Immediate and long-term results of retropubic prostatectomy and simultaneous preperitoneal hernia repair in patients with benign prostatic hyperplasia and inguinal hernia

Annotation. The aim of the study was to evaluate the immediate and long-term results of valvular prostatectomy and simultaneous peritoneal hernioplasty in patients with benign prostatic hyperplasia and inguinal hernia and assess the quality of life of patients. The article presents the treatment results of 152 patients with benign prostatic hyperplasia. All individuals were divided into two groups. The general group consisted of 32 (21.1%) patients with benign prostatic hyperplasia and inguinal hernia, who underwent one-stage retropubic prostatectomy and simultaneous preperitoneal hernia repair. The comparison group consisted of 120 (78.9%) patients with benign prostatic hyperplasia who underwent only a one-stage retropubic prostatectomy. Assessment of the life quality of patients after simultaneous preperitoneal inguinal hernia repair was performed according to the EuraHS - Quality of Life scale in 6 and 12 months after surgery. The obtained quantitative data were processed by the variation statistic methods with the calculation of t-Student criteria. The data were considered reliable at a significance level of 0.95 (p<0.05). The average age of men in the comparison group was 68.0±7.2 years, in the general group – 67.1±6.9 years; the average prostate volume in the comparison group was 94.4±42.3 cm3, in the general group – 91.2±32.6 cm3; 44 (36.7%) patients of the comparison group and 4 (12.5%) patients of the general group were admitted to the department urgently (due to acute urinary retention or chronic complete urinary retention). The inguinal hernia was found in all 32 patients of the general group, among them in 4 men – on both sides. The average time of ciliary prostatectomy in the general group and in the comparison group was the same (82.8±25.6 and 80.1±17.4 minutes). The simultaneous inguinal hernia repair on the one side lasted 55.0±17.4 minutes. Neurological complications in the general group were noted in 2 (6.25%) patients, in the comparison group – in 9 (7.5%); urological complications took place in 11 (34.2%) and 40 (33.3%), respectively. The average postoperative inpatient stay in the general group was 9.5±1.7; in the comparison group – 9.8±2.9. It was statistically better due to these periods after surgery when compared with preoperative life quality.

Elevated De Ritis Ratio as a Predictor for Acute Kidney Injury after Radical Retropubic Prostatectomy

Acute kidney injury (AKI) is related to mortality and morbidity. The De Ritis ratio, calculated by dividing the aspartate aminotransferase by the alanine aminotransferase, is used as a prognostic indicator. We evaluated risk factors for AKI after radical retropubic prostatectomy (RRP). This retrospective study included patients who performed RRP. Multivariable logistic regression analysis and a receiver operating characteristic (ROC) curve analysis were conducted. Other postoperative outcomes were also evaluated. Among the 1415 patients, 77 (5.4%) had AKI postoperatively. The multivariable logistic regression analysis showed that estimated glomerular filtration rate, albumin level, and the De Ritis ratio at postoperative day 1 were risk factors for AKI. The area under the ROC curve of the De Ritis ratio at postoperative day 1 was 0.801 (cutoff = 1.2). Multivariable-adjusted analysis revealed that the De Ritis ratio at ≥1.2 was significantly related to AKI (odds ratio = 8.637, p < 0.001). Postoperative AKI was associated with longer hospitalization duration (11 ± 5 days vs. 10 ± 4 days, p = 0.002). These results collectively show that an elevated De Ritis ratio at postoperative day 1 is associated with AKI after RRP in patients with prostate cancer.

Methods of Haemostasis and Restore of Bladder-urethral Segment During Retropubic Prostatectomy in Patients with Benign Prostatic Hyperplasia

The objective: to estimate methods of haemostasis and restore of bladder-urethral segment during retropubic prostatectomy in patients with benign prostatic hyperplasia. Materials and methods. Analysis of methods of haemostasis and restore of bladder-urethral segment during retropubic prostatectomy in patients with benign prostatic hyperplasia was performed. Results. Open retropubic prostatectomy (like transbladder prostatectomy) was recommended by European Association of Urology (EAU, 2020) as operation of first choice for surgical treatment big size prostatic hyperplasias. The authors gave such prevalences of retropubic prostatectomy over trans-bladder: operation is performed under visual control that gives haemostatic control of prostatic cavity and removing all parts of nodules; the bladder is not drainaged that avoids disuria in postoperative period, decreases postoperative bed-time and increases comfort for patients; urethra is cut by scissor in apical part of prostate that is prophylaxis tearing of urethra, trauma of exernal sphincter, stricture of memranaceas urethra and urine incontinence after operation; reconstruction of bladder-urethral segment is performed that is prophylaxis of stricture of bladder neck; surgeon can performed simultaneous hernioplasty and retropubic prostatectomy in case of inquinal hernia and benign prostatic hyperplasia. Arterial and venous blood supplying of bladder and enlarged prostate were wrote. Places of arterial and venous bleeding after cutting of prostatic capsule and removing nodules, prophylaxis suturing of arterial and venous bleeding places were noted. Original own methods of restoring of bladder-urethral segment and haemostasis of prostatic cavity by using two or three П-like catgut sutures were shown. For simplifying operation and decreasing time of performing operation and increasing haemostasis of prostatic cavity authors recommended performing passing haemostatic sutures throught prostatic capsule only once and linking of sutures on muscle peaces from rectus muscle (or pyramidal muscle). In case of absent bleeding from prostatic cavity the simplify method of bladder neck trigonisation by using two П-like catgut sutures or two V-like catgut sutures on bladder neck for prophylaxis of bladder neck stenosis was recommended (proximal trigonisation of bladder neck in prostatic cavity). Review of haemostatic merhods of prostatic cavity during retropubic prostatectomy was shown. Conclusion. Analysis of methods of haemostasis and restore of bladder-urethral segment and own original methods during retropubic prostatectomy in patients with benign prostatic hyperplasia allow improve haemostasis of prostatic cavity, prophylaxis of bladder neck and urethra stenosis, decrease intraoperative bleeding and period of operation.

The first 10 years’ experience in radical retropubic prostatectomy: Complications, lower urinary tract symptoms, and quality of life - a single-center experience

Introduction/Objective. This 10-year prospective study's primary objective was to evaluate the incidence of complications of radical retropubic prostatectomy (RRP). The secondary objective was to analyze how RRP affects lower urinary tract symptoms (LUTS) and quality of life (QoL) by using the International Prostate Symptom Score (IPSS). Methods. We analyzed 254 patients who underwent RRP in the period 2009-2018. All complications were graded according to Clavien-Dindo classification. To assess urinary symptoms and QoL all the examinees filled out the IPSS and International Prostate Symptom Score for QoL (IPSS QoL) questionnaires during preoperative preparation and 3, 6 12 months after surgery. Results. The incidence of complications Clavien-Dindo grade ? II and grade ? III were 26.4% and 16.5%, respectively. The mean overall IPSS for the entire group of patients after 12 months of follow-up was significantly different from the preoperative baseline value (p < 0.001). Patients with preoperative moderate (IPSS 8-19) and severe urinary symptoms (IPSS 20+) had a statistically significant reduction of urinary symptoms after RRP (p < 0.001). After 12 months, IPSS QoL was statistically significantly lower than preoperative (p < 0.05). Conclusion. For patients with clinically localized prostate cancer RRP is a safe and effective treatment option. It is associated with a higher rate of complications from the Clavien-Dindo grade ? II group. Radical retropubic prostatectomy has clinically beneficial effects on LUTS in patients with moderate and severe urinary symptoms and QoL related to LUTS.