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<article article-type="research-article" dtd-version="1.3" xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xml:lang="ru"><front><journal-meta><journal-id journal-id-type="publisher-id">urovest</journal-id><journal-title-group><journal-title xml:lang="ru">Вестник урологии</journal-title><trans-title-group xml:lang="en"><trans-title>Urology Herald</trans-title></trans-title-group></journal-title-group><issn pub-type="epub">2308-6424</issn><publisher><publisher-name>Rostov State Medical University</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="doi">10.21886/2308-6424-2024-12-1-9-18</article-id><article-id custom-type="elpub" pub-id-type="custom">urovest-825</article-id><article-categories><subj-group subj-group-type="heading"><subject>Research Article</subject></subj-group><subj-group subj-group-type="section-heading" xml:lang="ru"><subject>ОРИГИНАЛЬНЫЕ СТАТЬИ</subject></subj-group><subj-group subj-group-type="section-heading" xml:lang="en"><subject>ORIGINAL ARTICLES</subject></subj-group></article-categories><title-group><article-title>Хирургическое лечение гиперплазии простаты больших  размеров: сравнительный анализ результатов применения  стандартной и модифицированной лапароскопической  позадилонной аденомэктомии, дополненной временным  пережатием внутренних подвздошных артерий и уретроцистоанастомозом</article-title><trans-title-group xml:lang="en"><trans-title>Surgical treatment of large-volume benign prostate hyperplasia: a comparative analysis of the outcomes of using standard and modified laparoscopic retropubic simple prostatectomy combined with temporary clamping of the internal iliac arteries and vesicourethral anastomosis</trans-title></trans-title-group></title-group><contrib-group><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-2049-2191</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Волков</surname><given-names>С. Н.</given-names></name><name name-style="western" xml:lang="en"><surname>Volkov</surname><given-names>S. N.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Станислав Николаевич Волков — канд. мед. наук; заведующий отделением урологии и андрологии</p><p>Москва</p></bio><bio xml:lang="en"><p>Stanislav N. Volkov — M.D., Сand.Sc.(Med); Head, Urology and Andrology Division</p><p>Moscow</p></bio><email xlink:type="simple">volkov_stas08@mail.ru</email><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-6096-5723</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Пушкарь</surname><given-names>Д. Ю.</given-names></name><name name-style="western" xml:lang="en"><surname>Pushkar</surname><given-names>D. Yu.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Дмитрий Юрьевич Пушкарь — д-р мед. наук, профессор, академик РАН; заведующий кафедрой урологии</p><p>Москва</p></bio><bio xml:lang="en"><p>Dmitry Yu. Pushkar — M.D., Dr.Sc.(Med), Full Prof., Acad.of the RAS; Head, Dept. of Urology</p><p>Moscow</p></bio><email xlink:type="simple">pushkardm@mail.ru</email><xref ref-type="aff" rid="aff-2"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0003-4511-5998</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Колонтарев</surname><given-names>К. Б.</given-names></name><name name-style="western" xml:lang="en"><surname>Kolontarev</surname><given-names>K. B. </given-names></name></name-alternatives><bio xml:lang="ru"><p>Константин Борисович Колонтарев — д-р мед. наук; профессор кафедры урологии</p><p>Москва</p></bio><bio xml:lang="en"><p>Konstantin B. Kolontarev — M.D., Dr.Sc.(Med); Prof., Dept. of Urology</p><p>Moscow</p></bio><email xlink:type="simple">kb80@yandex.ru</email><xref ref-type="aff" rid="aff-2"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0003-2799-2241</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Степанченко</surname><given-names>В. С.</given-names></name><name name-style="western" xml:lang="en"><surname>Stepanchenko</surname><given-names>V. S.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Владимир Сергеевич Степанченко — врач-уролог-андролог лечебно-диагностического отделения андрологии и урологии</p><p>Москва</p></bio><bio xml:lang="en"><p>Vladimir S. Stepanchenko — M.D.; Urologist-Andrologist, Urology and Andrology Division </p><p>Moscow</p></bio><email xlink:type="simple">mark2013-2014@mail.ru</email><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-4478-5968</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Терещенко</surname><given-names>В. И.</given-names></name><name name-style="western" xml:lang="en"><surname>Tereshchenko</surname><given-names>V. I.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Виталий Игоревич Терещенко — врач-уролог лечебно-диагностического отделения андрологии и урологии</p><p>Москва</p></bio><bio xml:lang="en"><p>Vitaly I. Tereshchenko — M.D.; Urologist-Andrologist, Urology and Andrology Division</p><p>Moscow</p></bio><email xlink:type="simple">dr_tereshchenko@mail.ru</email><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0009-0007-7249-2058</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Джаримок</surname><given-names>А. Р.