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Introduction. The method of choice for surgical treatment of benign prostatic hyperplasia (BPH) with a volume of more than 80 сс is holmium enucleation of the prostate (HoLEP). However, laser enucleation of the prostate is associated with limitations that carry both a clinical and financial burden. Laparoscopic simple prostatectomy (LSP) has now emerged as an alternative to transurethral procedures. In addition to ensuring clinical efficacy, optimal approaches to surgical management of large-volume BPH must also be financially viable, which underlines the significance of this study.Objective. To conduct a comparative economic analysis of holmium laser enucleation of the prostate and laparoscopic retropubic simple prostatectomy combined with temporary clamping of the internal iliac arteries and vesicourethral anastomosis (LSP + TCA + VUA).Materials & methods. An economic analysis of the results of HoLEP (214 people) and LSP + TCA + VUA (215 people) was conducted in a multicenter, open-label study. The economic analysis aimed to calculate the direct costs associated with surgery, as well as indirect costs related to hospitalization. A comparative analysis of drug prescriptions was conducted, including an assessment of costs for conservative treatment during hospitalization and the postoperative period. The economic losses associated with the duration of patients' temporary disability were calculated as the total loss in gross domestic product (GDP) production.Results. The cost of basic surgical equipment was 15,701,000.0 and 36,927,827.0 rubles (₽) for LSP + TCA + VUA and HoLEP, respectively. The median direct costs for performing LSP + TCA + VUA and laser enucleation HoLEP was 54,990.6 [49,870.5; 67,850.8] and 69,158.9 [65,005.9; 72,351.7] ₽, respectively. The median of indirect costs in the LSP + TCA + VUA and HoLEP groups was 71,251.0 [68,039.0; 73,103.0] and 80,451.0 [74,423.0; 83,501.0] ₽, respectively. The indicators of lost profits in GDP production per person were 5,398.4 and 6,167.9 ₽ in the LSP + TCA + VUA and HoLEP groups, respectively.Conclusion. The rationale for the use of LPA + VPA + UCA in the surgical treatment of large-volume BPH is based on economically justified advantages compared with HoLEP.

Introduction. Analysis of complications after transurethral surgery for benign prostate hyperplasia (BPH) demonstrates that 20 – 30% of patients require prolonged postoperative treatment for severe lower urinary tract symptoms (LUTS) despite improvements in technology and surgical techniques. These complications play a significant role in reducing the quality of life of patients in the postoperative period. Severe storage symptoms and urgent urinary incontinence represent significant challenges in the postoperative phase when performing laser enucleation surgery. There are also limits to standard approaches to perform laparoscopic prostatectomy, which requires the development of improved techniques.Objective. To conduct a comparative assessment of the postoperative dynamics of LUTS in groups undergoing holmium laser enucleation of the prostate (HoLEP), a standard Millin laparoscopic simple prostatectomy (LSP), and a modified LSP.Materials & Methods. This multicenter study included 439 patients who were randomly assigned to 3 groups depending on the surgical treatment technique used for bladder outlet obstruction associated with large-volume BPH: the HoLEP group (n = 151), the standard Millin LSP (n = 142) and the modified LSP, combined with temporary clamping of the internal iliac arteries and vesicourethral anastomosis (n = 146). The main criterion assessed during six-months follow-up was the severity of LUTS on the IPSS scale (obstructive and irritative components). Complications that developed during the postoperative observation period were recorded.Results. A lower severity of LUTS was revealed in the group of the modified LSP compared to the standard LSP and HoLEP (p = 0.041 and p = 0.001, respectively). The average irritative component of IPSS was significantly lower in the modified LSP group compared to the standard LSP and HoLEP (p = 0.032 and p = 0.001, respectively). The observed trend continued to the third month after surgery. Comparison of changes in symptom severity six months after surgery demonstrated a significant advantage for the modified LSP both compared to HoLEP (p = 0.017) and a standard LSP (p = 0.032). All three groups showed comparable significant improvements in quality of life.Conclusion. The severity of postoperative storage symptoms is a limitation of HoLEP use, whereas the standard LSP is associated with lower severity of LUTS. The authors' modification of the LSP has the potential to reduce the severity of storage symptoms in patients for up to three months after surgery, and is associated with a low rate of urge incontinence.

