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Journal articles on the topic 'Urogenital Diseases - surgery'
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1
Kulchavenya, Ekaterina. "Urogenital tuberculosis: definition and classification." Therapeutic Advances in Infectious Disease 2, no. 5-6 (October 2014): 117–22. http://dx.doi.org/10.1177/2049936115572064.
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Objectives To improve the approach to the diagnosis and management of urogenital tuberculosis (UGTB), we need clear and unique classification. UGTB remains an important problem, especially in developing countries, but it is often an overlooked disease. As with any other infection, UGTB should be cured by antibacterial therapy, but because of late diagnosis it may often require surgery. Methods Scientific literature dedicated to this problem was critically analyzed and juxtaposed with the author’s own more than 30 years’ experience in tuberculosis urology. Results The conception, terms and definition were consolidated into one system; classification stage by stage as well as complications are presented. Classification of any disease includes dispersion on forms and stages and exact definitions for each stage. Clinical features and symptoms significantly vary between different forms and stages of UGTB. A simple diagnostic algorithm was constructed. Conclusions UGTB is multivariant disease and a standard unified approach to it is impossible. Clear definition as well as unique classification are necessary for real estimation of epidemiology and the optimization of therapy. The term ‘UGTB’ has insufficient information in order to estimate therapy, surgery and prognosis, or to evaluate the epidemiology.
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Stoyanov, V. B., V. A. Molochkov, T. B. Semenova, and O. B. Zhukov. "Therapy challenges in patients with <i>Mycoplasma genitalium</i> infection of the urogenital tract: clinical observations." Andrology and Genital Surgery 22, no. 4 (December 16, 2021): 86–91. http://dx.doi.org/10.17650/1726-9784-2021-22-4-86-91.
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Mycoplasma genitalium is a clinically significant intracellular bacterium from the family of genital mycoplasmas; it absolutely dominates in persistent/recurrent nongonococcal urethritis, causes chronic inflammatory diseases of the urogenital organs which dictates the necessity of treating this infection. The study presents observations of 2 patients with chronic recurrent urethritis caused by multiple drug resistant strains of M. genitalium. None of the administered schemes of antibacterial treatment covered in the international protocols on treatment of M. genitalium infection allowed to achieve clinical or microbiological cure in these patients. Practicing doctors require development and improvement of nucleic acid amplification methods with antimicrobial testing for M. genitalium resistance and new antimicrobial drugs with improved chemical and pharmacological characteristics for treatment of patients with intracellular urogenital infections.
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Proshchenko, O. M. "Urogenital disorders in women of reproductive age after radical surgeries about uterine myoma – optimization of diagnostic algorithm." Reproductive health of woman 5 (December 31, 2020): 29–32. http://dx.doi.org/10.30841/2708-8731.5.2021.224492.
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The article presents an assessment and analysis of the most important medical and social risk factors for long-term postoperative urogenital disorders in women of reproductive age after radical surgical treatment for uterine fibroids. Radical operations for uterine fibroids cause an increase in the proportion of urogenital disorders, the clinical manifestations of which have a negative impact on the physical, psycho-emotional form and social significance of women in society. A survey of 80 women aged 40 to 50 years, the main group included 40 patients who underwent vaginal hysterectomy, the comparison group consisted of 40 patients with hysterectomy performed by abdominal access. Data on the assessment of pelvic floor condition and urogenital dysfunction using a standardized POP-Q system, both at the stage of preoperative observation and for 3 and 5 years after surgery. Сonducted surveys, filling diaries of pain, urination, physical examination and bimanual examination, determination of the pH of the vaginal contents, colposcopy, evaluated the index of the vaginal condition, the state of the microbiota of the mucous membranes, a comprehensive urodynamic examination, cystometry, ultrasound examination of the pelvic organs and assessment of ovarian structure.The most important risk factors are identified, which would allow to form groups of patients that require individualized approaches in the choice of surgical techniques and rehabilitation program. These included obstetric and gynecological history (birth of large fetuses, episiotomies, birth injuries, high birth parity); ovarian surgery, the use of gonadotropin-releasing hormone agonists. chronic diseases of the respiratory system and gastrointestinal tract, accompanied by increased intra-abdominal pressure; the presence of stigmas of undifferentiated connective tissue dysplasia; clinical manifestations of pelvic floor failure and functional disorders of the urethral sphincter. When choosing a method and access in case of surgical treatment for uterine fibroids, it is advisable to take into account the presence of pelvic prolapse and initial dysuric manifestations in women, the functional state of the sphincter apparatus and urethral hypermobility, obstetric and gynecological pathology and previous surgery on the organs of the uterus. the patient, her awareness of possible complications, the surgeon’s experience and his choice of surgical techniques.
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Aliev, S. A., E. S. Aliev, R. A. Mirzoev, and K. A. Mirzoeva. "FOURNIER’S GANGRENE- VARIETY OF CLINICAL MODEL OF CRITICAL STATES IN SURGERY." Grekov's Bulletin of Surgery 174, no. 1 (February 28, 2015): 84–89. http://dx.doi.org/10.24884/0042-4625-2015-174-1-84-89.
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The investigation based on a retrospective analysis of the treatment results of Fournier’s gangrene (FG) in 27 patients aged from 34 till 82 years old. There were 27 patients. Diseases of colorectal zone were the nosological reasons of FG in 15 patients. Diseases of urogenital tract had 10 patients with FG. The development of FG was determined by closed trauma (1 patient) and a gunshot wound of the perineum and the scrotum in one patient. The slowly progressive (limited) forms of the disease were noted in 15 patients, although the rapid progressive (extensive) forms were in 12 patients. All the patients had the clinical manifestations of the disease and at the same time laboratory indices indicated a presence of generalized infection and they were characterized by symptoms of systemic inflammatory response syndrome (SIRS). There were 6 patient, who died out of 27.The lethality consisted of 22,2%. The reasons of the death were an infection- toxic shock (1 case), a progressive endotoxicosis (3 cases) and a pulmonary artery thromboembolism (2 cases). The results obtained testified that early diagnostics and the active strategy with radical surgical d-bridement of necrotic suppurative foci combined with programmed (staged) sanitation necrosectomy, complex system of local wound treatment, the rational antibacterial therapy, a task-specific and syndrome correction of dyscrasia could be the actual ways to improve the treatment results in patients with FG.
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Proshchenko, Olha, Iryna Ventskivska, Natalia Kamuz, and Svitlana Markitanyuk. "Predictors of genitourinary syndrome in women of elderly reproductive age after hysterectomy." ScienceRise: Medical Science, no. 2(41) (April 5, 2021): 10–13. http://dx.doi.org/10.15587/2519-4798.2021.228295.
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The article presents an analytical assessment of risk factors for distant postoperative urogenital disorders in women of older reproductive age after radical surgical treatment for uterine fibroids. The aim of the study was to optimize the diagnostic algorithm of genitourinary syndrome in women of older reproductive age after hysterectomy for uterine fibroids. Materials and methods – 80 women aged 40 to 50 years were examined: 40 patients after vaginal and laparoscopically assisted vaginal hysterectomy, 40 patients with abdominal hysterectomy, control – 30 relatively healthy women with asymptomatic fibroids. The examination was performed at the stage of preoperative observation and for 3 years after surgery. Research methods: data on the assessment of pelvic floor and urogenital dysfunction using a standardized POP-Q system, physical examination, the ICS classification was used to assess the severity of urinary incontinence; quality of life assessment using the MOS SF-36 questionnaire; standard methods of variation statistics. Research results and their discussion. The most important risk factors for genitourinary syndrome have been identified. These included obstetric and gynecological history (birth of large fetuses, episiotomies, birth trauma, high birth parity, ovarian surgery, the use of gonadotropin-releasing hormone agonists), chronic diseases accompanied by increased intramuscularly; the presence of stigmas of undifferentiated connective tissue dysplasia; clinical manifestations of pelvic floor failure and functional disorders of the urethral sphincter. Conclusions. In the case of surgical treatment of uterine fibroids, it is advisable to take into account not only the presence of vaginal prolapse and initial dysuric manifestations, but also their predictors in the preoperative stage of the examination, as this may affect the choice of method and access in the case of surgical treatment of uterine fibroids. rehabilitation program and will obtain the expected effect of surgical recovery.
