COMBINED METHOD FOR SURGICAL TREATMENT OF PATIENTS WITH LOCALISED FORMS OF PROSTATE CANCER AND STONES IN THE MIDDLE AND LOWER THIRDS OF THE URETER Russian patent published in 2022 - IPC A61B17/00 A61B17/94 

FIELD: medicine.

SUBSTANCE: invention relates to the field of medicine, namely, to urology, operative urology, and oncology. A ureteroscope is inserted freely through the urethra into the urinary bladder under endotracheal anaesthesia. The ostia are examined; the Olympus ureteroscope is inserted into the lower third of the ureter using a ureteral wire, wherein the calculus is visualised in the middle or lower third; contact ureteral lithotripsy is performed using laser energy, wherein the calculus is fragmented to the maximum degree. Then the calculus fragments are evacuated using a nitinol basket, ureteroscopy is performed from the left to the upper third, and the ureteroscope is removed. At the second stage, the patient is placed in a supine position without being de-anaesthesised; a 4 to 4.5 cm incision is made in the paraumbilical region 3 cm below the navel; an approach is made to the prevesical space in layers; a primary cavity is formed with the index finger, whereto a balloon dilator is inserted; pressure is injected into the dilator with a manual pump; a workspace is formed, then a laparoscope is inserted into the dilator to assess the correctness of the position of the dilator, and if the balloon dissector is positioned correctly, the latter is removed, and a laparoscope is inserted into the working cavity through the above approach. Then, a skin puncture is made with a scalpel on the right, 3 cm laterally to the main approach, followed by installing a 5 mm trocar is performed, similar actions are performed on the left. Then, a 12 mm port is installed 3 cm medial to the iliac spine on the right after a 1 cm long skin incision; similarly, a 5 mm port is installed on the left. The anterior surface of the prostate and urinary bladder are skeletonised; two tunnels are formed alternately to the right and to the left of the projection of the neck of the urinary bladder in the layer of fatty tissue located medial to the tendinous arch of the pelvis and lateral to the pubovesical complex; before the appearance of the vas deferens and the seminal vesicles, the external lateral detrusor bundles and the vesicoprostatic muscle are verified and transected, releasing the proximal urethra along the posterolateral semicircle, and the tunnels are united, followed by moving along the contour of the prostate bed from the depth outward from 6 to 12 o'clock of the conventional dial; the cranial anterior apron of the detrusor is dissected, then the proximal intraprostatic urethra is crossed; the seminal complex is isolated; the seminal ducts are crossed; posterior dissection of the prostate is performed, starting medial to the tendinous arch of the pelvis; the layer between the lateral periprostatic, intrapelvic fascia and fascia of the levator ani muscles is divided until the puboperineal muscle is exposed on both sides, after which, oriented on the layer of fatty tissue between the pubovesical complex and the anterior periprostatic fascia, the two are divided up to the urethral sphincter, wherein the dorsal venous complex is not sutured; the distal intraprostatic urethra is then isolated and crossed, the prostate gland is moved to a container for further extraction, an anastomosis is applied between the proximal urethra and the neck of the urinary bladder with continuous self-tightening sutures. The position of the profiled urethral Foley catheter is monitored, wherein the cylinder is inflated to 10 ml. The seal tightness of the anastomosis is monitored by injecting 150 ml of sterile saline solution; then the prostate and the seminal vesicles are removed as a single unit in a container through the central port approach, the tools and trocars are removed, sutures and an aseptic bandage are applied to the skin.

EFFECT: improved results of treatment of the patient due to the restored passage of urine through the ureter and the radical surgical treatment of localised forms of prostate cancer; method is applicable in patients with concomitant cardiovascular pathology due to the lesser rate of haemodynamic disorders and in patients with suspected difficulties during upper respiratory tract intubation, as it provides maximum efficiency and anaesthetic security to the fullest extent.

1 cl, 1 ex