INTRODUCTION: In closed intraperitoneal bladder trauma, an alternative to laparotomy is laparoscopy. The rupture is closed with endoscopic sutures, and the bladder is drained with a urethral catheter. In the literature, the issue of the placement of a trocar cystostomy during laparoscopic treatment of patients with intraperitoneal bladder ruptures requiring prolonged drainage is insufficiently covered. PURPOSE OF THE STUDY: Determination of the optimal trocar cystostomy method during laparoscopic treatment of intraperitoneal bladder rupture. MATERIALS AND METHODS: Trocar cystostomy was performed in 8 patients with intraperitoneal bladder ruptures, among whom 7 had concomitant diseases of the prostate gland, and 1 had urethral stricture. Trocar cystostomy during laparoscopic surgery was performed in three different ways. Results. In the first method, the rupture of the bladder was initially sutured. Then, through the urethral catheter, the bladder was filled with saline. A trocar cystostomy was inserted through the suprapubic region. The second method consisted in the installation of a trocar cystostomy under the control of a laparoscope even before the suturing of the bladder rupture. In the third method proposed by us (patent No. 2592023), a Foley-type catheter with a balloon capacity of at least 200 ml was inserted into the abdominal cavity through the laparoscopic port. A catheter was inserted from the abdomen through an intraperitoneal rupture into the bladder. Inside the bladder, the catheter balloon was filled with saline. Then, through the suprapubic region, the anterior abdominal wall, the bladder and the inflated balloon of the catheter were pierced layer by layer with a trocar. Another catheter was inserted through the trocar into the bladder. After removal of the catheter with a ruptured balloon, the intraperitoneal rupture of the bladder was sutured. FINDINGS: According to the results of the study, the third method of inserting a trocar cystostomy turned out to be the most optimal and safe.

BACKGROUND:Foreign bodies introduced by patients into the bladder and urethra are relatively rare in clinical practice. As a result, there is insufficient information in the scientific literature regarding methods of extracting foreign bodies from the urinary tract. AIM:determination of the optimal methods for extracting foreign bodies from the urethra and bladder. MATERIALS AND METHODS:Foreign bodies of the lower urinary tract were removed in 21 patients: 15 (71.4%) men and 6 (28.6%) women. Foreign bodies were found in the urethra in 7 (33.3%) patients and in the bladder in 14 (66.7%) patients. Removal of foreign bodies from the urethra and bladder was performed endoscopically or during open surgery. RESULTS:Removal of stabbing, cutting and glass objects from the urinary tract in 9 patients was performed during open surgery. Foreign bodies with even smooth edges were removed in 12 patients under urethrocystoscopic control. At the same time, in two patients, coagulated suppositories were first fragmented in the bladder cavity, and then removed in parts. Cystolithotripsy was performed in one patient with a suppository inlaid with calculus before fragmentation. CONCLUSIONS:Foreign bodies with sharp edges or made of glass are safer to be removed from the lower urinary tract during open surgery. Foreign bodies with a smooth and even surface are optimally removed endoscopically. Long and bulky foreign objects that can be fragmented in the bladder cavity are best removed in parts. When foreign bodies are encrusted with large calculi, cystolithotripsy should be performed before their endoscopic extraction.