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Aguiar-Santos, Ana Maria, Marcela Leal-Cruz, Maria José Netto, Arturo Carrera, Guilherme Lima, and Abraham Rocha. "Lymph scrotum: an unusual urological presentation of lymphatic filariasis. A case series study." Revista do Instituto de Medicina Tropical de São Paulo 51, no. 4 (August 2009): 179–83. http://dx.doi.org/10.1590/s0036-46652009000400001.
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Lymphatic filariasis (LF) causes a wide range of clinical signs and symptoms, including urogenital manifestations. Transmission control and disability/morbidity management/control are the two pillars of the overall elimination strategy for LF. Lymph scrotum is an unusual urological clinical presentation of LF with important medical, psychological, social and economic repercussions. A retrospective case series study was conducted on outpatients attended at the National Reference Service for Filariasis, in an endemic area for filariasis (Recife, Brazil), between 2000 and 2007. Over this period, 6,361 patients were attended and seven cases with lymph scrotum were identified. Mean patient age was 45 years (range, 26 to 64 years). Mean disease duration was 8.5 years (range, two to 15 years). All patients had evidence of filarial infection from at least one laboratory test (parasitological, antigen investigation or "filarial dance sign" on ultrasound). Six patients presented histories of urological surgery. The authors highlight the importance of the association between filarial infection and the inadequate surgical and clinical management of hydrocele in an endemic area, as risk factors for lymph scrotum. Thus, filarial infection should be routinely investigated in all individuals presenting urological morbidity within endemic areas, in order to identify likely links in the transmission chain.
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Lapina, Irina A., Julia E. Dobrokhotova, Vladislav V. Taranov, and Tatiana G. Chirvon. "Prevention of dysbiotic and inflammatory diseases of the vagina and vulva after surgical correction of genital prolapse and stress urinary incontinence." Gynecology 22, no. 6 (December 24, 2020): 111–14. http://dx.doi.org/10.26442/20795696.2020.6.200547.
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Normal vaginal microflora consists of a wide range of microorganisms that maintain optimal vaginal milieu, preventing the development of infectious and inflammatory diseases of the vulva and vagina. However, the use of drugs, changes in hormonal status, urinary incontinence and pelvic floor dysfunction can disrupt the optimal balance of the vaginal microbiota, which leads to the development of dysbiotic pathological processes. The first-line treatment for stress urinary incontinence is the installation of suburethral slings. If incontinence is combined with a cystocele, it is advisable to perform reconstructive surgery for anterior vaginal wall, which has high both anatomical and functional efficacy. Surgical correction of genital prolapse and stress urinary incontinence requires bladder catheterization, which further increases the risk for dysbiotic and inflammatory diseases of the urogenital tract. The widespread use of antibiotic therapy leads to the formation of resistant strains of microorganisms and is not always fully realized, especially in the presence of post void residual urine in the postoperative period. Vaginal Zalain suppositories are highly sensitive to Candida species, and the use of Zalagel Intim gel is associated not only with antifungal, but also anti-inflammatory effect. Complex therapy with Zalain suppositories and Zalagel Intim gel is highly effective in the treatment of cytolytic, bacterial vaginosis, vulvovaginal candidiasis, and can also be used as the prevention of infectious complications after corrective interventions for pelvic organ prolapse and stress urinary incontinence.
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Karanasheva, Albina Kh, and Yulia E. Dobrokhotova. "Cervical diseases after subtotal hysterectomy (modern aspects of diagnosis and tactics of management)." Gynecology 23, no. 6 (December 15, 2021): 504–8. http://dx.doi.org/10.26442/20795696.2021.6.201131.
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Aim. To study the state of the cervical stump after subtotal hysterectomy (STGE) without uterine appendages with and without excision of the endocervix in patients with myoma to justify the choice of a rational volume of surgical operation.
Materials and methods. Examination and treatment of 140 women was carried out with the formation of three groups: 1st 40 patients after laparoscopic STGE with excision of the endocervix; 2nd 38 patients after laparoscopic STGE without excision of the endocervix; 3rd (comparison group) 62 patients with uterine myoma that do not require surgical treatment.
Results. The study of the state of the cervical stump was carried out 5.10.3 years after surgery. The number of patients with cervical pathology after STGE with excision of the endocervix (in group 1) was 1.8 times less in percentage terms than after STGE without excision of the endocervix (in group 2), and 3.2 times less than in patients with uterine fibroids who do not require surgical treatment (in the 3rd comparison group).
Conclusion. Out of 3 (3.8%) patients after surgical treatment with diagnosed HPV type 16.1 (1.3%) in the STGE group without endocervical excision was diagnosed with grade II intraepithelial neoplasia (CIN II). In patients with uterine myoma, STGE can be performed only after a comprehensive preoperative examination, including: diagnosis and treatment of urogenital infections, DNA typing of HPV of high oncogenic types, cytological and colposcopic examination of the cervix, targeted biopsy of the cervix with histological examination of the material. If a subtotal hysterectomy is performed, it must be supplemented with excision of the endocervix. In the future, these women require careful follow-up to improve early diagnosis and treatment of underlying and precancerous diseases and reduce the risk of developing cervical stump cancer.
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Zhukov, O. B., E. E. Bragina, V. V. Evdokimov, A. E. Vasiliev, and M. Ulusoylu-Dumlu. "Evaluation of the Rotaprost mineral-herbal complex effectiveness for improvement of functional condition of the male urogenital system." Andrology and Genital Surgery 23, no. 1 (March 18, 2022): 60–75. http://dx.doi.org/10.17650/1726-9784-2022-23-1-60-75.
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Introduction. Modern studies indicate a close relationship between the deterioration of the quality of the ejaculate and the increase in the symptoms of the lower urinary tract (LUTS) with the increase in the age of the man. Taking into account the common pathogenesis of reproductive dysfunction, LUTS and the development of possible preventive measures, we conducted an independent study.The study objective was to evaluate the effectiveness of the combined dietary supplement Rotaprost to improve the functional state of the male genitourinary system.Materials and methods. The study included 30 patients with clinical and laboratory signs of infertility and LUTS aged 23–65 years (mean age 44.91 ± 4.5). Patients were divided into two groups of 15 patients. Group 1 with chronic pelvic pain syndrome (CPPS) of IIIb category (US National Institutes of Health, 1995) with secretory type of infertility and LUTS, group 2 of 15 patients with stage 1 benign prostatic hyperplasia (BPH), pathozoospermia and LUTS. During the study, clinical and laboratory parameters were registered, NIH-CPSI, IPSS-QoL, IIEF-5, NRS questionnaires were used, spermogram data, MAR test, oxidative stress, DNA fragmentation, and electron microscopy of spermatozoa were evaluated. All patients before and after treatment underwent triplex ultrasound of the scrotum and transrectal ultrasound of the prostate. Expert-class devices E-CUBE 15 (Alpinion) were used. Patients included in the design of the study took Rotaprost capsules No. 30, 1–2 times a day for 30 days at the place with meals, drinking a small amount of water. After the course of treatment, patients were examined again.Results. The results of the study showed a more significant effect on the parameter of progressive mobility after treatment in the group with CPPS IIIb (group 1) by 23.5 % compared to the BPH group, where the total increase was 10.7 %. Also, an interesting finding was the trend towards a decrease in the number of leukocytes in the semen while taking Rotaprost in patients with CPPS IIIb (from 1.22 million/ml to 0.43 million/ml) compared with the BPH group, where changes are less significant (from 0.68 million/ml to 0.36 million/ml). Comparing the level of reactive oxygen species in the ejaculate and assessing the DNA fragmentation of spermatozoa revealed a statistically significant decrease during treatment in both groups, reducing the amount of residual urine. The drug had a significant effect on the level of pain, assessed by the NRS scale and improved the quality of life, including IPSS-QoL and NIH-CPSI data. Conclusions. Rotaprost mineral-herbal complex allows to correct moderate pathozoospermia and indicators of impaired urination in the vast majority of patients with CPPS IIIb and men with stage 1 BPH.The use of the Rotaprost mineral-herbal complex for a month leads to an improvement in the quality of life of patients with CPPS IIIb, reducing their pain by 25 %, restoring the quality of urination, and reduce the prostate volume of men with stage 1 BPH.High safety and adherence to therapy in the studied groups of patients is explained by the general pathogenetic mechanisms of the development of these diseases in men over 40 years of age and the possibility of a complex effect on the key pathophysiological cellular mechanisms of age-related changes in the genitourinary system of men by multifactorial components of modern dietary supplements.