</given-names></name><name name-style="western" xml:lang="en"><surname>Dzharimok</surname><given-names>A.  R.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Анзаур Рамазанович Джаримок — канд. мед. наук; врач-уролог отделения урологии</p><p>Майкоп, Республика Адыгея</p></bio><bio xml:lang="en"><p>Anzaur R. Dzharimok — M.D., Сand.Sc.(Med); Urologist, Urology Division</p><p>Maykop, Republic of Adygea</p></bio><email xlink:type="simple">a.dzharimok@yandex.ru</email><xref ref-type="aff" rid="aff-3"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0009-0002-3745-8448</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Шевякина</surname><given-names>А. Е.</given-names></name><name name-style="western" xml:lang="en"><surname>Shevyakina</surname><given-names>A. E.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Анастасия Евгеньевна Шевякина — врач-уролог лечебно-диагностического отделения андрологии и урологии</p><p>Москва</p></bio><bio xml:lang="en"><p>Anastasia E. Shevyakina — M.D.; Urologist-Andrologist, Urology and Andrology Division </p><p>Moscow</p></bio><email xlink:type="simple">sh.anastasi@gmail.com</email><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0009-0008-4918-007X</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Дауров</surname><given-names>М. А.</given-names></name><name name-style="western" xml:lang="en"><surname>Daurov</surname><given-names>M. A.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Мурат Асланович Дауров — заведующий отделением урологии</p><p>Майкоп, Республика Адыгея</p></bio><bio xml:lang="en"><p>Murat A. Daurov — M.D.; Head, Urology Division</p><p>Maykop, Republic of Adygea</p></bio><email xlink:type="simple">muratdaurov@mail.com</email><xref ref-type="aff" rid="aff-3"/></contrib></contrib-group><aff-alternatives id="aff-1"><aff xml:lang="ru"><institution>Национальный медицинский исследовательский центр эндокринологии</institution><country>Россия</country></aff><aff xml:lang="en"><institution>National Medical Research Centre of Endocrinology</institution><country>Russian Federation</country></aff></aff-alternatives><aff-alternatives id="aff-2"><aff xml:lang="ru"><institution>Российский университет медицины</institution><country>Россия</country></aff><aff xml:lang="en"><institution>Russian University of Medicine</institution><country>Russian Federation</country></aff></aff-alternatives><aff-alternatives id="aff-3"><aff xml:lang="ru"><institution>Адыгейская республиканская клиническая больница</institution><country>Россия</country></aff><aff xml:lang="en"><institution>Adygea Republican Clinical Hospital</institution><country>Russian Federation</country></aff></aff-alternatives><pub-date pub-type="collection"><year>2024</year></pub-date><pub-date pub-type="epub"><day>04</day><month>03</month><year>2024</year></pub-date><volume>12</volume><issue>1</issue><fpage>9</fpage><lpage>18</lpage><permissions><copyright-statement>Copyright &amp;#x00A9; Волков С.Н., Пушкарь Д.Ю., Колонтарев К.Б., Степанченко В.С., Терещенко В.И., Джаримок А.Р., Шевякина А.Е., Дауров М.А., 2024</copyright-statement><copyright-year>2024</copyright-year><copyright-holder xml:lang="ru">Волков С.Н., Пушкарь Д.Ю., Колонтарев К.Б., Степанченко В.С., Терещенко В.И., Джаримок А.Р., Шевякина А.Е., Дауров М.А.</copyright-holder><copyright-holder xml:lang="en">Volkov S.N., Pushkar D.Y., Kolontarev K.B., Stepanchenko V.S., Tereshchenko V.I., Dzharimok A.R., Shevyakina A.E., Daurov M.A.</copyright-holder><license xml:lang="ru" license-type="creative-commons-attribution" xlink:href="https://creativecommons.org/licenses/by/4.0/" xlink:type="simple"><license-p>Данная работа распространяется под лицензией Creative Commons Attribution 4.0.</license-p></license><license xml:lang="en" license-type="creative-commons-attribution" xlink:href="https://creativecommons.org/licenses/by/4.0/" xlink:type="simple"><license-p>This work is licensed under a Creative Commons Attribution 4.0 License.</license-p></license></permissions><self-uri xlink:href="https://www.urovest.ru/jour/article/view/825">https://www.urovest.ru/jour/article/view/825</self-uri><abstract><sec><title>Введение</title><p>Введение. Оптимальные подходы к хирургическому лечению доброкачественной гиперплазии предстательной железы (ДГПЖ) большого объёма всё ещё не определены, однако лапароскопическая позадилонная аденомэктомия (ЛПА) является одним из предпочтительных методов оперативного лечения при ДГПЖ большого объёма. Существуют ограничения стандартных подходов к выполнению лапароскопической аденомэктомии, что определяет необходимость в разработке усовершенствованных методик.</p></sec><sec><title>Цель исследования</title><p>Цель исследования. Сравнительный анализ эффективности и безопасности стандартной ЛПА и модифицированной ЛПА, дополненной временным пережатием внутренних подвздошных артерий и уретроцистоанастомозом.