[Selection of the method of drainage of the urinary tract in patients with advanced-stage adenoma of the prostate].

An original method is proposed for urine collection in patients with prostatic adenoma (PA), complicated by chronic renal failure (CRF) and marked upper urinary retentive changes. The techniques of the operation, which is called longitudinal myotomy and epicystostomy, are described. The anterior wall of the bladder was longitudinally dissected through all layers in 2 patients, and leaving the mucosal layer untouched, in 4 patients. Follow-up investigation, including the measurement of serum urea and creatinine, endogenic creatinine clearance and ultrasonography of the kidneys and the bladder, demonstrated similar postoperative results: retention regressed, while serum urea and creatinine levels decreased or even returned to normal in all patients. Within 1 to 1.5 months, adenomectomy was performed successfully in 5 patients. In a control group of 9 PA patients with similar complications, trocar cystostomy (4) and conventional epicystostomy (5) were performed. Upper urinary retention disorders were only improved in 2 of 9 patients, and at later dates (within 4 to 6 months). Therefore, longitudinal myotomy and epicystostomy should be regarded as a successful method of urine collection for the cases of advanced prostatic adenoma, which sometimes may be an alternative to transcutaneous puncture nephrostomy where there are marked upper urinary retentive changes. It can also be a method of choice in those cases where radical surgery is not possible because of terminal chronic renal failure in the presence of a severe attendant disease.