Introduction. The optimal approaches to the surgical treatment of large-volume benign prostatic hyperplasia (BPH) have not yet been determined, but laparoscopic retropubic simple prostatectomy (LSP) is one of the preferred methods of surgical treatment for large-volume BPH. There are limitations to standard approaches to LSP, which necessitate the development of improved techniques.Objective. To provide comparative analysis of the efficacy and safety of standard LSP and modified LSP combined with temporary clamping of the internal iliac arteries and vesicourethral anastomosis.Materials & methods. The present multicenter study included 300 patients (mean age 67.0 ± 5.2 years) who were randomly assigned to standard and modified LSP groups. The main efficacy criteria of the intervention during 6 months of observation were: the severity of symptoms of urinary disorders (IPSS score), quality of life, peak urine flow rate and residual urine volume. All complications developed during the postoperative follow-up were recorded.Results. Of the 300 patients, 149 underwent standard LSP, and 151 underwent a modified LSP. Significant differences were detected in the hospital stay (p = 0.032), the rate of decrease in hemoglobin (p = 0.020) and the irrigation time (p = 0.001). In addition, the use of the modified technique was associated with a lower incidence of short-term urinary incontinence (p = 0.031), urinary retention due to urethral catheter occlusion (p = 0.002), and incidence of bladder tamponade (p = 0.001). After 6 months of postoperative follow-up, the groups were comparable in most of outcomes, except for peak urine flow (23.9 ± 2.3 and 20.3 ± 1.9 ml/s in the modified and standard LSP groups, respectively, p = 0.001). After 6 months of postoperative follow-up, the modified LSP group had a lower incidence of bladder tamponade (p = 0.010), urge urinary incontinence (p = 0.002) and bladder neck contracture (p = 0.031).Conclusion. The effectiveness of the modified LSP as a method of surgical treatment of large-volume BPH is not inferior to those in the standard LSP group, and the safety profile suggests the feasibility of wider testing of the technique in practice.

Introduction. Laparoscopic simple prostatectomy is the method of choice for surgical treatment of large-volume benign prostatic hyperplasia (BPH). However, the existing limitations of standard approaches are the reason for the development of new modifications.Objective. To evaluate the efficacy and safety of a modified laparoscopic simple prostatectomy (LSP), supplemented by temporary internal iliac arteries (IIA) clamping and vesicourethral anastomosis (VUA).Materials & methods. This multicenter open study included 195 patients (mean age 68.1 ± 6.4 years) who underwent LSP combined with temporary IIA clamping and VUA. The primary efficacy criterias during one follow-up year were the severity of urinary symptoms (IPSS), quality of life, maximum flow rate and post-void residual volume. All complications that developed during the 12-month postoperative follow-up period were registered. Statistical calculations were performed using IBM SPSS 23.2 software.Results. The average surgery time was 91.5 ± 23.2 minutes. Complications of Clavien-Dindo I, II, III grades were noted in 1.0%, 1.0% and 3.6% of patients, respectively; no complications of group IV developed. The mean bed-days were 5.2 ± 1.5 days, the decrease in hemoglobin was 0.6 ± 1.1 g/dL. No patient needed to use an irrigation system. Based on the results of 12 months postoperative follow-up, positive dynamics was established for average IPSS score (p = 0.003), QoL (p = 0.035), maximum urine flow rate (p = 0.012), residual urine volume (p = 0.004). The maximum urine flow rate one year after surgery reached 24.6 ± 2.8 ml/s, the post-void residual urine volume was 15.1 ± 11.9 ml, the average IPSS score was 9.1 ± 1.5, and the QoL score – 1.0 ± 0.7. During the 12-month follow-up period, a low amount of long-term complications was noted in 4 (2.1%) cases: 3 (1.6%) patients had stress urinary incontinence, 1 (0.5%) patient had bladder neck contracture.Conclusion. Modified LSP combined with temporary IIA clamping and VUA is associated with favorable efficacy and safety profile of the intervention in patients with large-volume BPH.

Surgical treatment of postinfarction left ventricular aneurysms in ischemic heart disease patients allows for a significant improvement of outcomes and clinical endpoints, an increase in quality of life and survival. The article deals with historical periods in surgical treatment of left ventricular aneurysms and chronologically describes the history of methods for reconstruction of the left ventricle.Despite the fact that within the last 50 years, mainly due to improvements in surgical techniques, in-hospital mortality decreased two-fold, it still remains high. The choice of technique for any kind of ventricular reparation depends on localization of the lesion that defines which sites of left ventricular asynergia should be repaired and how its form should be restored. At present, it is not possible to reliably assess benefits of any type of reparative surgery over another. Risk factors of inhospital mortality are: age, incomplete myocardial revascularization, high grade heart failure, female gender, immediate surgery, ejection fraction below 30%. To improve clinical outcomes one should strive to approximate to the physiological form of the left ventricle, to minimize negative influence of surgery on myocardial contractility.