Лікування захворювань, що супроводжуються інфравезикальною обструкцією у чоловіків молодого віку

Abstract

The purpose of the work was to study the possibilities of conservative and surgical treatment of infravesical obstruction in young patients with lower urinary tract symptoms. Materials and methods. Urodynamic diagnosis of infravesical obstruction due to increased resistance of the prostatic part of the urethra was established in 36 patients, whose age was 32.76 ± 1.13 years on average. The volume of the prostate gland according to transrectal ultrasound examination varied from 18 to 32 cm3 (on average 24.05 ± 1.28 cm3). Based on the results of a complex urodynamic study, 3 groups were identified: group 1 – 12 (33.3%) patients with infravesical obstruction with low-amplitude detrusor hyperactivity in the filling phase; group 2 – 13 (36.1%) patients with infravesical obstruction without an abdominal component during urination; group 3 – 11 (30.6%) men with infravesical obstruction in the presence of an abdominal component during urination. The control group included 16 men aged 21–48 years (on average 36.32 ± 2.34 years), who had no lower urinary tract symptoms. The effectiveness of drug therapy was assessed by comparing the initial indicators and quality of life indicators after 1 month, the IPSS index, the maximum volumetric rate of urination, and the residual urine volume. Results and discussion. To select the first line of therapy, the data of a complex urodynamic study and other examination methods (tamsulosin 0.4 mg, tamsulosin 0.4 mg + solifenacin 5 mg or tamsulosin 0.4 mg + mirabegron 25 mg) were taken into account. 16 patients who felt improvement after 1 month of drug treatment continued to experience it for 12–18 months. 17 (47.2%) persons out of 36 examined patients underwent surgical intervention due to symptoms of infravesical obstruction: 14 (70.0%) out of 20 – in whom drug therapy did not achieve the expected effect and 3 patients who refused conservative therapy despite its effectiveness. The patients underwent transurethral resection of the prostate gland. 12–18 months after observation, the patients determined a significant improvement in their condition, namely, in all parameters there was no significant difference from the control indicators. Conclusion. The effectiveness of conservative therapy in young men with infravesical obstruction reaches only 44.4%. But in case of improvement from treatment after 1 month, the stable positive effect of this type of treatment remains for 12–18 months. We believe that the main cause of infravesical obstruction in this contingent of patients may be benign prostatic hyperplasia, which debuted at earlier terms. Observation and treatment of this group of patients should be carried out according to the same principles as in patients with a similar pathology of an older age. If conservative therapy is ineffective within 1 month in this contingent of patients, transurethral resection of the prostate gland is indicated. After 12–18 months of observation, the operated patients determined a significant improvement in their condition, namely – in all parameters there was no significant difference from the control indicators. Thus, in case of absence of effectiveness of drug therapy in young male patients with infravesical obstruction, minimally invasive surgical intervention can significantly improve the quality of life, normalize urodynamic indicators, and reduce the IPSS score