Improving the choice of surgical tactics in geriatric patients with benign prostatic hyperplasia

Abstract

Background. The analysis of modern scientific literature indicates that if the list of indications for elective surgery in geriatric patients with benign prostatic hyperplasia (BPH) meets the requirements of urological practice, then the contraindications for this operation clearly do not correspond to them.Aim. Based on the current list of contraindications to elective surgery in geriatric patients with BPH, to develop rational surgical tactics aimed at reducing the frequency and severity of postoperative complications and deaths.Materials and methods. Examination and treatment of 295 geriatric patients with stage 2 BPH (main group A) who underwent planned transurethral resection of the prostate or transpusical adenomectomy in the period from 2007 to 2015 at the Samara Regional Clinical Hospital of War Veterans (the clinical base of the First Research Institute of Clinical Gerontology and Rehabilitation of War Veterans of the Medical University “Reaviz”). During this period, 116 geriatric patients with stage 2 BPH (main group B) using the author’s list of contraindications, elective surgery was contraindicated. They underwent conservative treatment. The control group consisted of 344 geriatric patients with stage 2 BPH who underwent elective transurethral resection of the prostate or transpusical adenomectomy in the same Hospital from 2000 to 2006, taking into account the contraindications to these operations that existed at that time. The age of patients in all groups was from 60 to 89 years.Results. The use of this list made it possible to establish among 116 patients (main group B) excretory absolute contraindications to surgery were performed in 48.3 % of patients, relative present contraindications of the second – in 33.6 %, temporary contraindications of rendering – in 13.8 %, a special contraindication to transurethral resection of the prostate – in 1.7 %, special contraindications to transvesical adenomectomy – in 2.6 %, which contributed to the prevention of possible postoperative complications and deaths among them.Conclusion. The clinical expediency of using the author’s approach to the choice of surgical tactics, taking into account contraindications to elective surgery in geriatric patients of the main group A, compared with patients of the control group, consisted in reducing of postoperative complications and deaths and increasing of good immediate treatment results among them.