Benign Prostatic Hyperplasia (BPH)
Backqround: The results of scientifical progress in recent years have contributed to the development of transurethral endoscopic surgery, prophylactics BPH the implementation of new methods, less invasive, for the treatment of the lower urinary tract diseases of different genesis.
Laser surgery, transurethral electorezection, electrovaporization, bipolar surgery plasmakinetic rezection and vaporization and the combination of these methods have a number of avantages over traditional open interventions and contribute to a significant change in the treatment approach of most urological diseases, including those causing infravesical obstruction IVO.
Conclusions: The implementation of personalized medicine with correct selecting and pathogenetic motivation of the methods of treatement in management of the IVO have been made in several directions: prophylactics, diagnosis and treatment. Medical and social importance, variety of clinic manifestations and evolution, evident alternation of quality of life, high cost of diagnostic, conservative management and of surgical treatment prophylactics BPH the statuts of infravesical obstruction as a current problem from scientific and practical point of view and motivates the need of a deep study of disorders manifested through IVO, minimizing complications and the rate of their relapse.
Prophylactics BPH author: vghicavii gmail. Received December 26, ; accepted February 10, Key words: infravesical obstruction, stricture, hyperplasia. Infravesical obstruction IVO is a polyetiological and pathological condition caused by a prophylactics BPH of urological diseases, which lead to an impaired urinary elimination from the bladder because of an obstruction in the bladder neck or urethral region. In prophylactics BPH Any kind of micturition prophylactics BPH may significantly reduce quality of life, develop psychological problems, which can affect family and employment relationships, and lead to social isolation.
Besides the life-threatening conditions patients may experience, micturition disorders can lead to serious physical and moral sufferings, caused by deep psychological trauma, sexual conflict, the onset of neurosis and neurasthenia. From the psychological perspective, IVO is often associated with depressive disorders prophylactics BPH is the most difficult pathology to diagnose. The long-lasting evolution, persistent dysuria and frequent recurrences may sometimes. Infravesical obstruction is caused by urological diseases, which lead to the impairment of prophylactics BPH evacuation, micturition difficulties, retention of urine and other prophylactics BPH of dysuria.
Infravesical obstruction is prophylactics BPH characteristic symptom related to the following diseases like fig. The urodynamic resconstructure of urinary tract and the remodeling of regional renal and pelvic blood flow occur in infravesical obstruction [5, 6].
Subvesical obstruction, which causes the impairment of urinary evacuation, leads to urinary infection of both lower and upper tracts, and may commonly develop into cystitis and pyelonephritis. The obstacle in the urinary passage causes disturbance of micturition, which may eventually become worse viz.
Recently, there have been made a number of scientific researches in order to determine the causes of infravesical obstruction and optimize the best-corrected medical and surgical methods of treatment prophylactics BPH, 10].
The latest scientific clinical trials and technical progress have prophylactics BPH considerably the traditional urological treatment approach for many urinary diseases fig. Infravesical obstruction is most commonly met in old age and, in most cases, is caused by the development of a hyperplastic process in the prostate [12,13,14]. Benign prostatic hyperplasia is one of the most widespread polyetiologi-cal diseases prophylactics BPH men of elderly and senile age, which occurs due to the proliferation of the transitional zone of the prostate, and paraurethral prophylactics BPH and lead to lower urinary tract obstruction [2, 15, 16, 17].
It is considered that most men, over the age of 50, show certain symptoms caused by BPH , whereas the high life expectancy rates of aging men lead to an increased number of patients suffering from this disease .
Lately, some authors  mention the growth of BPH morbidity rates in population amongst most of countries. Fig prophylactics BPH. Urological disorders leading to infravesical obstruction. Infravesical obstruction caused by benign prostatic hyperplasia.
The widespread BPH in men identifies prophylactics BPH acute problem of timely diagnosis and well-reasoned treatment in the pathogenesis of this disease. It is extremely important, while choosing a reliable method of treatment for patients with BPH, to perform an accurate diagnosis of the disease and prophylactics BPH the shape of the prostate hyperplasia, degree of infravesical obstruction, prostate volume, as well [8, 21]. According to F. Schroder and I.
Altwein , J. Mc Connell et al. Similar data were presented prophylactics BPH other authors [23, 24]. In terms of prophylactics BPH studies, the disease shows various symptoms related to the impairment of the prophylactics BPH passage through the lower urinary tract . The causes of micturition disorder are infravesical urethral obstruction and underactive detrusor. The obstruction is caused by the enlargement of prostate with the gradual narrowing of the ure-thral lumen mechanical component and the hypertonus of smooth muscle fibres of the prostate and posterior urethra prophylactics BPH component Fig.
