urovestВестник урологииUrology Herald2308-6424Rostov State Medical University10.21886/2308-6424-2023-11-4-141-150urovest-794Research ArticleОБЗОРЫ ЛИТЕРАТУРЫREVIEWS ARTICLEРоль инфекционных осложнений в общей структуре осложнений при уретропластике, лечение и антибиотикопрофилактика: систематический обзорImpact of infectious complications in the overall structure of urethroplasty complications, treatment and antibiotic prophylaxis: a systematic reviewhttps://orcid.org/0000-0002-4808-7024НабокаЮ. Л.NabokaYu. L.

Юлия Лазаревна Набока — д-р мед. наук, профессор; заведующая кафедрой микробиологии и вирусологии №1 

Ростов-на-Дону

Yulia L. Naboka — M.D., Dr.Sc.(Med), Prof.; Head, Dept. of Microbiology and Virology No.1

Rostov-on-Don

nagu22@mail.ruhttps://orcid.org/0000-0002-5595-8799КотиеваЕ. М.KotievaE. M.

Елизавета Михайловна Котиева — студентка 

Ростов-на-Дону

Elizaveta M. Kotieva — Student

Rostov-on-Don

elizaveta.kotieva@mail.ruhttps://orcid.org/0000-0003-1783-1073КотиеваВ. М.KotievaV. M.

Виолетта Михайловна Котиева — студентка 

Ростов-на-Дону

Violetta M. Kotieva — Student

Rostov-on-Don

kotieva.violetta@mail.ruhttps://orcid.org/0000-0002-1710-0169КоганМ. И.KoganM. I.

Михаил Иосифович Коган — д-р мед. наук, профессор, заслуженный деятель науки РФ; заведующий кафедрой урологии и репродуктивного здоровья человека (с курсом детской урологии-андрологии) 

Ростов-на-Дону

Mikhail I. Kogan — M.D., Dr.Sc.(Med), Full Prof., Honored Scientist of the Russian Federation; Head, Dept. of Urology, Pediatric Urology & Reproductive Health

Rostov-on-Don

dept_kogan@mail.ruРостовский государственный медицинский университетРоссияRostov State Medical UniversityRussian Federation202325122023114141150Copyright © Набока Ю.Л., Котиева Е.М., Котиева В.М., Коган М.И., 20232023Набока Ю.Л., Котиева Е.М., Котиева В.М., Коган М.И.Naboka Y.L., Kotieva E.M., Kotieva V.M., Kogan M.I.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.urovest.ru/jour/article/view/794

Введение. Уретропластика — урологическая операция, имеющая широкое распространение в лечении стриктуры уретры. Однако при данном вмешательстве довольно часто встречаются послеоперационные осложнения, в структуре которых инфекция занимает в большинстве случаев лидирующую позицию. Тем не менее на сегодняшний день проблема профилактики и лечения инфекционных осложнений, будь то инфекция мочевых путей или раневая инфекция, ещё остаётся слабо изученной.Цель исследования. Обобщение и критический анализ данных мировой литературы по структуре инфекционных осложнений при уретропластике, изучение целесообразности и обоснованности лечения инфекционных состояний перед уретральной хирургией, эффективности протективного действия антибиотикопрофилактики в ключе послеоперационных осложнений.Материалы и методы. Исследование проведено в соответствии с рекомендациями по предпочтительным элементам отчётности для систематических обзоров и мета-анализов. Поиск проведён в библиографической базе данных PubMed с 1992 по 2022 год по ключевым словам с учётом критериев включения и исключения, что привело к отбору двадцати работ для дальнейшего изучения. Результаты. Было отмечено влияние инфекции мочевых путей на послеоперационные осложнения или рецидивы. Наличие инфекционных послеоперационных осложнений, в свою очередь, также оказывает значительное влияние на возникновение рецидива стриктуры. Некоторые авторы обратили внимание на влияние хирургических аспектов, времени пребывания в стационаре и этиологии стриктур на частоту развития инфекции области хирургического вмешательства. Имеющие на сегодняшний день исследования дают скудные представления о целесообразности лечения инфекций перед уретропластикой и проведении антибиотикопрофилактики в контексте их влияния на осложнения и рецидивы стриктуры, что оставляет эти вопросы дискутабельными.Заключение. Инфекционные осложнения являются наиболее частыми внутрибольничными осложнениями после операции, как следствие, следует приложить больше усилий для их устранения у пациентов, получающих уретропластику. Проведённый систематический обзор выявил недостаточную изученность проблемы профилактики осложнений и рецидивов стриктур при уретропластических операциях, отсутствие единого мнения об оптимальных режимах антибиотикопрофилактики и целесообразности лечения инфекций мочевых путей перед операцией.

Introduction

Introduction. Urethroplasty is a urological operation that is widely used in the management of urethral stricture (US). However, postoperative complications are relatively common in this procedure. In their structure, infection takes the leading position in most cases. Nevertheless, to date the problems of prevention and treatment of infectious complications, be it urinary tract infection (UTI) or wound infection, remain poorly studied.Objective. To generalise and critically analyse the worldwide literature data on infectious complications in urethroplasty, as well as to study the expediency and validity of infectious conditions treatment before urethroplasty, the efficacy of the protective effect of antibiotic prophylaxis in the aspect of postoperative complications.Materials & methods. The study was conducted accordance with the recommendations on preferred reporting elements for systematic reviews and meta-analyses. The search was conducted in the PubMed database from 1992 to 2022 by keywords, considering the inclusion and exclusion criteria which led to the selection of twenty papers for further study. Results. We have observed the influence of UTI on postoperative complications or recurrence. The presence of infectious postoperative complications, in turn, also has a significant impact on US recurrence. Some authors have drawn attention to the influence of surgical aspects, bed-days and aetiology of US on the incidence of surgical site infection. The studies to date provide little insight into the appropriateness of preurethroplasty infection treatment and antibiotic prophylaxis in the context of their impact on complications and US recurrence which leave these issues open to debate.Conclusion. Infectious complications are the most frequent hospital-acquired sequela after surgery; consequently, more efforts should be made to eliminate them in patients receiving urethroplasty. The systematic review revealed insufficient study of the issues of complications and US recurrence prevention in urethroplasty, no consensus on the optimal antibiotic prophylaxis regimes and the appropriateness of preoperative UTI treatment.

 

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The authors declare that there are no conflicts of interest present.