Vol. 18 No. 2 (2026): EURASIAN HEALTH JOURNAL

Bladder neck contracture is one of the most common complications following surgical treatment of benign prostatic hyperplasia. It impairs lower urinary tract urodynamics and carries a high risk of repeat surgery. This study aimed to improve the outcomes of the prevention and treatment of bladder neck contracture, with the severity of postoperative complications assessed using an adapted Clavien-Dindo classification. The study included 106 patients with bladder neck contracture who underwent surgery between 2020 and 2025. The main group comprised 56 patients who received local postoperative administration of Longidaza® according to the protocol developed by the authors, while the control group included 50 patients who received the drug intramuscularly. The effectiveness of prevention and treatment was evaluated using urodynamic and instrumental examinations and by assessing the severity of postoperative complications according to the Clavien-Dindo classification adapted for the surgical treatment of bladder neck contracture. Treatment was effective in 92.9% of patients in the main group and 66.0% of those in the control group, while recurrence rates were 7.1% and 34.0%, respectively. During the first postoperative month, bladder function improved relative to preoperative values in both groups, with statistically significant differences also observed between the groups (p < 0.05). At one year, the maximum urinary flow rate (Qmax) reached 22.45 ± 2.78 mL/s in the main group, compared with 15.62 ± 1.54 mL/s in the control group. Residual urine volume decreased to 20.02 ± 8.48 mL and 70.34 ± 11.25 mL, respectively. Postoperative complications corresponded to Grades I-III of the adapted Clavien-Dindo classification; no Grade IV or V complications were recorded. In 44.3% of cases, postoperative complications were classified as minor and were managed conservatively; 36.2% of these cases occurred in the main group and 63.8% in the control group. Disease recurrence was confirmed in 19.8% of cases and required repeat surgery; 19.0% of recurrent cases occurred in the main group and 81.0% in the control group. When recurrent bladder neck contracture was diagnosed, repeat surgery was performed between six months and one year after the initial procedure. Treatment consisted of transurethral resection followed by local and intramuscular administration of the antifibrotic agent according to the protocol developed by the authors. No further recurrence was recorded during the subsequent 6-12 months.

Acute paraproctitis is a clinically significant suppurative inflammatory lesion of the pararectal tissue that requires timely diagnosis, adequate surgical drainage, and follow-up because of the risk of recurrence and anal fistula formation. The purpose of this study was to summarise current literature on the aetiology, pathogenesis, classification, diagnosis, surgical treatment, and postoperative management of patients with acute paraproctitis. A narrative literature review with elements of comparative analysis was carried out. The review established that acute paraproctitis most often develops as a manifestation of cryptoglandular infection, with polymicrobial flora and spread of pus into the perianal, intersphincteric, ischioanal, or supralevator space. For a typical superficial abscess, clinical inspection and digital rectal examination are sufficient, whereas recurrent, deep, and Crohn- associated forms require magnetic resonance imaging or endoanal ultrasonography. Timely incision and drainage remain the basic method of treatment. Primary fistulotomy was justified only for a clearly verified low fistula, whereas complex forms required a staged approach, with possible use of a draining seton. According to the reviewed sources, the rate of fistula formation after drainage was 23.0-33.9%, and, in a randomised study, omission of packing reduced pain from 38.2 to 28.2 points without a statistically significant increase in fistula or recurrence rates. Antibiotic therapy had selective value in systemic infection, cellulitis, immunosuppression, or diabetes mellitus. The optimal management strategy should be stratified according to anatomical form, fistula risk, systemic manifestations, and comorbid background. The practical significance of the study lies in substantiating a stratified algorithm for managing patients with acute paraproctitis, which differentiates simple and complex forms of the disease, identifies the need for imaging, antibacterial therapy, and staged surgical treatment in due time, and accounts for the risk of recurrence and anal fistula formation