On the basis of secondary changes of the detrusor with obstructed genesis, the stressors direct influence of catecholamines and ischemic va-sospasm lesions of the smooth muscle elements of the bladder are of great importance. In these cases the bladder supports a prophylactics BPH influence of catecholamines and, as a result of this process, disorders in bioenergetics and detrusor function occur [26, 27]. The pathogenesis of impaired micturition in patients with BPH A. Sivkov and co.
Both theoretical and practical knowledge of the prophylactics BPH mechanisms present great importance in the development of obstructive uropathies. The research results of multilateral mechanisms of the pathogenesis of infravescal obstruction facilitate the detection of obstructive uropathies at the early stages, which enables the optimization of treatment methods in patients from the prophylactics BPH of modern concepts, regarding the pathogenesis of this disorder, and allows the monitoring and timely performing of necessary changes in the selected treatment schemes.
Nowadays, the problem of benign prostatic hyperplasia treatment remains a current issue [17, 28, 29, 30]. Over prophylactics BPH past 20 prophylactics BPH, there has been an opportunity to treat patients at early stages of the disease using pathogenetically substantiated drug theraphies . The successful obtained prophylactics BPH, in the study of the pathogenesis of prostatic hyperplasia and the use of medicinal treatment with pathogenetic oriented mechanism, made the drug therapy possible and truly effective for certain categories of patients, affected prophylactics BPH this disease.
Modern urology provides many methods of treatment of this disease [9,15,33], but the prophylactics BPH radical procedures are considered the surgical methods only, which include open adenomectomy and transurethral resection of BPH [31,34,35]. In the treatment of large benign prostatic hyperplasia, transvesical adenomectomy has long been considered as main surgical method . But despite its high efficiency, the prophylactics BPH of postoperative complications shows higher indices compared to endoscopic interventions.
Thus, the total number of complications after a prophylactics BPH adenomectomy is between Prophylactics BPH data , this indicator reaches After transurethral resection, the postoperative complication rates range from Complications differ by structure as well; thus in late postoperative adenomectomy the incidence of bladder neck sclerosis ranges from 2. Therefore, a major issue of modern surgery today, is the choice of surgical methods of treatment for patients with late obstructive complications of transvesical adenomecto-my .
Obstructive complications bladder neck sclerosis and posterior prophylactics BPH strictureprophylactics BPH are detected in 1. Transurethral prostatectomy or transurethral resection of prophylactics BPH prostate is the second generation of surgical methods for the treatment of obstructive uropathies caused by benign prostatic hyperplasia. In fact, according to data of international meetings American and European Association of Urology for the treatment of prostatic hyperplasia, as well as different authors' opinions, transurethral resection of the prostate TURP is considered the "gold prophylactics BPH treatment of BPH [29,33,38].
Actually, this method is equally efficient compared to an open surgery and simultaneously, it shows a number of advantages like less trauma, lower risk of recurrence in patients, fewer complications, reduced hospital stays, shorter rehabilitation period, low postoperative mortality rate, etc. TURP implementation has contributed to considerable prophylactics BPH of indications to surgical treatment for patients with BPH and pronounced recurrent diseases, who until recently were prophylactics BPH to a lifelong elimination of urine through cystostomy [33,47,48].
Additionally, in case of some categories of patients with BPH, open prostatectomy adenomectomy or TURP are life-threatening or contrain-dicated procedures, whereas drug therapy is inefficient due to the pronounced symptoms of infravesical obstruction . Such patients are often bound to live with cystostomy, which seriously reduces their quality of life and leads to social inadequacy of the patient. Despite its high prophylactics BPH efficiency, Prophylactics BPH has prophylactics BPH number prophylactics BPH complications, which are detected in These prophylactics BPH false and true recurrences of BPH, intra- and postoperative bleeding, TUR syndrome, urinary incontinence, bladder neck sclerosis, urethral stricture, retrograde ejaculation, etc.
Thus, according to A. Martov et al. Sergienko et al. Complications of transurethral resection are divided into early and late intraoperative and postoperative ones [9,17,18]. During intraoperative and early postoperative periods, the following complications may occur: profuse hemorrhage, signs of water intoxication TURP syndromeurinary tracts injury, acute urinary retention, infections and inflammatory complications; whereas during late postoperative periodcomplications like maintainance of irritative symptoms, urethral stricture, bladder neck sclerosis, incontinence of urine, disease recurrence, retrograde ejaculation may prophylactics BPH occur.
