COMORBIDITY IN PATIENTS UNDERGOING OPEN AND LAPAROSCOPIC PROSTATECTOMIES FOR LARGE BENIGN PROSTATE HYPERPLASIA (over 80 cm3) IN STATE MEDICAL INSTITUTIONS

INTRODUCTION. According to the Order of the Ministry of Health of Ukraine № 181 dated April 4, 2008, the physical status of patients before surgical intervention, including prostatectomy, is determined using the American Society of Anesthesiologists (ASA) classification. When performing prostate surgeries for benign prostatic hyperplasia (BPH), urologists also assess the patients’ physical condition before surgery using the Charlson Comorbidity Index (CCI). The Charlson Index can help predict how successful treatment will be in patients with comorbidities and can also be used to compare treatment outcomes in different patient groups with the same or varying levels of comorbidity. THE AIM OF THE STUDY. To identify comorbid diseases and determine the Charlson Comorbidity Index in patients undergoing open and laparoscopic prostatectomy for benign prostatic hyperplasia big size (more than 80 cm3) in state medical institutions. MATERIALS AND METHODS. In the Department of Urology, Nephrology and Kidney Transplantation of the Clinical Center for Oncology, Hematology, Transplantology, and Palliative Care of the Cherkasy Regional Council, the Urology Department of Vinnytsia Regional Pirogov Hospital, and Odesa City Clinical Hospital № 1, during the period from 2021 to 2025, 100 laparoscopic extraperitoneal retropubic (transcapsular) prostatectomies, 100 open retropubic prostatectomies, and 100 open transvesical prostatectomies were performed in patients with benign prostatic hyperplasia big size (more than 80 cm3). Preoperative assessment of the patients’ physical status was carried out using the American Society of Anesthesiologists (ASA) classification system and the Charlson Comorbidity Index (CCI). Postoperative uroflowmetry (upon discharge) was performed using the domestic uroflowmeter «Potik-K» (Dnipro). Intraoperative blood loss was determined by the gravimetric method. Intra- and postoperative complications were evaluated using the Clavien-Dindo classification. Statistical processing of the obtained data was performed using methods of variation statistics. RESULTS. In 300 patients who underwent simultaneous laparoscopic and open prostatectomies, 333 comorbid nosological units of various organs and systems were identified. Thus, each patient with benign prostatic hyperplasia had on average about 1.1 concomitant diseases. The Charlson Comorbidity Index in patients who underwent laparoscopic prostatectomy was 3.8±1.9, open retropubic prostatectomy — 4.0±1.7, and open transvesical prostatectomy — 3.9±1.8. Concomitant diseases occurred with the same frequency in patients who underwent simultaneous laparoscopic and open prostatectomies. The majority (up to 90%) of comorbid diseases were coronary heart disease and hypertension. Laparoscopic prostatectomy was characterized by the longest operation time (120.3±12.7 minutes), but the lowest intraoperative blood loss (112.7±23.2 ml), the lowest number of postoperative complications (4%), and the shortest postoperative hospital stay (6.3±1.9 days). Both laparoscopic and open prostatectomies allowed equally effective restoration of urination after surgery. CONCLUSIONS. Before performing prostatectomy for benign prostatic hyperplasia, it is necessary to assess the physical status of patients not only according to the American Society of Anesthesiologists (ASA) classification but also to determine the Charlson Comorbidity Index. In patients who underwent simultaneous laparoscopic and open prostatectomies for benign prostatic hyperplasia big size (more than 80 cm3), at least one concomitant disease was detected. Comorbid diseases occurred with the same frequency among patients who underwent simultaneous laparoscopic and open prostatectomies in state medical institutions. The majority (up to 90%) of comorbid diseases were coronary heart disease and hypertension. Laparoscopic prostatectomy is characterized by the longest operative time but the lowest intraoperative blood loss, postoperative hospital stay, and number of postoperative complications. Both laparoscopic and open prostatectomies provide equally effective restoration of urination after surgery. It is necessary to analyze a larger number of patients before prostatectomy to determine the influence of the Charlson Comorbidity Index on the rate of postoperative complications.