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Chaava, Lali I., Ekaterina I. Kakhiani, Vasiliy N. Tsygan, Alexey N. Drygin, and Maria A. Pakhomova. "Endocrine and metabolic consequences of surgical interventions in uterine myoma: pathogenetic characteristic." Pediatrician (St. Petersburg) 10, no. 2 (June 19, 2019): 75–82. http://dx.doi.org/10.17816/ped10275-82.
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This paper presents analysis results of the research on endocrine and metabolic disorders in women who underwent surgery interventions for uterine myomas. Uterine myoma is one of the most common gynecological diseases. Main types of surgical interventions to treat uterine myomas are: hysterectomy, which is an organ-removing operation with various volume of surgical intervention: supravaginal amputation or extirpation of the uterus. Another type is myomectomy — an organ-preserving operation — when myoma nodes are removed, but the uterus and ovaries are preserved if they have no pathology. Removal of the uterus with appendages or without ovaries results in a decreasing production of estrogens, which play a key role in regulation of metabolism and various functions of the body systems. Estrogen deficiency, occurring after hysterectomy, deprives patients of a comprehensive protective effect of female sex hormones in all types of metabolism and normal functioning of organ systems. Hypoestrogenemia leads to development of a post-hysterectomy syndrome that comes out in early development of atherosclerosis, circulatory diseases, osteoporosis, psychological status disorders and urogenital disorders. Hypoestrogenemia is a key link in the pathogenesis of endocrine and metabolic disorders after hysterectomy. Endocrine disorders can be found at almost all levels of the regulatory and executive axis of the endocrine system. So far, hormonal function of the peripheral endocrine glands after myomectomy has been poorly studied. Currently available publications give no data on endocrine and metabolic disorders in patients after the myomectomy.
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Khominets, Vladimir V., Evgeniy B. Nagorny, Konstantin A. Nadulich, Andrey V. Teremshonok, Alexey L. Kudyashev, and Alexander A. Strelba. "Surgical treatment strategy in patients suffering from post-traumatic coccygodynia." Bulletin of the Russian Military Medical Academy 23, no. 4 (December 15, 2021): 161–70. http://dx.doi.org/10.17816/brmma83512.
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Clinical effectiveness of coccus removal in post-traumatic coccigodinia is evaluated. The study included 34 patients with diagnosed post-traumatic coccigodinia who underwent surgical treatment in resection or coccyx removal volume. A long history of trauma-related pain syndrome and ineffective conservative treatment were noted in all patients. The exclusion criteria were: inflammatory or oncological process, chronic urogenital diseases, previously undergoing operations on the lumbosacral spine, complicated by the course of the hernia of the intervertebral disc with root syndrome and neurological disorders. Before the operation, patients underwent manual examination, radiography (in direct and lateral projections) and computed tomography of the sacrum and coccyx, examination of the gynecologist (for women) and urologist (for men), examination of the proctologist, according to the indications magnetic resonance imaging of the spine in order to exclude hernia of the intervertebral disc with neural compression and dermoid cysts of the copcystic. Evaluation of treatment results was performed using a visual analogue pain scale and a verbal 5-point operation satisfaction scale. The observation period was from 1 year to 4 years. Cupping of pain syndrome after surgery was noted in 28 (82.4%) cases, in 6 (17.6%) patients there was a decrease in the intensity of pain syndrome with discomfort only after a prolonged sitting position. 5 (14.7%) patients were "satisfied" with surgery, 28 (82.4%) patients were "completely satisfied", in one (2.9%) case there was "doubtful satisfaction" with surgery. Thus, surgical treatment of coccigodinia in the volume of partial or complete coccyx removal is indicated in cases of ineffectiveness of conservative treatment in its post-traumatic instability. Surgical intervention leads to the cessation of pain syndrome and allows patients to return to their previous physical activity.
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Potapov, V. O. "Pelvic inflammatory diseases: clinical aspects of therapy and early rehabilitation of reproductive health." Infusion & Chemotherapy, no. 3.2 (December 15, 2020): 250–51. http://dx.doi.org/10.32902/2663-0338-2020-3.2-250-251.
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Background. Pelvic inflammatory diseases (PID) include the wide range of inflammatory processes in the upper reproductive tract of women. 70 % of PID occur in women under 25 years. Adverse consequences of PID include chronization and recurrence of the disease, purulent tuboovarian formations, obstruction of the fallopian tubes, and ectopic pregnancy.
Objective. To describe the main aspects of PID treatment and rehabilitation of reproductive health.
Materials and methods. Analysis of literature data on this topic.
Results and discussion. Risk factors for PID include intrauterine interventions and contraceptives, surgery on uterine appendages, and risky sexual behavior. There are three main targets for PID therapy: infection, release of inflammatory mediators, and repair of damaged tissues. Etiotropic therapy is used to overcome infections, nonsteroidal anti-inflammatory drugs and detoxification drugs are used to prevent active inflammation, and microcirculation correction is used to promote tissue repair. Broad-spectrum antibiotics (ceftriaxone, doxycycline, metronidazole) are used for etiotropic therapy. Fluoroquinolones (levofloxacin) are especially relevant in modern PID treatment regimens because they are effective against 94 % of urogenital tract pathogens, penetrate cell membranes, and slowly cause resistance. The combination of levofloxacin + ornidazole is highly effective against mixed aerobic-anaerobic and protozoal-bacterial infections. A solution for intravenous administration containing a combination of levofloxacin and ornidazole is widely used to treat severe PID. Tobramycin is the drug of choice for PID, mainly caused by antibiotic-resistant intestinal pathogens. After an acute episode of PID, abnormal blood flow in the vessels of the uterus and ovaries is significantly more common. Circulatory disorders contribute to blood stagnation, fibrotization, and sclerosis with the subsequent development of infertility, anovulation, premenstrual syndrome, abnormal uterine bleeding, adhesions, and obstruction of the fallopian tubes. In order to accelerate the excretion of toxic substances and inflammatory metabolites and eliminate oxidative stress, infusion solutions based on sorbitol and L-arginine are prescribed. Sorbitol-based hyperosmolar solution promotes the opening of precapillary sphincters, improves the rheological properties of blood, corrects metabolic acidosis and normalizes water-electrolyte balance. L-arginine solution, in turn, causes dilatation of peripheral vessels, promoting better microcirculation. L-arginine also acts as a substrate for the NO formation. The latter has an antibacterial activity, promotes the migration of T-cells, and takes part in the regulation of the sex hormones synthesis in the ovaries. According to our own data, infusions of L-arginine in PID reduce the proportion of adhesions from 34 to 5.4 %.
Conclusions. 1. PID is a spectrum of diseases with a number of adverse consequences, a significant part of which develops in young women. 2. The main components of PID treatment and restoration of reproductive health include elimination of the pathogen, blockade of inflammation and detoxification, correction of microcirculation and tissue repair. 3. Infusion solutions based on sorbitol and L-arginine are successfully used in the comprehensive therapy of PID.
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Proshchenko, О. М., and I. В. Ventskivska. "Effect of hysterectomy on the function of saved ovaries and correction of hormonal imbalance." Reproductive health of woman, no. 3 (May 31, 2022): 18–26. http://dx.doi.org/10.30841/2708-8731.3.2022.262367.
