Декомпенсований сечовий міхур на тлі доброякісної гіперплазії передміхурової залози: 10 років клінічного досвіду

Bladder decompensation and related complications require surgical treatment of benign prostatic hyperplasia (BPH) in two stages. In this case, the results of treatment are associated with the functional ability of the detrusor. Materials and methods. The results of treatment of 80 patients with BPH were analyzed. Patients were divided into two groups. Group I – 40 patients who underwent cystostomy as a first stage of surgical treatment of BPH. Group II – 40 patients who, in addition to cystostomy, underwent metabolic-corrective and anticholinesterase therapy. The second stage – all patients underwent retropubic prostatectomy, transvesical prostatectomy or transurethral resection of the prostate. During the operation, a biopsy of the bladder wall was performed, followed by pathomorphological examination. Results. In patients who underwent metabolic-corrective therapy before surgery, morphological changes in the bladder were less pronounced. The diameter of SMCs was 32.75% larger. Due to partial recovery of muscle mass, the proportion of connective tissue in the bladder wall was 31.41% lower. In the immediate and distant postoperative period after metabolism-correcting and anticholinesterase therapy, uroflowmetric indicators were better, quality of life increased, lower urinary tract symptoms decreased. In patients of Group II compared to patients of Group I, the diameter of the arterioles lumen was 21.56% larger (p < 0.001), the wall thickness of the arterioles was less by 12.58% (p < 0.001), the Kernohan index was lower by 29.58% (p < 0.001), the diameter of smooth muscle cells – more by 32.75% (p < 0.001), the proportion of connective tissue in the bladder wall – 31.41% lower (p < 0.001), probably due to the restoration of muscle mass. Conclusions. The therapeutic strategy to restore the functional capacity of the detrusor in patients with BPH with bladder decompensation is to eliminate microcirculatory disorders and to correct bioenergetic processes disorders by prescribing drugs that normalize redox processes, stimulate cellular respiration, synthesize nerve fibers and contract smooth muscles.