Лечение простатита и повышение потенции

• Следует помнить, влияние данных синдромов на урологическую симптоматику (боли в промежности, яичках, дизурия) до сих пор является дискуссионным в среде урологов.

• Установка стента является необратимой процедурой и имеет ряд серьезных возможных негативных последствий таких как тробмоз глубоких вен и миграция стента в предсердие. Длительная практика наблюдения за пациентами подвергшимися установке венозного стента на 2020г в России отсутствует.

• Согласно проведенному опросу среди прооперированных участников форума на 2020г большинство отмечают некоторые улучшения, но полностью избавиться от урологических симптомов не удалось никому (см "Реальные отзывы").

• МР-Флебография вен малого таза (МРТ);

• Ультразвуковое внутривенное исследование IVUS;

• Cелективная флебография.

Важно:

Реальные отзывы

Papech писал(а):Источник цитаты Речь о левом яйце. По сути даже более чем на 25% с 3.1 до 4.1

I think one of the most difficult decision for NCS pts is first, whether to move forward with surgery, and also which surgery. Here I will go through them as much as I know and risk and benefits involved.
Non-Operative Management: generally for mild to tolerable symptoms.
1. Stretching Exercise: this is more for MALS, but I’ve heard patients with mild symptoms get better with this for NCS as well.
https://vascsurg.me/.../nonoperative-management.../amp/...
2. Herbal Medicine: this I read about from one of the posters in NCS group so very little knowledge here of my own.
3. Pain Management with various non-narcotics and narcotic medication. This I would suggest if you are not an operative candidate for good reasons -severe heart and lung disease for example.
Operative Management: less invasive to more invasive.
1. Endovascular Stenting: this is done by small needle access without cutting, and done under sedation. A stent is placed in the left renal vein to lift up the compression. At this time and age of endovascular techniques especially using IVUS to accurately assess to select correct size stent, migration, dislodging, and thrombosis/clogging issues are really not something I worry about. There are several papers (some up to 50 patients out of Europe showing success in short term, but there’s no long-term data yet. My experience with this is less than 50/50: less than half of them had more than 5 year pain improvement, and others went into get AT. Left renal vein transposition after endovascular stenting isn’t ideal as the left renal vein has stent well-incorporated on it with significant scarring involving aorta, SMA, and renal vein. AT can be done, some robotically, as transplant surgeons really need 1.5cm of the end left renal vein that is closest to the kidney. Other transplant surgeons take out the stent and do AT but this is mostly done with open incision. At this point in my career, I no longer offer this as first choice especially in young and still growing pts, though I am working on a few additive procedures that may make this work with much higher success rate.
2. Extravascular Stenting: done under general anesthesia and usually with open incision though some are doing this laparoscopically or with robotics, this is when a PTFE graft (GoreTex), which is often used in vascular procedures for bypasses and dialysis accesses, is used to wrap around the left renal vein thereby structure my lifting up the compression of the left renal vein at the same time lifting up the SMA. Advantage with this is that surgeons are not cutting or sowing on the vein, but rather putting a scaffolding around it. Sandmann and Scholbach group in In Germany have been doing this for a while with great success. They also will fix MALS and MTS at the same time if indicated. Downside is that there still is a failure rate (some patients of the German group have consulted me to trouble shoot their issues) and other disadvantages are the foreign material in the body that increases the risk of infection rate and restrictive scarring of the left renal vein from the PTFE wrap. While I do not have experience with this, I am well-aware of their surgery as I know Sandmann and Scholbach from Liepzig vascular meetings, and over exchanging information re patients who are consulting both me and them. We have agreed to meet sometime this year to discuss various issues involving these compressions abd for me to gain more insight into their techniques.
3. Nephropexy: this is a procedure when you have a condition called nephroptosis - mobile or floating kidney that causes kinking in the vein enough to cause hemodynamically significant left or right renal vein flow dysfunction (if you are presenting with right flank pain instead of the typical left side, nephroptosis is a working diagnosis). People with this condition is likely to have EDS if not already diagnosed. This is done by general anesthesia, and can be done in in itself as a stand-alone procedure if this is the only compression you have, but can be done in conjunction when doing extravascular stenting or left renal vein transposition.
4. Left Renal Vein Transposition (LRVT): done under general anesthesia with open midline incision, left renal vein is transacted at the connecting point of IVC and moved down about 3-5cm depending on the length of renal vein to work with, and reconnecting it to IVC. Takes about 1.5 hours and about 7-10 days hospital stay (one day in ICU). Out of 15 cases I’ve done, I have one patient who is making plans to covert to AT. Rest of them are in various stages of trouble shooting: some have complete resolution of all symptoms, some have exacerbation of neurogenic MALS (most common issue after LRVT, unless you’ve already had MALS surgery though incomplete MALS surgery must be considered), GI work up with subsequent treatment of SIBO. Considering these needed trouble shooting and making corrective action, success rate in my experience been over 90%. The failure rates that’s being quoted 50% by some institution seems quite different from my experience; perhaps they are not trouble shooting after the surgery as I have described above. Advantage of LRVT is that most of the times no foreign material is used like PTFE, and infection risk minimal (had one infection but just on the incision site). If you have MALS and/or MTS together, then all three can be addressed at the same time with choice of extravascular or endovascular stenting for MTS especially if you have a strong metal allergy. Downside of this is that it’s a big surgery to get through and recovery time may vary depending on the patient. Patients can still have left renal vein stenting, or AT after this surgery. None of my patients so far with suspected diagnosis of SMAS needed surgery for it.
5. Autotransplant: done under general anesthesia by transplant surgeons by open, laparoscopic, or robotics, left kidney is moved from its original position to usually right pelvis, or sometimes more to the midline depending on the length of healthy renal vein available. This procedure is actually done initially for Loin Pain Hematuria Syndrome (LPHS) but has translated to having very good success rate - some reporting 90%- for NCS. AT patients do go through same trouble shooting for neurogenic MALS exacerbation and GI workup for SIBO and end up getting corrective surgery for MALS or treatment for SIBO. Advantage with AT is that while it’s the most drastic surgery, there usually isn’t more surgery that can be done for NCS less Nephrectomy which some patients do go one to have due to persistent pain now in right pelvis, exacerbation of pelvic congestion, or worsening venous congestion in the leg. Risk of loss of kidney or declining of transplanted kidney function are there but I believe there’s numbers are very low. Some transplant surgeons do this routinely, while some always make LRVT as first recommendation before considering AT as a last resort given most invasive and risk involved among all surgeries that are possible. While I have just as many patients who went through AT route under my care, it is my hope that at some point we are able to figure out ways to have less patients go through it and still achieve high success rate - symptom free life. In upcoming American Vein and Lymphatic Society meeting in October, I will be debating merits of LRVT with that of AT with transplant surgeons, in hope to learn from each other’s experiences for the better outcomes of the patients we care for.
Next, will discuss a bit about how these various compression syndromes seem to be interrelated and importance of thorough evaluation for all compression and planning surgeries accordingly is important.
Best Regards,
Dr. Kim

