Vol 9, No 1 (2019)

The article presents the results of surgical treatment of 36 men aged 18 to 35 years with testicular torsion who were treated at the urological clinic of the Alexandrovskaya Hospital from 2012 to 2017. Indications for surgical treatment were pains in the inguinal region, the absence or sharp decrease in blood flow below the site of the alleged testicular torsion by ultrasound dopplerography of the scrotum organs. Orchidpexy was performed in 8 patients, orchiepididimectomy was performed in 28 patients. The indication for orchidpexy was the viable testicle, which was observed with incomplete testicular torsion and its duration of less than 6 hours. Testicular prosthesis was performed in 11 patients.

Introduction. Autosomal dominant polycystic kidney disease (PKD) is one of the most common hereditary diseases leading to the development of end-stage renal failure. According to modern concepts, nephrectomy of polycystic-altered kidneys in such patients is performed in the event of complications, as well as in order to prepare for kidney transplantation. The creation of intense carboxyperitoneum leads to carbon dioxide resorption and the development of hypercapnia and respiratory acidosis in the patient. Taking into account the age of patients and the high incidence of cardiovascular and valvular pathology in patients with PKD, this fact becomes significant and can lead to the development of severe complications. The solution to this problem, in our opinion, is to perform laparoscopic nephrectomy under low-pressure carboxyperitoneum (LPC).

Materials and methods. In the period from 2013 to 2018, 55 monolateral laparoscopic nephrectomies were performed in 36 patients with PKD. The study identified 2 groups of patients. The study group included 8 patients who were diagnosed at the preoperative stage with cardiovascular disease performed LPC (12 operations). The second group was represented by 28 patients who were operated laparoscopically with the creation of intense carboxyperitoneum (41 operations). Workspace when LPC was created with the help of laparolift – mechanical device for lifting the abdominal wall on the abdominal cavity.

Results. The mean duration of surgery in the groups was 126 ± 18 and 114 ± 11 minutes, respectively (p < 0.05). Intraoperative blood loss was significantly different: in the comparison group – 225 ± 45 ml, in the study group – 440 ± 76 ml (p < 0.05). Mean blood pCO2 and pH levels in the study group were 38.2 ± 2.7 mm Hg and 7.371 ± 0.021, the comparison group – 44.4 ± 3.8 mm Hg and 7.231 ± 0.035 (p < 0,05). Among the patients who underwent LPC, there was one fatal outcome. The frequency of postoperative complications was 16.6% (2) in the study group and 12.2% (5) in the comparison group.

Summary. Laparoscopic nephrectomy in conditions of low pressure carboxyperitoneum allows to completely avoid the development of hypercapnia and respiratory acidosis in the patient, to prevent severe cardiovascular complications despite the high risk of their development among patients with PKD.

The article reviews the current trends in the organ-preserving treatment of patients with muscular-invasive bladder cancer. An historical insight into the treatment tactics for this malignant disease included. The current trends in the use of surgical technology, radiation therapy, chemotherapy and immunotherapy, as well as molecular genetic diagnostic in patients with invasive bladder carcinomas are demonstrated. Due to the lack of randomized studies we are not able to use such organ-preserving techniques into practice, but it allows to performthis approach in carefully selected groups of patients.

The article reflects the history of treatment of benign prostatic hyperplasia from the age of antiquity to the present day. Approaches to surgical treatment have undergone significant changes in the last century – from traumatic open operations to minimally invasive surgical interventions using innovative endoscopic technologies. However, some issues in the treatment of benign prostatic hyperplasia remain unresolved which leads to the search for new, safer and more effective methods of surgical treatment of the disease.

The article is devoted to the 150th anniversary of the outstanding russian physician, scientist and health care organizer Sergey Petrovich Fedorov (1869–1936). As head of the department of hospital surgery at the Military Medical Academy from 1903 to 1936, S.P. Fedorov made an invaluable contribution to many areas of surgery, and especially to urology. For the first time in Russia, S.P. Fedorov performed cystoscopy with ureteral catheterization and proposed a method for determining a separate kidney function – an indigo carmine test. Also he was the first in our country who performed a suprapubic adenomectomy. On top of that he developed a renal clamp bearing his name. In 1907, in St. Petersburg, the first urological society in Russia was established on the initiative of Fedorov. In 1923, on his initiative, the publication of the journal Urology was launched. These and other achievements of S.P. Fedorov forever immortalized his name among the most prominent representatives of the medical science of our country. In 1907, on the initiative of S.P. Fedorov in St. Petersburg was created the first Russian urological society. In 1923 he initiated the publication of the journal “Urology”. These and other achievements of S.P. Fedorov forever immortalized his name among the most outstanding representatives of medical science of our country.