PECULIARITIES OF TREATMENT TACTICS IN PATIENTS WITH URINARY BLADDER DECOMPENSATION DUE TO INFRAVESICAL OBSTRUCTION, COMPLICATED WITH MEGACIST

Abstract

Infravesical obstruction is a common pathological condition inherent in more than 80% of older men. Among the causes of infravesical obstruction, the leading place is occupied by benign prostatic hyperplasia. Often, men of older age groups fail to seek medical help due to lack of attention to their health, the erroneous idea that urination problems are «normal age-related changes». Also, unsatisfactory clinical results are associated with a delay in surgical treatment due to complex concomitant pathology, high operational risk, and ineffective medicine therapy. Responding to a prolonged violation of the urine outflow, remodeling of the urinary bladder occurs, which goes through three sequential stages: compensation, subcompensation and decompensation of the detrusor. Prolonged intravesical hypertension, which causes a violation of blood supply and chronic detrusor hypoxia, is accompanied by a progressive decrease in muscle and an increase in connective tissue mass, bladder rigidity. In addition, the result of chronic hypoxia is bladder innervation violation. Morphologically, the decompensation stage is characterized by degradation of smooth muscle fibers and excessive fibrosis. The urinary bladder loses contractile function. Due to decompensation of detrusor with formation of a megacyst, it is not possible to restore complete emptying of the urinary bladder after elimination of obstruction, which causes recurrent urinary infection, stone formation, ureterohydronephrosis, and renal failure. According to the indications, infravesical obstruction is removed, on next stage, additionally carried out by the duplication of anterior wall of the urinary bladder by liberalization from adventitia dissected across the anterior wall of the urinary bladder for 5-7 cm in the direction of the neck and from the mucosa for 5-7 cm in the direction of the bottom and imposition of the upper part of the urinary bladder on the lower and suturing in VICRYL 2-3/0. The wound is drained and sutured in layers, the urethral catheter is removed for 8-10 days after surgery. The proposed method for the surgical treatment of megacyst patients with creating duplicated bladder wall, which ensures a decrease in the volume of the bladder while preserving muscle tissue, thus improving detrusor contractility, restoring bladder emptying, eliminating complications such as ureterohydronephrosis, recurrent urinary infection, stone formation, renal failure.

Keywords

• infravesical obstruction
• decompensated urinary bladder
• megacyst surgical correction.