Papech писал(а): ↑

Пн фев 14, 2022 12:10 am

Я уже не знаю, что делать. У меня после эмболизации ППС вены слева по узи расширились более чем на 25%.
Я устал бороться с этим.
Единственное, что осталось недоделанным это:
Определяется сужение левой почечной вены, вызванное компрессией ее правой почечной артерией (с гемодинамической значимостью до 70%)

bnp89 писал(а):Источник цитаты Пролактин

bnp89 писал(а): ↑

Вт фев 15, 2022 10:09 pm

А кто-нибудь проверял гормоны при СМТ, особенно если варикоцеле беспокоит?
Меня уролог направил, в общем сдал, оказалось:
Пролактин - 624,2 мкМЕ/мл - выше верхней границы нормы в 2 раза;
ГСПГ - 59,9 нмоль/л - превышает норму;
общий тестостерон (25нмоль/л) - в норме у верхней границы;
свободный тестостерон - 10,29 пг/мл - у нижней границы нормы.
Есть у кого опыт, что делать при отклонениях от норм или бессмысленно что-то делать, пока не решён вопрос с СМТ?

bnp89 писал(а):Источник цитаты Пока изучаю вопрос этот.

dom писал(а):Источник цитаты Если СМТ подтвержден, с на гармоны уже можешь не смотреть.

Kushka787 писал(а):Источник цитаты Пару раз думал скорую вызывать, от таких болей аж зубы сводило. Что посоветуете?

onsteady писал(а):Источник цитаты Может даже съездить или по почте заказать

spaunnw писал(а):Источник цитаты Почему там Валстенты не нравится

maximuz373 писал(а):Источник цитаты подходят больше для вен.