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The objective: to assess the hormonal disorders in patients after the radical treatment for leiomyoma and to develop the therapeutic options for correction.Materials and methods. The clinical and laboratory assessment of postoperative course after leiomyoma surgery in 160 women of reproductive age was carried out. The following groups of patients were formed: I group – 90 patients after vaginal hysterectomy (HE) with opportunistic salpingectomy and ovarian preservation, II group – 70 patients after abdominal HE with opportunistic salpingectomy and ovarian preservation. The control group included 50 women of reproductive age with asymptomatic leiomyoma.Then the following groups were formed to assess the effectiveness of the proposed medical correction program: the main group – 46 patients after vaginal HE with fallopian tubes and 36 persons after abdominal HE with fallopian tubes – received the proposed medical correction program, and the comparison group – 44 and 34 individuals after vaginal and abdominal HE with opportunistic salpingectomy and ovarian preservation, respectively, with standard approach for postoperative and rehabilitative periods.The diagnostic program included the assessment of hormonal level, post-hysterectomy syndrome degree by modified menopausal index using survey, urogenital and sexual dysfunction, and the indicators of vulvovaginal atrophy according to the Barlow scale.Results. Neurovegetative symptoms were observed in 36,7 % patients in the I group and 48.6 % - II group, vegetative-vascular symptoms – 46.7 % and 62.3 %, respectively. Insomnia was characterized by the sleep process disorders, the preservation of the feeling of fatigue after waking up. It is necessary to mention that an increase in the proportion of cardiovascular diseases up to 36 months after surgery (hypertension, dyshormonal cardiomyopathy and their combinations, 23.1 % were diagnosed with dyshormonal mastopathy, the women complained on arthralgia, morning joint stiffness, ostealgia twice more.The assessment of sexual disorders and manifestations of urogenital tract dysfunction allowed to indicate the most significant rate of dysuria complains in 72.9 % of cases in the II group after classical abdominal HE. Up to 36 months after surgery the subclinical hypothyroidism was found in 62.2 % of women in the I group and 31.4 % – II group, clinically significant hypothyroidism – in 21.1 % and 55.7 %, respectively.In the half of the cases the hormonal imbalance like hypoesrogenia was determined up to 36 months of monitoring without statistically significant differences between groups of different HE methodic. The main factor was patient’s age in which endocrine, vegetative-vascular disorders and the clinical manifestations of psychosomatic are developed in a larger percentage of significantly earlier in women of late reproductive age.The use of proposed program of therapeutic options after HE with ovarian preservation allowed to provide a tendency of the estradiol, progesterone and testosterone levels normalization, prolactin and cortisol concentrations were close to the reference values. Estradiol concentration in the women in main group increased, although it remained significantly below the age normal indices, and the most significant normalization of theses parameters were determined in women who received hormonal replacement therapy. Clinically positive effect in patients on the severity of neurovegetative and psychoemotional manifestations on the background of differentiated treatment was observed after 3 months from the beginning of therapy.Conclusions. The obtained results suggest that the optimization of the treatment program with the the proposed drugs in women in the groups leads to relative optimization of hormonal status and initiation of compensatory-adaptive responses of the organism, which improves the quality of life and eliminates symptoms of hypoestrogenism.
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Radovanovic, Milan, Zoran Dzamic, Aleksandar Vuksanovic, Tomislav Pejcic, and Predrag Nikic. "Vesicovaginal fistulas: Results of surgical treatment during ten years." Srpski arhiv za celokupno lekarstvo 140, no. 11-12 (2012): 756–59. http://dx.doi.org/10.2298/sarh1212756r.
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Introduction. Vesicovaginal fistulas (VVF) are the most common and the most frequent type of urogenital fistulas. They may have a different etiology. In most cases, surgery is required for treatment. Objective. The aim of the study was to analyze the results of surgical therapy of VVF in a tertiary level institution over the last decade. Methods. The retrospective study of results was conducted involving a total number of 99 women who were surgically treated for VVF at the Clinic of Urology of the Clinical Center of Serbia in Belgrade in the period from 2001?2010. Results. Over the past ten years VVF occurred after hysterectomy in 74.7% of cases, and almost twice more frequently after hysterectomy for a benign gynecological disease. In the surgical treatment of primary VVF transvesical approach was used in 53.53% (52/99) of cases. Relapses were treated surgically using transperitoneal approach in all cases. No significant difference was found in respect to the applied approach in the surgical treatment of primary fistulas. In even 94% (93/99) of cases the problem of VVF was solved by a single surgical intervention only. In total, in 107 interventions 8 (7.4%) relapses were recorded. Conclusion. The study showed that VVF occurred after hysterectomy in three quarters of cases, more frequently after hysterectomy due to a benign gynecological disease. Early detection with timely and appropriate treatment of gynecological diseases will reduce the number of conditions that may lead to VVF. Surgical treatment of VVF yielded satisfactory results; it was shown that even in 94% of cases the problem of VVF was solved by a single surgical intervention only, however further improvement is certainly necessary.
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Aliev, S. A., and E. S. Aliev. "Fournier’s gangrene: the current state of the problem and our treatment experience." Grekov's Bulletin of Surgery 181, no. 2 (March 28, 2022): 39–48. http://dx.doi.org/10.24884/0042-4625-2022-181-2-39-48.
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The OBJECTIVE of the study was to analyze the results of treatment of patients with lightning scrotal gangrene (Fournier’s gangrene).METHODS AND MATERIAL. The work is based on the analysis of the results of treatment of 31 patients with Fournier’s gangrene aged 32 to 82 years. In 19 (61.3 %) patients, the most probable nosological causes of Fournier’s gangrene were diseases of the anorectal zone, in 10 – pathology of the urogenital sphere. In 2 patients, Fournier’s gangrene developed as a result of a closed injury (1) and a gunshot wound (1) of the perineum and scrotum. A limited (slowly progressing) form of the disease was observed in 18 (58.1 %) patients, a common form with a lightning (9) and rapidly progressing (4) course – in 13 (41.9 %). 6 (19.3 %) patients suffered from diabetes mellitus of varying severity. In all patients, the clinical manifestations of the disease and laboratory parameters were characterized by the phenomena of generalized surgical infection with signs of systemic inflammatory response syndrome and endotoxicosis. In 93.5 % of patients, causative microflora was represented by various associations of both facultative-anaerobic and obligateaerobic gram-negative and obligate-facultative anaerobic gram-positive microorganisms. The growth of anaerobic gramnegative non-clostridial flora was also obtained.RESULTS. Out of 31 patients, 6 (19.3 %) patients died who had a common form of FG with a lightning and rapidly progressing clinical course in the format of systemic inflammatory response syndrome and systemic endotoxicosis with an outcome in organ-system dysfunction. The causes of death were: septic shock (in 1), progressive systemic endotoxicosis (sepsis) with the outcome of multiple organ failure (in 3) and pulmonary embolism (in 2).CONCLUSION. Multidisciplinary approach to solving organizational and therapeutic and tactical tasks with the participation of doctors of related specialties, active surgical tactics in the format of «aggressive surgery», providing for the widest possible excision of necrotic and non-viable tissues, performed in combination with programmed (stage-by-stage) sanitation necrectomy, pathogenetically justified correction of violations of the homeostasis system, rational antibacterial therapy, a comprehensive system of local wound treatment and plastic replacement of lost integumentary tissues are priority ways to optimize the results of treatment of patients with Fournier’s gangrene.
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Rahman, Fahmin, Mohiur Rahman, Nusrat Mahmud, GU Ahsan, and Mitheel Ibna Islam. "Prevalence of Male Infertility among the Infertile Couples Attended at BIRDEM General Hospital, Dhaka." Ibrahim Cardiac Medical Journal 6, no. 1-2 (March 20, 2018): 25–32. http://dx.doi.org/10.3329/icmj.v6i1-2.53754.
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Background & objective: Infertility is a problem of public health importance because of its high prevalence and serious social implications on affected couples and families. Although once believed that the problem is solely due to female factor, it is now generally accepted that male factor infertility is equally as important as the female factor. However, it is not known how far the problem is attributed to male factor. The present study is intended to find the prevalence of male infertility among the infertile couples and its determinants in the context of Bangladeshi population.
