VALUE DOPPLEROGRAPHIC CHANGES OF PROSTATE IN SELECTION HEMOSTASIS IN ADENOMECTOMY
VALUE DOPPLEROGRAPHIC CHANGES OF PROSTATE IN SELECTION HEMOSTASIS IN ADENOMECTOMY
Kadiri T.R., Rakhimov D.A., Saidullaev L.S..
Department of Urology and Andrology of State Educational Establishment «Institute of Postgraduate Education in Health Sphere of Republic of Tajikistan» CRH B. Gafurov
Aim. Improve the results of open adenomectomy of prostate through the development and introduction of a new approach to hemostasis in intraoperative bleeding.
Materials and methods. The material consisted of 122 patients with benign prostatic hyperplasia the main group. The comparison group included 104 patients with benign prostatic hyperplasia. In the basic group was divided into three subgroups of patients according to age: group I — patients with average age of 45 — 64 years, elderly-group II — 65-74 years old and senile at age 75 and older. Group I patients were the control group. Complications of benign prostatic hyperplasia from the urinary system were observed in 79 (64,7%) patients. In the main group the open trans-vesical adenomectomy carried out in a planned manner in 60 patients, emergency — 62. The most frequently subjected to operation patients with II and III stage of benign prostatic hyperplasia. Apart from the standard techniques used ultrasound Dopplerography of the prostate.
Results. It was established that disease, compared to I, according to data IPSS is observed consistent increase in of symptomatology indicators (S) — 2,3 — 4,1 times, the life and quality (Q) — 1,8 — 2,4 times, according to data of uro-flowmetry elongation delay time of urination (Z) — 1,6-2,2 times and reducing uroflowmetric index (UVI) 51,9 — 74,5%. In color Doppler ultrasound in patients with benign prostatic hyperplasia degree of changes of vascular architectonics in capsular and periurethral arteries depends on the size of the prostate and the character growth of the adenomatous nodes. At Dopplerography of benign prostatic hyperplasia is observed unidirectional hemodynamic changes, expressed in enhancing blood flow velocities in the all arteries of the prostate. The degree of severity changes dopplerographic parameters, except SDR (systolic-diastolic ratio) practically the same and is not associated with the development of clinical stages benign prostatic hyperplasia. In benign prostatic hyperplasia with a total unidirectional enhancing of maximal and minimal velocities of blood flow is important for select the method of hemostasis in adenomectomy. The increase in of vascular density in the prostate, exceeding the number of vessels in the field scan by more than 5, is an unfavorable risk factor for bleeding from the bed of the prostate during adenomectomy.
Conclusion. The proposed method of stopping bleeding from the bed of the prostate during enucleation nodes is effectively prevents the intraoperative bleeding and reduces the percentage of intra- and postoperative complications and mortality in adenomectomy.
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