Cancer UrologyCancer UrologyОнкоурология1726-97761996-1812Publishing House ABV Press76810.17650/1726-9776-2017-13-4-70-78DIAGNOSIS AND TREATMENT OF URINARY SYSTEM TUMORS. PROSTATE CANCERДИАГНОСТИКА И ЛЕЧЕНИЕ ОПУХОЛЕЙ МОЧЕПОЛОВОЙ СИСТЕМЫ. Рак предстательной железыThe problem of early continence recovery after radical prostatectomyПроблема раннего восстановления удержания мочи после радикальной простатэктомииKachmazovA. A.КачмазовА. А.
Russian Federation

Build. 1, 51 3rd Parkovaya St., Moscow 105425 

Александр Александрович Качмазов.

105425 Москва, ул. 3-я Парковая, 51, стр. 1

kac.68@mail.ruKeshishevN. G.КешишевН. Г.
Russian Federation

Build. 1, 51 3rd Parkovaya St., Moscow 105425 

105425 Москва, ул. 3-я Парковая, 51, стр. 1 

OgnerubovaI. N.ОгнерубоваИ. Н.
Russian Federation

Build. 1, 51 3rd Parkovaya St., Moscow 105425 

105425 Москва, ул. 3-я Парковая, 51, стр. 1 

Grigor’evaM. V.ГригорьеваМ. В.
Russian Federation

Build. 1, 51 3rd Parkovaya St., Moscow 105425 

105425 Москва, ул. 3-я Парковая, 51, стр. 1 

KazachenkoA. V.КазаченкоА. В.
Russian Federation

Build. 1, 51 3rd Parkovaya St., Moscow 105425 

105425 Москва, ул. 3-я Парковая, 51, стр. 1 

AlekseevB. Ya.АлексеевБ. Я.
Russian Federation

Build. 1, 51 3rd Parkovaya St., Moscow 105425 

105425 Москва, ул. 3-я Парковая, 51, стр. 1 

N.N. Lopatkin Scientific Research Institute of Urology and Interventional Radiology – branch of the National Medical Research Radiology Center, Ministry of Health of RussiaНаучно-исследовательский институт урологии и интервенционной радиологии им. Н.А. Лопаткина – филиал ФГБУ «Национальный медицинский исследовательский центр радиологии» Минздрава России3012201713470781601201816012018https://oncourology.abvpress.ru/oncur/article/view/768

Background. The highest rate of incontinence after radical prostatectomy (RP) is observed in the first 2–6 months after surgery. In order  to decrease the period of incontinence, virous surgical methods aimed at preservation and reconstruction of structures participating  in the mechanism of urine retention has been developed and improved.

The study objective is to evaluate effectiveness of an original method of formation of an urethral anastomosis in the early continence recovery.

Materials and methods. Data on 126 patients who underwent retropubic RP were analyzed. Depending on the method of urethral anastomosis formation, patients were divided into 2 groups: in the 1st group (n = 52) the patients underwent PR with urethra suspension m. levator ani, in the 2nd (n = 74) – standard RP. In the 1st group, 6 ligatures were applied to the anterior and posterior urethra walls: at the 12 and 6 hour projections through the mucosa, submucosa, and smooth muscle; at the 10, 2, 4, and 8 hour projections – more laterally with capture of the m. levator ani medial margins. Continence recovery was evaluated on days 1, 7, and 14 after urinary catheter removal and then at days 30, 90, 180, and 365 after RP. The criteria of continence were absence of urine leakage at rest and during physical activity and a necessity of using a safety liner.

Results. There weren’t any significant differences at day 1 after urinary catheter removal between the two groups (р > 0.05). In the 1st group, continence values at days 30, 90, and 180 after RP were significantly higher (57.7, 69.2, and 71.1 %, respectively) compared to the 2nd group (35.1, 41.9, and 51.3 %, respectively) (р <0.05).

Conclusion. Results of this work show significant benefits of RP with urethra suspension m. levator ani compared to standard RP per continence recovery criteria at days 7, 14, 30, 90, and 180 after the surgery. The technique of urethra suspension m. levator ani is easy to perform and ensures early continence recovery after RP.

Введение. Часто недержание мочи после выполнения радикальной простатэктомии (РПЭ) регистрируют в первые 2–6 мес после оперативного вмешательства. В целях сокращения периода инконтиненции разработаны и усовершенствованы различные хирургические методы, направленные на сохранение и восстановление структур, участвующих в механизме удержания мочи.

Цель работы – оценить эффективность применения оригинального метода формирования уретроцистоанастомоза в раннем восстановлении функции удержания мочи.

Материалы и методы. Проанализированы данные 126 пациентов, подвергнутых позадилонной РПЭ. В зависимости от метода формирования уретроцистоанастомоз больные были разделены на 2 группы: пациентам 1-й группы (n = 52) выполнена РПЭ с суспензией уретры m. levator ani, 2-й (n = 74) – стандартная РПЭ. В 1-й группе на переднюю и заднюю стенки уретры накладывали 6 лигатур: в проекции 12 и 6 ч условного циферблата через слизистую, подслизистую оболочки и гладкомышечный слой; на 10, 2, 4 и 8 ч – более латерально с захватом медиальных краев m. levator ani. Восстановление функции удержания мочи оценивали через 1, 7 и 14 сут с момента удаления уретрального катетера и далее через 30, 90, 180 и 365 сут после проведения РПЭ. Критерием удержания мочи служило отсутствие подтекания мочи в покое или при физической нагрузке и необходимости использования страховочной прокладки.

Результаты. Достоверных различий в показателях удержания мочи на 1-е сутки после удаления уретрального катетера в обеих группах не выявлено (р >0,05). В 1-й группе показатели континенции через 30, 90 и 180 сут после выполнения РПЭ были достоверно выше (57,7; 69,2 и 71,1 % соответственно) по сравнению со 2-й группой (35,1; 41,9 и 51,3 % соответственно) (р <0,05). Заключение. Результаты настоящей работы демонстрируют значительные преимущества РПЭ с суспензией уретры m. levator ani по сравнению со стандартной РПЭ по показателю восстановления континенции на 7, 14, 30, 90 и 180-е сутки после операции. Техника суспензии уретры m. levator ani проста в выполнении и обеспечивает восстановление функции удержания мочи в более ранние сроки после РПЭ.continenceradical prostatectomyanterior urethra suspensionконтиненциярадикальная простатэктомиязадняя суспензия уретры1. Состояние онкологической помощи населению России в 2015 году. Под ред. А.Д. Каприна, В.В. Старинского, Г.В. Петровой. 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