Patients & Methods: The present study was a descriptive cross-sectional study conducted on male partners of infertile couples (over a period of three months) visiting the Infertility Clinic of Bangladesh Institute of Research and Development in Endocrine & Metabolism (BIRDEM) General Hospital, Dhaka. Male infertility was defined as the inability of a man to make his partner conceive (because of quantitative and/or quantitative deficiency of his sperm) after 12 months of regular unprotected sexual intercourse. On the basis of semen analysis, male partners were divided into two groups – Infertile Group and Fertile Group and the suspected factors were compared between groups using crosstab analysis to determine the factors responsible for male infertility.
Result: The present study demonstrated that respondents were generally middle aged (between 30-50 years) with mean age being 35.5 years. Majority (88.5%) was Muslim and belonged to middle class (74.3%). Nearly half (47%) was service-holder and one-third (35.8%) was businessman. About 62% of the male partners were revealed to be infertile on semen analysis [combined prevalence of azoospermia (19%), asthezoospermia (29.2%) oligospermia (12.8%), and teratzoospermia (7.1%)]. Of them nearly one-third (azoospermic ones) was solely responsible for infertility and the rest played contributing role to the overall infertility. The reproductive tract infection (STDs) was reported to be alarmingly high among infertile males (21.4%) than that among their fertile peers (p = 0.002). Smoking, varicocele, overweight or obesity and diabetes also demonstrated their significant presence among infertile males compared to the fertile male group. History of occupational exposure to high temperature, pesticide, trauma to testes, abdominal and urogenital surgery were not associated with male partner fertility.
Conclusion: From the findings of the present study, it can be concluded that a substantial proportion of infertility can be attributed due to male partner infertility and its significant predictors are reproductive tract infections or sexually transmitted diseases. The second leading causes are varicocel, diabetes and obesity.
Ibrahim Card Med J 2016; 6 (1&2): 25-32
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Peshekhonov, K. S., E. S. Shpilenia, B. K. Komyakov, O. O. Burlaka, and M. S. Sargsyan. "Endoscopic Treatment of Prostatic Hyperplasia in Elderly Patients: A Comparative Analysis of Resection and Enucleation Technique." Urology Herald 8, no. 1 (April 20, 2020): 25–38. http://dx.doi.org/10.21886/2308-6424-2020-8-1-25-38.
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Introduction. The pharmacological market, which is rapidly developing, as well as the appearance of combined forms of drugs, determine the trend in the conservative treatment of patients with symptoms of the lower urinary tract due to benign prostatic hyperplasia (BPH). However, simultaneous administration of drugs from several drug groups, by the patients, who are burdened with concomitant diseases (cardiovascular disease, diabetes) in certain cases, makes surgical treatment of BPH preferable and sometimes the only possible option. In this instance, the doctor’s task is to choose the optimal method of surgery that minimizes the risks of complications and provides a long-term clinical effect. The actively developing technique of endoscopic enucleation of prostate corresponds to the current needs. Various types of energies, which have appeared lately in urological practice for enucleation of the prostate, have become an attractive alternative to transurethral resection of the prostate (TURP). The introduction of a bipolar technology into clinical practice has allowed to significantly expand the use of operations among elderly patients with comorbidities. Laser endourology has gone further in reducing the risks of possible complications. Currently we are witnessing a lack of research, which compares the use of modern methods with bipolar TURP (B-TURP) in elderly patients, i.e. groups with a high risk of intraoperative & postoperative complications.Purpose of the study. To compare the results of various types of BPH endoscopic surgical treatment in elderly patients (> 60 years old).Materials and methods. The study included patients who underwent three different operations treating BPH (B-TURP, B-TUEP, HoLEP) from October 2017 to September 2018. The criteria for inclusion in the study were as follows: the presence of moderate or severe obstructive symptoms of the lower urinary tract, prostate volume > 40 cm3, maximum urine flow <15 ml/s. Exclusion criteria were as follows: the presence of cystostomy drainage, the presence of the oncological process in urinary tract, active inflammatory process of urogenital system, earlier received surgical interventions on the organs of the urinary system. Each group of patients has been assessed on following criteria: International Prostate Symptom Score (IPSS and QoL), international index of erectile function (IIEF-5), the dynamics of postoperative changes in prostate specific antigen (PSA), maximum flow of urine, postvoid residual urine volume, intraoperative and postoperative parameters.Results. 190 patients operated during the year were examined in the current study. Duration of operation, extent of resection, time of postoperative catheterization and duration of hospital stay rates were significantly lower in the HoLEP group. There have been no cases of complications above the 3 level by the Clavien‒Dindo scale.Conclusions. HoLEP is the preferred method of surgical treatment of prostatic hyperplasia over 40 cm3 in terms of surgical safety, efficacy, and the duration of the patient’s recovery period. This method can serve as an alternative to electrosurgical techniques in elderly patients.
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Vdovychenko, S. Yu, and S. N. Salnikov. "Threatened abortion in women with retrohorial hematomas in the first trimester." Reproductive health of woman, no. 9-10 (December 30, 2021): 73–78. http://dx.doi.org/10.30841/2708-8731.9-10.2021.252596.
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The objective: to study the features of the clinical course of the first trimester of pregnancy, complicated by the threat of abortion with the formation of retrochorial hematoma (RCH). Materials and methods. 100 pregnant women aged 18–44 years (average age 28.08±3.5 years) in 6–13 weeks of gestation were examined. The main group consisted of 70 patients and was divided into two subgroups: subgroup A (n=40) – 40 primigravida women with the threat of abortion and RCH; subgroup B (n=30) – 30 multigravida women with the threat of abortion and RCH and a complicated obstetric and gynecological history. Control group (n=30) – primi- and multigravida women with physiological course of the current and previous pregnancies. All women had a complete clinical and laboratory examination, ultrasound examination of the uterus and fetus with Doppler, determination of the infectious profile (bacterioscopy).Results. The majority of the patients in all groups had a complicated somatic history, while in half of the cases there was a combination of two or more somatic diseases – in 45.7% of pregnant women in the main group and 33.3% – control group. 32.9% of women in the main group had a genetically determined form of thrombophilia. A complicated obstetrical and gynecological history was established in 22.5% of patients in subgroup A, 30% – subgroup B and 16.6% of pregnant women in the control group. Mostly, inflammatory diseases of the pelvic organs were detected in the main group – 15–21.4% (in both subgroups) and previous surgery on the pelvic organs (11.4% in total). A high incidence of spontaneous miscarriages was found in patients of subgroup B (13–43.3%). Every fourth pregnant woman in the main group had a 3–4 degree of purity of vaginal smears. For the first time, the hematoma was diagnosed before 6 weeks of gestation in 8% of pregnant women of subgroup A (2.5% of these patients had a spontaneous abortion at 9–10 weeks) and in 30% of women in subgroup B (23.3% of them had an interruption of pregnancy at 7–12 weeks). The corporal location of RCH was found in 28.6% of patients in the main group (15.7% and 12.9% in subgroups, respectively), supracervical – 71.4% (almost the same in both subgroups), while hematomas of more than 25 cm3 were detected in 8 patients of the main group (25% and 75% in subgroups, respectively), all of such RCH were located corporally. In 70% of supracervical RCH, a small and medium volume of hematoma was diagnosed, which was in 1.5 times more often detected in pregnant women of subgroup A. Hematomas of a larger size were found in 3 times more often in women of subgroup B. The main clinical symptoms of threatened abortion with the formation of RCH were bleeding from the genital tract (53–75.7%), pain syndrome (48–68.5%), uterine hypertonus or a combination of these symptoms (39–55.7%).Conclusions. The presence of chronic extragenital pathology, chronic urogenital infection, surgical interventions on the pelvic organs, a high frequency of artificial and spontaneous abortions, recurrent miscarriage, a history of missed pregnancy in combination with a large volume of RCH, the corporal location of PCH, the term of gestation in which a hematoma is found, as well as ultrasound signs of uterine hypertonus are unfavorable predictors of early miscarriage and reproductive losses.
