearance (CrCl) < 60 ml/min/1.73 m2), and with exposure to colchicine, interleukin-1 inhibitors, non-steroidal anti-inflammatory drugs (NSAIDs), and glucocorticoids. All study designs were included. A total of 33 studies with efficacy and/or safety analysis stratified by renal function were reviewed—colchicine (n = 20), anakinra (n = 7), canakinumab (n = 1), NSAIDs (n = 3), and glucocorticoids (n = 2). A total of 58 studies reported these primary outcomes without renal function stratification—colchicine (n = 29), anakinra (n = 10), canakinumab (n = 6), rilonacept (n = 2), NSAIDs (n = 1), and glucocorticoids (n = 10). Most clinical trials excluded study participants with severe CKD (i.e. eGFR or CrCl of < 30 mL/min/1.73 m2). Information on the efficacy and safety outcomes of gout flare prophylaxis and therapy use stratified by renal function is lacking. Clinical trial results cannot be extrapolated for those with advanced CKD. Where possible, current and future gout flare studies should include patients with CKD and with study outcomes reported based on renal function and using standardised gout flare definition.

scholarly journals EAU, AUA and NICE Guidelines on Surgical and Minimally Invasive Treatment of Benign Prostate Hyperplasia: A Critical Appraisal of the Guidelines Using the AGREE-II Tool

2021 ◽  
pp. 1-10
Author(s):  
Dmitry Enikeev ◽  
Vincent Misrai ◽  
Enrique Rijo ◽  
Roman Sukhanov ◽  
Denis Chinenov ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Treatment Options ◽  
Stakeholder Involvement ◽  
Minimally Invasive Treatment ◽  
Invasive Treatment ◽  
Agree Ii ◽  
Prostate Hyperplasia ◽  
Assessment Score ◽  
Nice Guideline ◽  
Agree Ii Tool

<b><i>Objective:</i></b> To critically appraise the methodological rigour of the clinical practice guidelines (CPGs) vis-à-vis BPH surgery as used by specialist research associations in the US, Europe and UK, and to compare whether the guidelines cover all or only some of the available treatments. <b><i>Methods:</i></b> The current guidelines issued by the EUA, AUA and NICE associations have been analyzed by 4 appraisers using the AGREE-II instrument. We also compared the recommendations given in the guidelines for surgical and minimally invasive treatment to find out which of these CPGs include most of the available treatment options. <b><i>Results:</i></b> According to the AGREE II tool, the median scores of domains were: domain 1 scope and purpose 66.7%, domain 2 stakeholder involvement 50.0%, domain 3 rigor of development 65.1%, domain 4 clarity of presentation 80.6%, domain 5 applicability 33.3%, domain 6 editorial independence 72.9%. The overall assessment according to AGREE II is 83.3%. The NICE guideline scored highest on 5 out of 6 domains and the highest overall assessment score (91.6%). The EAU guideline scored lowest on 4 out of 6 domains and has the lowest overall assessment score (79.1%). <b><i>Conclusions:</i></b> The analyzed CPGs comprehensively highlight the minimally invasive and surgical treatment options for BPH. According to the AGREE II tool, the domains for clarity of presentation and editorial independence received the highest scores. The stakeholder involvement and applicability domains were ranked as the lowest. Improving the CPG in these domains may help to improve the clinical utility and applicability of CPGs.

“Proximalization is Advancement”—Zone 3 Frozen Elephant Trunk vs Zone 2 Frozen Elephant Trunk: A Literature Review

2021 ◽  
pp. 153857442110024
Author(s):  
Rozina Yasmin Choudhury ◽  
Kamran Basharat ◽  
Syeda Anum Zahra ◽  
Tien Tran ◽  
Lara Rimmer ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Surgical Treatment ◽  
Literature Review ◽  
Treatment Options ◽  
Frozen Elephant Trunk ◽  
Elephant Trunk ◽  
Descending Aorta ◽  
Cord Injury ◽  
Aortic Pathologies

Over the decades, the Frozen Elephant Trunk (FET) technique has gained immense popularity allowing simplified treatment of complex aortic pathologies. FET is frequently used to treat aortic conditions involving the distal aortic arch and the proximal descending aorta in a single stage. Surgical preference has recently changed from FET procedures being performed at Zone 3 to Zone 2. There are several advantages of Zone 2 FET over Zone 3 FET including reduction in spinal cord injury, visceral ischemia, neurological and cardiovascular sequelae. In addition, Zone 2 FET is a technically less complicated procedure. Literature on the comparison between Zone 3 and Zone 2 FET is scarce and primarily observational and anecdotal. Therefore, further research is warranted in this paradigm to substantiate current surgical treatment options for complex aortic pathologies. In this review, we explore literature surrounding FET and the reasons for the shift in surgical preference from Zone 3 to Zone 2.

scholarly journals The Investigation and Management of Adenomyosis in Women Who Wish to Improve or Preserve Fertility

2018 ◽  
Vol 2018 ◽  
pp. 1-12 ◽  
Author(s):  
Jin-Jiao Li ◽  
Jacqueline P. W. Chung ◽  
Sha Wang ◽  
Tin-Chiu Li ◽  
Hua Duan
Keyword(s):  
Surgical Treatment ◽  
Minimally Invasive ◽  
Treatment Options ◽  
Management Strategies ◽  
Definitive Treatment ◽  
Surgical Approaches ◽  
Child Bearing ◽  
Fertility Sparing

The management of adenomyosis remains a great challenge to practicing gynaecologists. Until recently, hysterectomy has been the only definitive treatment in women who have completed child bearing. A number of nonsurgical and minimally invasive, fertility-sparing surgical treatment options have recently been developed. This review focuses on three aspects of management, namely, (1) newly introduced nonsurgical treatments; (2) management strategies of reproductive failures associated with adenomyosis; and (3) surgical approaches to the management of cystic adenomyoma.

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