COMPARISON OF IMMEDIATE AND LONG-TERM RESULTS OF SIMULTANEOUS PUBIC AND TRANSVESICAL PROSTATECTOMIES IN SURGICAL TREATMENT OF LARGE BENIGN PROSTATIC HYPERPLASIA (MORE THAN 80 ML)

Abstract. The purpose of the study is to compare and evaluate the immediate and late results of single-stage retropubic (transcapsular) and transvesical prostatectomies in the surgical treatment of large benign prostatic hyperplasia (more than 80 ml). There are immediate (inpatient) and long-term (after discharge from the hospital) results of 120 one-moment retropubic (transcapsular) and 120 one-moment transvesical prostatectomies presented in patients with benign prostatic hyperplasia who were operated in the urological department of the Vinnytsia Regional Clinical Hospital named after M. I.. Pirogov in 2020-2023. Assessment of intra- and postoperative complications after operations was carried out according to the Clavien-Dindo classification, intra-operative blood loss was determined by the weight method, uroflowmetry before and after the operation with determination of the maximum rate of urination (Qmax, ml/s) was carried out on a domestic uroflowmeter «Potik - K». The integrated system STATISTICA (USA) was used for statistical calculations. The average time of one-stage retropubic prostatectomy was (86.1±17.4) minutes, one-stage transvesical prostatectomy was (67.2±15.3); average intraoperative blood loss – (520.5±67.4) ml and (314.5 ± 52.3) ml, postoperative bed-day (9.8 ± 2.9) and (14.3 ± 3.2), respectively. Transfusion of blood components (erythrocyte mass and/ or fresh frozen plasma) due to blood loss was performed in 9 (7.5%) patients after single-stage retropubic (transcapsular) prostatectomy and 10 (8.3%) - after one-stage transvesical prostatectomy. Urological complications after one-stage retropubic prostatectomy were noted in 23 (19.2%) patients, one-stage transvesical prostatectomy – 25 (20.8%), postoperative complications according to Clavien- Dindo – 39 (32.5%) and 37 (30.8%) in accordance. Nonurological complications after one-stage retropubic prostatectomy were noted in 8 (6.7%) patients, one-stage transvesical prostatectomy — in 7 (5.8%). According to the conducted uroflowmetry, it was noted that simultaneous retropubic and transvesical prostatectomies allow equally effective recovery of the act of urination in patients after surgery, 1 and 3 months later. When analyzing the late results of treatment of patients with benign prostatic hyperplasia, complications (bladder neck stricture, urethral stricture, acute epididymorrhitis, bladder stone, stress urinary incontinence, exacerbation of chronic pyelonephritis) were noted in 8% of patients after one-stage retropubic prostatectomy and 9% of patients after one-stage prostatectomy. Transvesical one-moment retropubic (transcapsular) and transvesical prostatectomies are effective surgical interventions for the treatment of patients with benign prostatic hyperplasia of large sizes with satisfactory immediate (stationary) and long-term results, as well as satisfactory restoration of the act of urination.