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Le, Nhung, Melissa Cregger, Veronica Brown, Julio Loret de Mola, Pamela Bremer, Lyn Nguyen, Kathleen Groesch, Teresa Wilson, Paula Diaz-Sylvester, and Andrea Braundmeier-Fleming. "Association of microbial dynamics with urinary estrogens and estrogen metabolites in patients with endometriosis." PLOS ONE 16, no. 12 (December 16, 2021): e0261362. http://dx.doi.org/10.1371/journal.pone.0261362.
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Endometriosis is an estrogen dependent gynecological disease associated with altered microbial phenotypes. The association among endogenous estrogen, estrogen metabolites, and microbial dynamics on disease pathogenesis has not been fully investigated. Here, we identified estrogen metabolites as well as microbial phenotypes in non-diseased patients (n = 9) and those with pathologically confirmed endometriosis (P-EOSIS, n = 20), on day of surgery (DOS) and ~1–3 weeks post-surgical intervention (PSI). Then, we examined the effects of surgical intervention with or without hormonal therapy (OCPs) on estrogen and microbial profiles of both study groups. For estrogen metabolism analysis, liquid chromatography/tandem mass spectrometry was used to quantify urinary estrogens. The microbiome data assessment was performed with Next generation sequencing to V4 region of 16S rRNA. Surgical intervention and hormonal therapy altered gastrointestinal (GI), urogenital (UG) microbiomes, urinary estrogen and estrogen metabolite levels in P-EOSIS. At DOS, 17β-estradiol was enhanced in P-EOSIS treated with OCPs. At PSI, 16-keto-17β-estradiol was increased in P-EOSIS not receiving OCPs while 2-hydroxyestradiol and 2-hydroxyestrone were decreased in P-EOSIS receiving OCPs. GI bacterial α-diversity was greater for controls and P-EOSIS that did not receive OCPs. P-EOSIS not utilizing OCPs exhibited a decrease in UG bacterial α-diversity and differences in dominant taxa, while P-EOSIS utilizing OCPs had an increase in UG bacterial α-diversity. P-EOSIS had a strong positive correlation between the GI/UG bacteria species and the concentrations of urinary estrogen and its metabolites. These results indicate an association between microbial dysbiosis and altered urinary estrogens in P-EOSIS, which may impact disease progression.
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Cosma, Stefano, Domenico Ferraioli, Marco Mitidieri, Marcello Ceccaroni, Paolo Zola, Leonardo Micheletti, and Chiara Benedetto. "A simplified fascial model of pelvic anatomical surgery: going beyond parametrium-centered surgical anatomy." Anatomical Science International, June 11, 2020. http://dx.doi.org/10.1007/s12565-020-00553-z.
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Abstract The classical surgical anatomy of the female pelvis is limited by its gynecological oncological focus on the parametrium and burdened by its modeling based on personal techniques of different surgeons. However, surgical treatment of pelvic diseases, spreading beyond the anatomical area of origin, requires extra-regional procedures and a thorough pelvic anatomical knowledge. This study evaluated the feasibility of a comprehensive and simplified model of pelvic retroperitoneal compartmentalization, based on anatomical rather than surgical anatomical structures. Such a model aims at providing an easier, holistic approach useful for clinical, surgical and educational purposes. Six fresh-frozen female pelves were macroscopically and systematically dissected. Three superficial structures, i.e., the obliterated umbilical artery, the ureter and the sacrouterine ligament, were identified as the landmarks of 3 deeper fascial-ligamentous structures, i.e., the umbilicovesical fascia, the urogenital-hypogastric fascia and the sacropubic ligament. The retroperitoneal areolar tissue was then gently teased away, exposing the compartments delimited by these deep fascial structures. Four compartments were identified as a result of the intrapelvic development of the umbilicovesical fascia along the obliterated umbilical artery, the urogenital-hypogastric fascia along the mesoureter and the sacropubic ligaments. The retroperitoneal compartments were named: parietal, laterally to the umbilicovesical fascia; vascular, between the two fasciae; neural, medially to the urogenital-hypogastric fascia and visceral between the sacropubic ligaments. The study provides the scientific rational for a model of pelvic retroperitoneal anatomy based on identifiable anatomical structures and suitable for surgical planning and training.
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Cammalleri, Lisa, Romina Custureri, Monica Pomata, Fabio Bonini, Giacomo Capponi, Carlo Introini, and Alberto Pilotto. "Urological-Geriatric Integrated Diagnostic-Therapeutic Pathway for elderly patients with urologic diseases." Geriatric Care 5, no. 2 (November 4, 2019). http://dx.doi.org/10.4081/gc.2019.8501.
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Aging of population represents a new challenge for physicians who have to deal with the balance of risk and benefit in a population that is poorly represented in clinical trials. Frail patients need individualized treatments because of their high risk of developing complications in the course of therapies. Several studies have reported the effect of frailty on falls, hospitalization and mortality, but only few have focused on surgical patients and frailty is not included in the traditional surgical risk scales. Geriatric surgery patients have a physiologic vulnerability requiring assessment beyond the traditional preoperative evaluation of adults. Although single organ evaluation cannot be ignored in elderly population, recognition of frail patients during preoperative assessment may provide additional insight in predicting poor outcome; thus, aiding preoperative decision-making. We developed a Urological-Geriatric Integrated Diagnostic-Therapeutic Pathway in order to evaluate ≥65 years old patients affected by urogenital pathologies which require major surgery and to early identify frail subject.
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Wang, Qiang, Xiaofang Tang, and Stijn van der Veen. "Mycoplasma hominis bloodstream infection and persistent pneumonia in a neurosurgery patient: a case report." BMC Infectious Diseases 22, no. 1 (February 21, 2022). http://dx.doi.org/10.1186/s12879-022-07137-4.
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Abstract Background Mycoplasma hominis is typically associated with a urogenital tract infection, while its association with bacteremia and pneumonia is rare and therefore easily overlooked. Here we report a M. hominis bloodstream infection and pneumonia in a surgical patient. Case presentation A 56-year-old male with symptoms of pneumonia underwent microsurgery and decompressive craniectomy after a left basal ganglia hemorrhage. The patient recovered well from surgery, but pulmonary symptoms progressively worsened, with antimicrobial therapies seemingly ineffective. Culturing of bilateral blood samples resulted in pin-point-sized colonies on blood agar plates, which were subsequently identified as M. hominis by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry. Furthermore, sequencing of bronchoalveolar lavage samples also identified M. hominis as the main pathogen responsible for the pulmonary symptoms. The M. hominis strain was ciprofloxacin resistant, but susceptible to doxycycline and moxifloxacin. Doxycycline and moxifloxacin were subsequently used in a successful combination therapy that finally alleviated the patient’s fever and resulted in absorption of pleural effusion. At 1-month follow-up, following complaints of dysuria, a prostate abscess containing M. hominis was detected as the likely primary source of infection. The abscess was successfully drained and treated with doxycycline. Conclusions Mycoplasma hominis should be considered as a source of bloodstream infections and pneumonia, particularly when the response to standard antimicrobial therapy is limited. In this case, effective antimicrobial therapy was only commenced after identification of M. hominis and antimicrobial susceptibility testing.
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Humayon, D., A. Baby, and T. Mahesan. "906 Schistosomiasis: The New ‘Gap Year’ Problem." British Journal of Surgery 109, Supplement_6 (August 19, 2022). http://dx.doi.org/10.1093/bjs/znac269.518.
