Simultaneous surgeries on the lower urinary tract

Panferov A.S., Gadzhiev N.K., Yastrebov V.S.

1) Medical Center «Medassist», Kursk, Russia; 2) SouthWest State University, Kursk, Russia; 3) Saint Petersburg State University Hospital, Saint Petersburg, Russia

The article presents a clinical case of successful simultaneous laparoscopic intervention in a 70-year-old patient with combined diseases of the lower urinary tract: large benign prostatic hyperplasia (113 cm3) and iatrogenic stricture of the lower third of the right ureter, which developed after contact ureterolithotripsy. The patient’s complications included an obstructive ureteral stone, stricture formation with hydronephrosis, secondary pyelonephritis, prostate abscess after a transrectal biopsy, and acute urinary retention, which required a comprehensive surgical approach.
The intervention involved laparoscopic transvesical adenomectomy and Boari ureteralplasty. The surgery lasted 120 minutes, and the blood loss was 100 ml. The postoperative period was uneventful. Follow-up examinations after 3 and 6 months showed a significant improvement in functionality. The article presents a clinical case of successful simultaneous laparoscopic intervention in a 70-year-old patient with combined diseases of the lower urinary tract: large benign prostatic hyperplasia (113 cm3) and iatrogenic stricture of the lower third of the right ureter, which developed after contact ureterolithotripsy. The patient’s complications included an obstructive ureteral stone, stricture formation with hydronephrosis, secondary pyelonephritis, prostate abscess after a transrectal biopsy, and acute urinary retention, which required a comprehensive surgical approach.
The intervention involved laparoscopic transvesical adenomectomy and Boari ureteralplasty. The surgery lasted 120 minutes, and the blood loss was 100 ml. The postoperative period was uneventful. Follow-up examinations at 3 and 6 months demonstrated a significant improvement in functional parameters: the maximum urine flow rate (Qmax) increased from 5.3 to 20.2–23.4 ml/s, and the residual urine volume decreased from 130 to 0 ml. There was an improvement in kidney function (decreased serum creatinine levels and increased GFR) and resolution of hydronephrosis. No signs of detrusor overactivity, vesicoureteral reflux, or reflux pyelonephritis were detected, indicating that the anastomosis was successful and that the bladder function was preserved.
The authors emphasize the main advantages of the simultaneous approach: the radical treatment of multiple diseases with a single anesthesia and hospitalization, the reduction of the overall rehabilitation period, and the decrease in the overall surgical risk. This observation illustrates the relevance of simultaneous surgeries in modern urology, especially for elderly polymorbid patients, and demonstrates their high efficiency and safety with careful preoperative planning. The introduction of such techniques into routine practice can optimize the treatment of patients with complex combined diseases of the lower urinary tract.

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About the Authors

Corresponding author: V.S. Yastrebov – Urologist at the Urology Center of the Medical Center «Medassist», Kursk, Russia; e-mail: yastrebov.vetaly@yandex.ru

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