</p></sec><sec><title>Материалы и методы</title><p>Материалы и методы. В настоящее многоцентровое исследование включены 300 пациентов (средний возраст — 67,0 ± 5,2 лет), которые были случайным образом распределены в группы стандартной и модифицированной ЛПА. Основными оцениваемыми критериями эффективности вмешательства в течение 6 месяцев наблюдения служили выраженность симптомов нарушений мочеиспускания по шкале IPSS, оценка качества жизни, показатели максимального потока мочи и остаточного объёма мочи. Фиксировали все осложнения, развившиеся в период послеоперационного наблюдения.</p></sec><sec><title>Результаты</title><p>Результаты. Из 300 пациентов 149 подверглись стандартной ЛПА, а 151 — выполнена модифицированная методика ЛПА. Значимые различия зафиксированы в отношении длительности госпитализации (р = 0,032), показателя снижения уровня гемоглобина (р = 0,020) и длительности функционирования промывной системы (р = 0,001). Кроме того, применение модифицированной методики было ассоциировано с более низкой частотой кратковременного недержания мочи (р = 0,031), задержки мочи в связи с закупоркой уретрального катетера (р = 0,002), а также частоты развития тампонады мочевого пузыря (р = 0,001). Через 6 месяцев послеоперационного наблюдения группы были сопоставимы по большинству из показателей эффективности за исключением показателей максимального потока мочи (23,9 ± 2,3 и 20,3 ± 1,9 мл/с в группах модифицированной и стандартной ЛПА соответственно, р = 0,001). Через 6 месяцев послеоперационного наблюдения в группе модифицированной ЛПА отмечали меньшую частоту развития тампонады мочевого пузыря (р = 0,010), ургентного недержания мочи (р = 0,002) и рубцовой деформации шейки мочевого пузыря (р = 0,031).</p></sec><sec><title>Заключение</title><p>Заключение. Показатели эффективности применения модифицированной ЛПА как методик хирургического лечения ДГПЖ большого объёма не уступают таковым в группе стандартной ЛПА, а профиль безопасности позволяет предполагать целесообразность более широкой апробации методики в практике.</p></sec></abstract><trans-abstract xml:lang="en"><sec><title>Introduction</title><p>Introduction. The optimal approaches to the surgical treatment of large-volume benign prostatic hyperplasia (BPH) have not yet been determined, but laparoscopic retropubic simple prostatectomy (LSP) is one of the preferred methods of surgical treatment for large-volume BPH. There are limitations to standard approaches to LSP, which necessitate the development of improved techniques.</p></sec><sec><title>Objective</title><p>Objective. To provide comparative analysis of the efficacy and safety of standard LSP and modified LSP combined with temporary clamping of the internal iliac arteries and vesicourethral anastomosis.</p></sec><sec><title>Materials &amp; methods</title><p>Materials &amp; methods. The present multicenter study included 300 patients (mean age 67.0 ± 5.2 years) who were randomly assigned to standard and modified LSP groups. The main efficacy criteria of the intervention during 6 months of observation were: the severity of symptoms of urinary disorders (IPSS score), quality of life, peak urine flow rate and residual urine volume. All complications developed during the postoperative follow-up were recorded.</p></sec><sec><title>Results</title><p>Results. Of the 300 patients, 149 underwent standard LSP, and 151 underwent a modified LSP. Significant differences were detected in the hospital stay (p = 0.032), the rate of decrease in hemoglobin (p = 0.020) and the irrigation time (p = 0.001). In addition, the use of the modified technique was associated with a lower incidence of short-term urinary incontinence (p = 0.031), urinary retention due to urethral catheter occlusion (p = 0.002), and incidence of bladder tamponade (p = 0.001). After 6 months of postoperative follow-up, the groups were comparable in most of outcomes, except for peak urine flow (23.9 ± 2.3 and 20.3 ± 1.9 ml/s in the modified and standard LSP groups, respectively, p = 0.001). After 6 months of postoperative follow-up, the modified LSP group had a lower incidence of bladder tamponade (p = 0.010), urge urinary incontinence (p = 0.002) and bladder neck contracture (p = 0.031).</p></sec><sec><title>Conclusion</title><p>Conclusion. The effectiveness of the modified LSP as a method of surgical treatment of large-volume BPH is not inferior to those in the standard LSP group, and the safety profile suggests the feasibility of wider testing of the technique in practice.</p></sec></trans-abstract><kwd-group xml:lang="ru"><kwd>доброкачественная гиперплазия предстательной железы</kwd><kwd>наблюдательные исследования</kwd><kwd>подвздошная артерия</kwd><kwd>лапароскопическая позадилонная простатэктомия</kwd><kwd>качество  жизни</kwd><kwd>задержка мочи</kwd><kwd>недержание мочи</kwd><kwd>везикоуретральный анастомоз</kwd></kwd-group><kwd-group xml:lang="en"><kwd>benign prostatic hyperplasia</kwd><kwd>follow-up studies</kwd><kwd>iliac artery</kwd><kwd>laparoscopic retropubic simple prostatectomy</kwd><kwd>quality of life</kwd><kwd>urinary retention</kwd><kwd>urinary incontinence</kwd><kwd>vesicourethral anastomosis</kwd></kwd-group></article-meta></front><back><ref-list><title>References</title><ref id="cit1"><label>1</label><citation-alternatives><mixed-citation xml:lang="ru">Sun F, Sun X, Shi Q, Zhai Y. 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