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Abstract Introduction Schistosomiasis is endemic in Africa, Asia, and South America. The parasite, found in freshwater lakes, ultimately deposits eggs in the veins around organs including the bladder. It causes chronic inflammation resulting in fibrosis of the urogenital tract and malignancy. In the UK, cases of schistosomiasis are unusual and historically confined to the immigrant population. The patient We present the case of a British born 21-year-old who returned from a round-the-world gap year. Upon return he reported dysuria, abdominal pain, poor flow, and malaise. He was investigated for tropical diseases, treated for recurrent urine infections, and sexually transmitted infections before disclosing on direct questioning to swimming in Malawi. Cystoscopy demonstrated tight pan-urethral strictures. Sandy patches were seen throughout the bladder. Histology from bladder biopsy confirmed schistosomiasis eggs. The patient was treated with Praziquantel. Despite treatment he will likely require repeat urethral dilatations. Discussion Changes in travel practice has led to a shift in patients who present with schistosomiasis. Clinicians should consider the diagnosis in anyone with lower urinary tract symptoms who has visited Asia, Africa, or South America. In those diagnosed, clinicians have a duty to encourage them to urge fellow swimmers to seek urological input. Similarly travel-clinics should be encouraged to warn travellers against fresh-water swimming prior to travel. To avoid long term schistosomiasis sequelae, prevention is preferable, but early and prompt intervention is the next best alternative. Clinicians need a low threshold to suspect and exclude this damaging diagnosis.
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E.B., Klester, Elykomov V.A., and Klester K.V. "ANALYSIS OF THE FREQUENCY AND NATURE OF CONCOMITANT DISEASES AS A RISK FACTOR FOR COMPLICATIONS AND ADVERSE OUTCOME IN CORONARY ARTERY BYPASS GRAFTING IN ELDERLY AND SENILE PATIENTS." "Medical & pharmaceutical journal "Pulse", April 10, 2022, 10–15. http://dx.doi.org/10.26787/nydha-2686-6838-2022-24-4-10-15.
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Abstract. Objective: to study the frequency of occurrence of concomitant pathology of the circulatory and respiratory system, digestive organs and urogenital system to improve the quality of prognosis of developing complications and adverse outcomes during coronary artery bypass grafting in elderly and senile patients with coronary heart disease, including taking into account gender differences. Materials and methods. 164 patients (70% - men), operated on a planned basis for coronary heart disease in the Altai Regional Clinical Hospital, were under observation. The average age of patients at the time of surgery was 58.7± 7.3 years. Coronary bypass surgery was performed according to indications in conditions of artificial circulation and pharmacoholodic cardioplegia. Results. The Charlson comorbidity index was 5.3 [4.4-5.9] points; in young and middle-aged patients 3.5 [3.0-4.3], in elderly and senile patients - 5.9 [4.9-6.3] (p=0.03). It correlated with the following surgical complications: heart failure that required inotropic support for more than 5 days (r=0.68); perioperative MI (r=0.61); acute cerebrovascular accident confirmed by computed tomography (r=0.52); cardiac arrhythmias (atrial fibrillation, paroxysmal ventricular tachycardia) (r=0.49); respiratory insufficiency, which led to prolonged artificial ventilation of the lungs for more than 5 days (r= 0.45). Conclusions: Comorbidity in CABG is characterized by a high risk of an unfavorable prognosis in elderly and senile patients (survival rate is less than 21% in the next 10 years). The presence of a significant frequency of both multi and comorbid diseases determines a high associated surgical and anesthetic risk, which must be taken into account at the stage of preoperative preparation in gerontological patients, requires additional examination, increased costs and mandatory medical correction.
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Mosendz, Olena. "Clinical and anamnestical aspects of very early preterm birth." Perinatology and reproductology: from research to practice 1, no. 3 (September 25, 2021). http://dx.doi.org/10.52705/2788-6190-2021-3-4.
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The objective: determine risk factors, causes and clinical features of patients with very early preterm birth. Materials and methods. The study analyzed the data of anamnesis, the course of pregnancy, childbirth and perinatal outcomes of 166 women of reproductive age with very early preterm birth at 22–27 weeks of gestation. The fact of childbirth at these stages of pregnancy is the main criterion of inclusion. The patients were divided into two groups depending on the criteria of live birth: group 1 – 79 women, whose labor was regarded as late miscarriage (retrospective study); group 2 – 87 women, whose labor occurred as a very early preterm (prospective study). Exclusion criteria: congenital malformations of the fetus. Patients of both groups have got a comprehensive examination using clinical, instrumental and laboratory research methods. Results. During the management of pregnancy of patients of these groups, special attention was paid to the assessment of risk factors for the development of very early preterm labor, among which the main ones were urogenital infections (83,7% and 78,9% in groups 1 and 2, respectively), which caused perinatal mortality in both groups (p˂0,05). A combination of pathogens was found in almost half of the subjects (43% in group 1,44% in group 2). Patients of both groups had a serious general and obstetric anamnesis, high frequency of inflammatory processes of the genitals, surgery and hormonal disorders with diseases caused by them. The main complications of gestation of pregnant women of both groups in the second trimester were the miscarriage risk (43% and 30%, respectively) and dysfunction of the fetoplacental complex (FPC) (22,7% and 21,8%, respectively), which caused the syndrome of delayed fetal development in both groups of subjects - in 66% and 63% of children, respectively. Conclusion. Analysis of general and obstetric history, the presence of infectious factor in combination with extragenital pathology confirm the polyetiology of the causes that leads to very early preterm birth. Considering the main risk factors of preterm birth, a thorough examination for urogenital infections in women at the stage of pre-pregnancy and during pregnancy, followed by treatment and restoration of normal vaginal biocenosis, as well as study of fetoplacental system function from early pregnancy. Preventive measures and timely treatment of fetoplacental disorders should promote prolonging pregnancy to longer gestations, which is the best way to improve perinatal outcomes.
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Molinaro, F., R. Angotti, E. Bindi, M. Sica, M. Aglianò, M. Messina, and F. Mariscoli. "HYPOSPADIAS: LONG TERM FOLLOW-UP IN A SINGLE CENTER." Journal of the Siena Academy of Sciences 7, no. 1 (December 13, 2016). http://dx.doi.org/10.4081/jsas.2015.6414.
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<em>Introduction</em>: Hypospadias is one of the most common birth defects that affect the male urogenital tract. It can present as isolated anomaly, but sometimes can arise in the context of complex disorders of sex development (DSD). These malformations are characterized by a great variety of clinical manifestations and compromise the aesthetic appearance, but also functional and psychological impact that the malformation can determine the patient. <br /><em>Materials and Methods</em>: We conducted a retrospective study of patients undergoing surgery for hypospadias from March 2000 to January 2015. The data was extrapolated from a prospective database. It was considered for each patient: demographics; type of hypospadias; surgical technique; average age for surgery; intraoperative and postoperative complications (early and late). Duckett’s classification was used. <br /><em>Results</em>: 343 urethroplasties were performed. 320 (93%) were primary urethroplasties and 23 (7%) reoperations in patients who had performed many other surgical procedures. 7 patients with megameatus were excluded. The hypospadias have been ranked according to Duckett’s classification, 35 patients had associated diseases. In total were performed: 186 (55%) Snodgrass, 71(21%) Duckett,10 (3%) augmented Duckett, 42 (13%) Magpi, 16 (5%) Duplay, 1 (0,3%) Bracka, 1 (0,3%) was a Bianchi’technique and 5 (1,4%) were Standoli. In 4 patients (1%) were used mixed technique. There were no intraoperative complications. The mean age at surgery was 15 months (range 12-22 months). Postoperative complications were 12%. Long term follow up was done with uroflussimetrie at 3 and 6 months in those who had reached the continence and possible urethral calibrations in those who had submitted a stenosis in post-op.<br /><em>Conclusions</em>: The improvement of surgical techniques, the use of optical amplification tools, the use of suture material (PDS) and the experience gained in recent years have enabled us to optimized the results. Though aware of the potential and actual complications that this type of microsurgical correction can lead to the results we have obtained are comparable to those of major international series and can be considered satisfactory, both from an aesthetic and functional.
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"Mesothelial Cyst in a Young Female: Case report and literature review." International Journal of Case Reports, 2021, 203. http://dx.doi.org/10.28933/ijcr-2021-02-2005.
