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INTRODUCTION

Problem urgency

For today the prostate cancer (RPZH) is considered one of the most actual problems of urology [24, 67, 104]. Thanks to active screening, frequency of revealing of initial stages of this disease that dictates necessity of application of effective and safe methods of treatment localised RPZH which concerns nizkodoznaja brahiterapija [9, 12, 25, 41, 90, 169] is enlarged.

One of the most frequent complications brahiterapii RPZH is infravezikalnaja the obstruction (Iwo) and the disorders of an emiction bound to it [91]. Thus, emiction disturbance is observed at 60-80 % of patients RPZH, and radial influence on a prostate does not eliminate, and on the contrary aggravates

infravezikalnuju obstruction [27, 29, 128, 145, 196]. infravezikalnoj obstructions in postimplantatsionnom the period carry To development risk factors: the maximum rate of an emiction (Qmax) less than 10 ml/SEC, a total point of the international scale of an estimation of prostatic symptoms (IPSS) more than 12-20, the residual urine volume (OOM) more than 50 see cubic and the prostate volume (PZH) more than 60 see cubic [15, 41, 94, 173].

For preventive maintenance infravezikalnoj obstructions at planning brahiterapii a prostate cancer hormonal therapy (GT) which optimal regimen the maximum androgenic blockade (MAB) for a period of 3 months [116 is considered is used neoadjuvantnaja. 133, 206]. Such treatment effectively reduces volume PZH, however does not exclude development urodinamicheskih disorders after performance brahiterapii, and also can lead to augmentation of a nonspecific mortality [19, 47, 144]. Such treatment is toxic for cardiovascular system and negative impact on erectile function [125] makes. In this connection, appointment of hormonal therapy for the purpose of preventive maintenance of development of Iwo at planning BT has not found a wide clinical embodiment.

One of alternative methods of preventive maintenance infravezikalnoj obstructions is the transurethral resection (ROUND) of a prostate [215]. Operation allows to reduce volume of a prostate and to eliminate obstructive symptoms, thus not rendering negative influence on current RPZH [13, 29, 66, 114, 137]. At the same time, a number of researchers binds presence ROUND PZH in the anamnesis to development of an incontience of urine after performance brahiterapii, and also with augmentation of quantity of radial damages, supposing thus, that frequency of development of complications depends on a technique and operation volume, from terms between performance ROUND PZH and implantation of sources [48, 211, 215].

Degree of a readiness of a theme of research

Brahiterapii, as to a method of treatment of the localised cancer

Prostate, numerous publications of domestic and foreign researchers are devoted. Efficiency of a technique at various stages of disease is defined on the basis 5, 10 and 15-year-old observation over patients [72, 90, 101]. Thus restrictions to carrying out brahiterapii, considering an initial condition mochevydelitelnoj systems, have been formulated still in the early eighties and till now were not reconsidered [213]. The basic way of preparation of patients to brahiterapii is hormonal therapy RPZH which effectively reduces prostate volume, however does not provide high-grade preventive maintenance of risk of development infravezikalnoj obstruction after implantation of sources of radiation [19, 47, 86, 116, 142, 203].

Surveying a transurethral resection of a prostate as a preventive maintenance method infravezikalnoj obstructions at planning brahiterapii, it is necessary to note separation of data about a technique of an electroresection and terms of its carrying out before implantation of sources, a fragmentariness of the information on influence ROUND on efficiency of radial therapy, and also about its advantages over hormonal therapy [48, 147, 211, 215]. As consequence, absence of accurate algorithm of preventive maintenance of development infravezikalnoj obstructions after brahiterapii limits possibility of carrying out of this operation at appreciable number of patients localised RPZH, having risk factors of its development.

Thus, despite high frequency of revealing of risk factors of development infravezikalnoj obstructions after carrying out brahiterapii, search of the uniform approach to planning of this operation and preventive maintenance of possible complications now proceeds, as has defined the work purpose.

Research objective

To develop preventive maintenance and treatment methods infravezikalnoj obstructions at sick of the localised cancer of a prostate with high risk of its development after brahiterapii.

Problems

1. To study influence of a transurethral prostatectomy and neoadjuvantnoj medicamental hormonal therapy of a cancer of a prostate before brahiterapiej on volume of a prostate and indicators urodinamiki the bottom urinary ways at patients with high risk of development infravezikalnoj obstructions in postimplantatsionnom the period.

2. To carry out the comparative analysis of frequency of development and character infravezikalnoj obstructions after brahiterapii at the patients initially having high risk of its development in postimplantatsionnom the period, depending on a preventive maintenance method (surgical or hormonal).

3. To tap features of a current postimplantatsionnogo the period at patients localised RPZH, having high risk infravezikalnoj obstructions, in comparison with patients with initially low risk of its development.

