Prostatic hyperplasia in patients with kidney tumour: specificities of surgical treatment
Patients and methods. Among 1380 patients, operated due to KT over the period from 2006 to 2015, and 3368 patients, operated due to BPH, 6.8% had indications to surgical treatment due to the both combined diseases. All patients were older than 50 years. The volume of the prostate was 38 to 190 cm3 (68.7 ± 4.8 cm3). The peak urine flow rate according to uroflowmetry was within the range 7.6 ± 1.7 ml/s. Eight patients (15.4%) from this group along with prostatic hyperplasia had stones in the urinary bladder (UB), with maximal sizes 5 to 40 mm, and their number varied from 1 to 10.
Results. All patients had symptoms associated with infravesical obstruction, and only 15.4% of patients reported of symptoms conditioned by kidney tumour. In 41 (78.9%) patients, the first step was surgical treatment due to kidney tumour. In 10 (19.2%) patients, the first step was surgery due to BPH. No simultaneous surgical interventions due to KT and BPH were performed. Most patients (57.7%) underwent nephrectomy (NE) due to KT. The main methods of treatment of BPH were
transurethral resection (TURP) or holmium laser enucleation of the prostate (HoLEP). 7.7% of patients, who underwent surgery due to kidney tumour at the first stage, developed acute urinary retention (AUR) in the postoperative period. No specific complications (except for AUR), relapse of tumour or progression of oncological process related to the chosen tactics of treatment were recorded.
Conclusion. In treatment of 52 patients with KT in combination with BPH we used 20 different combinations of surgical methods, which is demonstrative of the necessity to determine the tactics of treatment for each patient individually, taking into consideration all possible factors of disease. Step-by-step surgical intervention is an effective and safe procedure in this cohort of patients. Initially, surgical intervention due to KT can be recommended. In patients, who at the time of hospitalisation or in their medical history had an AUR episode, while the clinical signs of KT are absent and the risk of its progression is low, intervention due to BPH is expedient at first. In combination of BPH with UB stones, their one-step removal is expedient, which would permit to avoid repeat surgical intervention and to improve the quality of life of the patient. The method of laser enucleation of the prostate permits to remove prostate adenoma of practically any size, which permits to rule out open interventions. Laparoscopic interventions due to KT and early activation of patients make it possible to reduce the risk of AUR in patients with peak urine flow rate (Qmax) less than 5 ml/sec.
Key words: kidney tumour, kidney cancer, laparoscopic partial nephrectomy, laparoscopic nephrectomy, prostate adenoma, benign prostatic hyperplasia, urinary bladder stones, laser cystolithotripsy, transurethral resection, holmium laser enucleation.
For citation: Alyaev Yu.G., Rapoport L.M., Pshikhachev A.M., Shpot' E.V., Sorokin N.I., Dymov A.M., Perekalina A.N. Prostatic hyperplasia in patients with kidney tumour: specificities of surgical treatment. Vopr. urol. androl. (Urology and Andrology). 2019; 7(1): 5–11. (In Russian).