Pathogenesis-based approach to the treatment of benign prostatic hyperplasia with chronic urinary retention

Shormanov I.S., Uharskiy A.V., Vorchalov M.M.

The function of the urinary bladder is decompensated in 15-32% of patients with benign prostatic hyperplasia leading to the chronic urinary retention, two-sided hy-dronephrosis and chronic kidney disease. Disturbances in the bladder and kidney hemodynamics and consecutive tissue hypoxia are the main pathogenetic factors in the development of these complications. Cystostomy is considered as the first step in the treatment of these patients. Urodynamics restoration leads also to the nor-malization of organ hemodynamics, initiates the reverse development of the struc-tural alterations in the tissues of bladder and kidneys, recovery of the contractile function of the bladder and excretory function of the kidneys. Unsatisfactory re-sults of the radical operative treatment of BPH could be a consequence of the in-completeness of these regeneration processes. Moreover, infection and inflamma-tion, associated with the BPH, and also bacteriuria in patients with continuous cys-tostomic drainage could stipulate the postoperative complications after adenomec-tomy.

This study shows the potential of hyperbaric oxygenation early postoperatively af-ter cystostomy in patients with BPH and chronic urinary retention, who were later operated on using transurethral resection. With the use of laboratory and urody-namic studies, dopplerography of the bladder and kidney vessels and standardized questionnaires it was shown, that hyperbaric oxygenation could exert positive ac-tion on the kidney and bladder urodynamics and the functional state of these or-gans, and also reduce the complications after transurethral resection of prostate.

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