4. To develop algorithm of preventive maintenance infravezikalnoj obstructions in a post-implantatsionnom the period at patients with high risk of its development.

Scientific novelty

At research carrying out new data about influence neoadjuvantnoj hormonal therapy and prostate ROUND before brahiterapiej on development risk factors infravezikalnoj obstructions in postimplantatsionnom the period are obtained. It is proved, that the most effective method of preventive maintenance infravezikalnoj obstructions in postimplantatsionnom the period is ROUND of a prostate which eliminates available risk factors and allows to dilate indications to performance brahiterapii at patients localised RPZH. It is established, that neoadjuvantnaja hormonal therapy, as a preventive maintenance method infravezikalnoj obstructions, possesses low efficiency, in comparison with prostate ROUND. The developed technique of a transurethral prostatectomy before brahiterapiej allows to eliminate development risk factors infravezikalnoj obstructions in postimplantatsionnom the period, does not render negative influence on current RPZH, results brahiterapii and frequency of postradial complications.

The practical importance

The algorithm of preventive maintenance infravezikalnoj obstructions depending on presence and expression of risk factors of its development is developed. The stereotaxic attachment intended for carrying out of implantation of sources of radiation under the control of a computer tomograph is developed and patented. Treatment tactics infravezikalnoj is offered obstruction after brahiterapii. The developed methods of preventive maintenance infravezikalnoj obstructions will allow to dilate indications for carrying out brahiterapii the sick localised cancer of a prostate initially having high risk of its development in postimplantatsionnom

The period.

Methodology and research methods

Methodological basis of dissertational research was consecutive application of methods of scientific knowledge. Work is executed in design opened randomizirovannogo clinical research. Were used clinical, tool, laboratory,

Statistical methods of research.

The substantive provisions which are taken out on protection

1. The volume of a prostate at patients localised RPZH can contraindicate to brahiterapii only at a combination to other risk factors of development infravezikalnoj obstructions in postimplantatsionnom the period

2. The transurethral prostatectomy, taking into account features of its performance, is unique way of preventive maintenance and treatment infravezikalnoj obstructions in postimplantatsionnom the period and does not enlarge frequency of development of an incontience of urine after brahiterapii.

3. Hormonal therapy cannot be surveyed as a high-grade method of preventive maintenance infravezikalnoj obstructions in postimplantatsionnom the period at patients localised RPZH.

The personal contribution of the author

Personal participation of the author in preparation of research and reception of results was carried out at all stages of work. The author independently collects and generalises the given literatures on a research theme, are defined its purpose and problems, the structure and volume of methods of work is developed. All medical manipulations are independently executed, and also the collecting, ordering and statistical data processing is carried out, the received results are stated, conclusions are generated and practical references are prepared.

Approbation of results of research

Materials of dissertational work are reported and discussed at conference urology Pressing questions (Moscow, 2010), the All-Russia forum Pirogovsky surgical week (St.-Petersburg, 2010), session of the St.-Petersburg urological society of S.P.Fedorova (Sankt - Petersburg, 2011), VII Congress of the Russian society of oncourologists (Moscow, 2012), the Neva urological forum (St.-Petersburg, 2012), IX Congress Man's health (St.-Petersburg, 2013г), conferences the Role of an out-patient link in diagnostics and treatment onkourologicheskih diseases (St.-Petersburg, 2014)

Introduction of results in practice

The received results are introduced in practical activities FGBUZ the Hospital by №122 it. L.G. The Sokolov FMBA Russia.

Publications

On a dissertation theme 10 printing works, from them 3 in magazines, from list VAK the Russian Federation are published. 2 patents of the Russian Federation are received.

Volume and dissertation structure

The dissertation is stated on 174 pages of the typewritten text and consists of introduction, the review of the literature, the description of a material and research methods, 5 heads of results of own researches, the conclusion, conclusions, practical references and the list of the used literature. The literature index contains 33 domestic and 197 foreign sources. Work is illustrated by 35 tables and 50 drawings.

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A source: GORELOV Victor Pavlovich. PREVENTIVE MAINTENANCE INFRAVEZIKALNOI of OBSTRUCTION AT PLANNING BRAHITERAPII of the CANCER of the PROSTATE. The DISSERTATION on competition of a scientific degree of the candidate of medical sciences. St.-Petersburg. 2014

More on topic INTRODUCTION:

  1. in introduction
  2. INTRODUCTION
  3. INTRODUCTION
  4. 10.1. Introduction
  5. INTRODUCTION
  6. approbation and introduction of results.
  7. Introduction
  8. Introduction
  9. INTRODUCTION
  10. INTRODUCTION
  11. Introduction
  12. Introduction
  13. INTRODUCTION
  14. Instead of Introduction …
  15. PRACTICAL INTRODUCTION OF RESULTS OF WORK
  16. 5. Attention strengthening to questions of legal introduction.
  17. Introduction