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Mesenteric cysts are rare intra-abdominal benign tumors (1 in 100,000 cases in adults) with various clinical presentations. [1,2] They commonly originate from the small bowel mesentery, although a proportion has been found to originate from the mesocolon, and retroperitoneum. [1,3] The formation of mesenteric cysts depends on the histologic origin, where they could be classified into cysts of lymphatic origin, cysts of mesothelial origin, cysts of enteric origin, cysts of urogenital origin, dermoid cysts and pseudocysts. [4,5] Diagnosis is extremely difficult since. The Mesenteric cyst is usually asymptomatic, but if symptomatic, abdominal pain (82%), nausea and vomiting (45%), constipation (27%) are the most common presenting symptoms. [2,3] The clinical finding of abdominal mass is encountered in more than 61% of the patients. [2,3]. As this condition is very rare and its symptomatology can resemble any other abdominal diseases, diagnosis is extremely difficult and incorrect preoperative diagnosis is often made. Hence, performing physical examination and conducting radiological investigations such as ultrasonography (USG) and computed tomography (CT) are important in making a correct diagnosis. [2,3] As well as cases of mesothelial cysts, they are typically asymptomatic but occasionally, their symptoms are vague and non-specific. [6,7] As mentioned above, imaging modalities such as USG, CT and magnetic resonance imaging (MRI) are great in identifying the character, size, location, surrounding tissues and the wall and content of the cysts. [7] Surgery is the treatment of choice, as a complete resection with negative borders is curative and often prevents recurrence. [3] We report a case of a young female patient who presented with a vague abdominal symptoms and a large cystic mass in lower abdomen. After proper evaluation, surgical exploration revealed a large simple mesothelial cyst.
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Kalybekova, A., V. Lukinov, S. Rakhmonov, and A. Chernyavskyi. "Predictors of atrial fibrillation recurrence after surgical ablation of long-standing persistent AF with concomitant coronary artery bypass grafting." European Heart Journal 42, Supplement_1 (October 1, 2021). http://dx.doi.org/10.1093/eurheartj/ehab724.0423.
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Abstract Background A long-standing persistent form of atrial fibrillation (AF) in anamnesis, requiring surgical ablation together with coronary artery bypass surgery (CABG), significantly increases the risk of reccurence in the postoperative period. Before operation should consider the predictors of AF for long-term preservation of rhythm after surgery. Purpose To evaluate the predictors of AF recurrence on 3rd day and at discharge in patients after CABG with concomitant surgical ablation of long-standing persistent AF. Methods A prospective randomized single-center analysis was performed on patients with long-standing persistent AF, undergoing CABG with concomitant left atrial ablation (LAA) or biatrial ablation (BA) between 2016 and 2019. 116 patients were randomized into two groups: 58 in LAA+CABG, 58 in BA+CABG. The median age of the patients was 65 (IQR, 61 to 67.75) years in gr. BA and 62 (IQR, 58 to 66) in gr. LAA (Mann-Whitney U-test, p=0.050), 83% of men were in gr. BA (Fisher test, p>0.999). Predictors of AF development on day 3 were identified using multivariable logistic regression from the following baseline characteristics: myocardial infarction in anamnesis, time of artificial circulation, time of application of radiofrequency energy, the size of the left and right atrium, funcrional class of cardiac angina and heart failure, gender, age, acute cerebrovascular accident (CVA), additional intervention on the heart (operations for aortic aneurysm, mitral, aortic and tricuspid valves replacement), concomitant cardiovascular, respiratory, digestive and urogenital diseases. Results Using a multivariate model of logistic regression, the following significant predictors of arrhythmias on the 3rd day in gr. BA were included: additional intervention on the heart valves (OR 63.13, p=0.001); an increase in the functional class (FC) of chronic heart failure (CHF) NYHA by 1 (OR 40.06, p=0.018); a history of CVA (OR 9.13, p=0.026). The following significant predictors of AF reccurence on the 3rd day in gr.LAA were identified: an increase in the long axis of the right atrium by 1 cm (OR 3.05, p=0.006); an increase of the FC of cardiac angina by 1 (OR 7.11, p=0.011); in women (OR 7.14, p=0.017). In BA significant predictors of AF reccurence at discharge were: an increase in the long axis of the left atrium by 1 cm (OR4.86, p=0.015); reccurence of AF on the 3rd day (OR 17.45, p=0.005); 1 year increase in age (OR 1.24, p=0.023); the presence of diabetes (OR 47.67, p=0.002). In gr. LAA the predictors at discharge were: reccurence of AF on 3rd day (OR 38.35, p=0.001); a history of CVA increases the chances of arrhythmia (OR 210.83, p=0.032). Conclusion Number of clinical and functional characteristics of a patient may be predictors of AF. We examined the predictors of reccurence of AF after surgical ablation of long-standing persistent AF with concomitant CABG. Taking them into account when choosing the optimal strategy of treatment is important. Funding Acknowledgement Type of funding sources: None.
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Spaska, A., and N. Dolynko. "P–052 Structural and functional changes in the prostate gland of men following orchitis." Human Reproduction 36, Supplement_1 (July 1, 2021). http://dx.doi.org/10.1093/humrep/deab130.051.
Full textAbstract:
Abstract Study question The aim of the study was to establish echometric parameters, hemodynamic and cytohistological changes in the prostate gland in men of reproductive age after orchitis. Summary answer After orchitis, volume and mass of the prostate increased compared to the control group, blood flow was reduced, histologically and electron microscopy changes were observed. What is known already According to the literature, prostate diseases in men of reproductive age are an important issue in urology and andrology. The most common among them are infectious lesions of the genitourinary system, which constitute about 45%. These include, orchitis, as a part of the infectious process of the entire reproductive system. Half of the cases of orchitis are sexually transmitted infections or associated with infections that come from urogenital tract. In the majority of patients orchitis leads to infertility. But the state of the prostate, under these conditions, remains poorly understood. Study design, size, duration We used ultrasound diagnostics and colour ultrasound angiography of the prostate gland of 10 men aged 36–42 years, who suffered from orchitis. The data of 7 healthy men of the same age served as control. For histological and electron microscopy served tissues of prostate gland obtained from the 5 men of the same age group during minor invasive surgery. Statistical processing of the results was carried out using the program Statistica 10. Participants/materials, setting, methods: The length, width, height, volume and mass of the prostate were determined in the grey scale mode. The vascular pattern was determined by colour Doppler mapping (the course of the blood vessels, their diameter, the number in the symmetric sections of prostate). Qualitative hemodynamic indicators: peak systolic blood flow velocity (Vps) cm/s, diastolic blood flow velocity (Vd) cm/s, time average velocity (TAV) cm/s, pulsatility index (PI), volumetric flow rate (V) L/min. Histological methods and TEM. Main results and the role of chance After orchitis, the volume of prostate gland increased to (26.0 ± 1.4) cm3 vs (21.2±1.3) cm3 in control and its mass increased to (27.4±1.2) g vs (22.1±1.6) g in control group. The blood flow in the prostate was reduced: peak arterial blood flow velocity in the peripheral zone decreased up to (6.8±0.46) cm/s vs (18.8±3.0) cm/s in control and diastolic blood flow velocity decreased up to (2.75 ± 0.26) cm/s vs (5.7±0.1) cm/s in the control group. The final sections of the glands were cystically enlarged, the squamous epithelium was flattened, the nuclei were pyknotic and the cell borders were indistinguishable. Epithelial folds and shape were preserved, prostatic bodies and acidophilus secretion in the gaps were preserved. The relative volume of the glandular epithelium decreased up to 56.5% and the volume of the fibrous-muscular-elastic component around the lobules increased up to 43.5%. In the capillaries of the prostate, the nuclei of the endothelial cells were deformed, the cytoplasm was vacuolated, the crysts in the mitochondria were reduced, the basement membrane was expanded and uneven. In the nuclei of the prostatic epithelium the perinuclear condensation of chromatin observed, cytoplasm was vacuolated and accumulated drops of fat, the mitochondrial cristae were homogenized. Limitations, reasons for caution The results of the investigation approved by the Commission on Biomedical Ethics of the Precarpathian National University as appropriate and those do not violate moral and ethical norms in conducting research (Protocol №3 dated 16.10.2019). Wider implications of the findings: The results of research indicated changes in the prostate, which require further investigation of hormonal balance in men under these conditions. Trial registration number *