Many of these complications require prophylactics BPH surgery [9,25]. Retrospective analysis of TURP complications  showed that the occurrence of intraoperative and early postoperative complications is related to the level of prophylactics BPH of TURP techniques it has been reduced from 21 to 4. In this regard, a considerable attention is paid to the peculiarities of form and morphological structure of BPH, since prophylactics BPH inflammatory complications prophylactics BPH on the already pre-existing diseases chronic prostatitis and chronic.
According to the authors, scarce results of endoscopic interventions characterized by persistent irritative symptoms were determined, in most cases by dynamic components, simultaneously with detrusor dysfunction. In this case, incorrect indications and unjustified surgical treatment play an important role prophylactics BPH the development of complications and require further scientific and practical research. The highest percentage prophylactics BPH all postoperative complications refers to infravesical prophylactics BPH recurrence.
According to M. Trapeznikova et al. In fact, early postoperative IVO recurrence has technical aspects of interventions, whereas late postoperative IVO is caused by scarring of the urethra and vesico-urethral portion strictures and obliterations and the continuous growth prophylactics BPH adenomatous tissue true or false recurrence prophylactics BPH BPH [9,25].
The existing scientific studies, regarding prophylactics BPH problem of postoperative complications of transvesical adenomectomy and transurethral resection, as well as the measures used to prevent them, do not clarify a number of issues, such as: causes of complications in the postoperative period; their relation to the morphological structure of the prostate; the dependence of the late complications development on the early postoperative period development.
Until nowadays, there is no clear picture of the recurrent causes of infravesical obstruction after BPH, mechanisms of its development, methods of treatment and prophylaxis. According to A. Therefore, minimally invasive alternative methods, such as TURP will successfully solve the problem of infravesical obstruction, whereas a number of complications restrict their use in clinical practice. According to the same group of authors , new transurethral endoscopic interventions highly reduce the number of intraoperative complications.
Despite the continuous improvement of surgical treatment, postoperative prophylactics BPH still remain at a high level of incidence and do not tend to decrease. There have not been sufficiently studied the particularities of clinical progression of large BPH , nor the development of it, as well as identification prophylactics BPH treatment of infravesical obstruction in patients with median lobe hyperplasia of BPH.
Clinical manifestations of BPH are largely dependent upon the patterns of nodular hyperplasia growth and volume, which eventually lead to infravesical obstruction. It is a well-known fact that in patients with BPH, hyperplasia may occur in the lateral lobes, median lobe or all three lobes of the gland simultaneuosly . Some authors [56,57] consider the specific feature of median lobe of BPH, is inefficiency in treatment of this disease via different drug therapies.
Up prophylactics BPH now, we have little information on the peculiarities of diagnosis and treatment of patients with BPH median lobe hyperplasia prophylactics BPH. There are known only basic criteria that would contribute to an objective assessment of the participation degree of the median lobe hyperplasia, concurrently with the lateral lobes, in the evolution of infravesical obstruction in patients with BPH.
Complex research data on urodynamics pressure-flow also confirm the presence, characteristics and expressiveness of infravesical obstruction. It is also important to determine the role of an enlarged median prophylactics BPH of BPH, which acts as a valve in the development of infravesical obstruction, and as a prophylactics BPH factor of possible complications following surgical interventions, as well as its effect on late treatment outcomes in such patients.
Traditionally, TURP treatment was applied to a relatively small prostate volume - up to 80 cm3. But along with the improvement of transurethral surgery, this method has prophylactics BPH used to prophylactics BPH the large prostate gland, as well, about cm3 the prophylactics BPH requirement is sufficient experience of the surgeon.
The prophylactics BPH of adenoma of such dimensions is possible prophylactics BPH various means, including: transvesical and retropubic ade-nomectomy, transurethral resection, laser enucleation of the prostate, transurethral bipolar enucleation TURBE. There have already been developed various techniques of trans-urethral interventions according to the prophylactics BPH of gland hyper-plasia. The prophylactics BPH combines the minimally invasive TURP and radical pattern of open surgery. Prophylactics BPH doubt, minimally invasive interventions are more preferable compared to open adenomectomy.
The removal of enucleated nodes can be performed via morcellators, by a common resection loop for TURP procedure prophylactics BPH by cysto-tomic access for large bladder gallstones [54,59]. Due to the obtained results following transurethral electroenucleation procedures using morcellators in HBP of various sizes, a number of authors were able to conclude [54,59] that transurethral electroenucleation of prostate TURBE by morcel-lation is an effective method to treat large BPH.