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Reichelt AC, Dressler FF, Gratzke C, Miernik A, Schoeb DS. Evaluation of functional parameters, patient-reported outcomes and workload related to continuous urinary bladder irrigation after transurethral surgery. Transl Androl Urol 2021; 10:2921-2928. [PMID: 34430394 PMCID: PMC8350243 DOI: 10.21037/tau-21-165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 05/13/2021] [Indexed: 11/06/2022] Open
Abstract
Background Continuous saline bladder irrigation (CBI) is a common procedure after transurethral surgery and to treat gross hematuria. We conducted this study to gather data on parameters of CBI, medical staff’s work load associated with CBI monitoring, patients’ feeling of safety and of patients’ impairments during CBI. Methods We observed CBI taking place after transurethral surgery for a 2–9-hour period. Patients were asked to rank how safe they felt, general impairments and impaired mobility. Irrigation parameters and complications were documented at least every 30 minutes. The staff’s workload was evaluated through the frequency of visits and presence time. Results The patients’ mobility was notably reduced with an average of 10.5%±16.7% of time spent outside of bed, pain was low (mean 0.60±1.15). Patients felt very safe with CBI (8.8±1.9), hardly impaired overall (3.8±3.0), but restricted in mobility (5.9±2.8). Pain was associated with general impairment and impaired mobility. Clot retention occurred in 5 patients. Average irrigation speed was 9.46±8.69 mL/min (0 to 86.7 mL/min). Urine bags were emptied on average every 2.2±1.2 hours. Patients were visited by medical personnel 1 to 11 times. Conclusions CBI remains an improvable procedure in terms of the irrigation process itself to prevent complications, the patients’ feeling of safety and comfort during CBI and the amount of work associated with its monitoring. We have provided parameters for the implementation of more individualized CBI monitoring. Trial registration German Clinical Trial Registry; DRKS00023707; Registered retrospectively November 25 2020, https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00023707
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Affiliation(s)
- Anja Christina Reichelt
- Faculty of Medicine, Department of Urology, Medical Center - University of Freiburg, Freiburg, Germany
| | - Franz Friedrich Dressler
- Faculty of Medicine, Department of Urology, Medical Center - University of Freiburg, Freiburg, Germany.,Faculty of Medicine, Institute of Pathology, University Medical Center Schleswig Holstein Lübeck Campus, Ratzeburger Allee, D-23538 Lübeck, Germany
| | - Christian Gratzke
- Faculty of Medicine, Department of Urology, Medical Center - University of Freiburg, Freiburg, Germany
| | - Arkadiusz Miernik
- Faculty of Medicine, Department of Urology, Medical Center - University of Freiburg, Freiburg, Germany
| | - Dominik Stefan Schoeb
- Faculty of Medicine, Department of Urology, Medical Center - University of Freiburg, Freiburg, Germany
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Moschovas MC, Timóteo F, Lins L, de Castro Neves O, Seetharam Bhat KR, Patel VR. Robotic surgery techniques to approach benign prostatic hyperplasia disease: A comprehensive literature review and the state of art. Asian J Urol 2020; 8:81-88. [PMID: 33569274 PMCID: PMC7859458 DOI: 10.1016/j.ajur.2020.10.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 08/14/2020] [Accepted: 09/09/2020] [Indexed: 12/17/2022] Open
Abstract
Abstract Objective: The robotic-assisted approach to simple prostatectomy (RASP) was conceived, essentially reproducing the fundaments of open simple prostatectomy. Since the first report, RASP underwent several technical modifications. The study aims to identify and describe the current robotic surgery techniques to approach benign prostatic hyperplasia (BPH). Methods The paper performed a non-systematic literature review accessing PubMed and Embase databases for all full-text articles published from 2008 to May 2020, assessing robot-assisted surgical techniques for BPH treatment using the terms "robot-assisted simple prostatectomy" OR "robotic simple prostatectomy" OR "RASP" AND "surgical technique". Results After careful review of 180 studies in PubMed and 198 in Embase, 16 papers reporting different RASP techniques. After the first procedure described by Sotelo et al. [9], several authors contributed to the development of the RASP technique. John et al. [24] proposed the extraperitoneal access, and Yuh et al. [23] first reported the adenoma transcapsular dissection. Some modifications were proposed by Coelho et al. [31] on trigonization, posterior reconstruction, and urethro-vesical anastomosis. Other groups focused on urethral-preserving procedures. Moschovas et al. [28] and Clavijo et al. [32] recently described an intrafascial RASP with the removal of the entire prostatic tissue. Finally, Kaouk et al. [29] reported the feasibility and safety of the da Vinci Single Port approach. Conclusion In the last eighteen years, the robotic-assisted approach to BPH disease has been evolved, and different techniques have been described. This review details all the technical developments on RASP that distinctive groups have proposed since the multiport robotic platforms until the new da Vinci Single Port.
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Affiliation(s)
- Marcio Covas Moschovas
- Department of Robotic Surgery, AdventHealth Global Robotics Institute, FL, USA.,Faculdade de Medicina do ABC, São Paulo, Brazil
| | | | | | | | | | - Vipul R Patel
- Department of Robotic Surgery, AdventHealth Global Robotics Institute, FL, USA
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Pansadoro V, Emiliozzi P, Del Vecchio G, Martini M, Scarpone P, Del Giudice F, Veneziano D, Brassetti A, Assenmacher C. Monopolar Transurethral Enucleation of Prostatic Adenoma: Preliminary Report. Urology 2017; 102:252-257. [PMID: 28087281 DOI: 10.1016/j.urology.2016.12.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 12/09/2016] [Accepted: 12/14/2016] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To describe preliminary results of our monopolar transurethral enucleation of prostatic adenoma (mTUEPA). MATERIALS AND METHODS A consecutive series of male patients treated with mTUEPA, a retrograde enucleation of the prostatic adenoma performed by means of a standard monopolar resectoscope, were prospectively enrolled. Symptoms, uroflowmetry parameters, and post-voiding residual were assessed at baseline and at 1, 6, and 12 months postoperatively. Prostate volume was evaluated at baseline by means of transrectal ultrasound. Antiplatelet and anticoagulant drugs were stopped at least 1 week before the operation. RESULTS Forty-seven patients were enrolled. Mean preoperative prostate volume was 64.9 ± 28.5 g. When assessed at baseline, the mean total International Prostatic Symptoms Score was 15.2 ± 3.9, peak flow rate (Qmax) was 8.4 ± 2.9 mL/s and the post-voiding residual was 103.2 ± 90.6 mL. Four weeks after surgery, patients reported a mean International Prostatic Symptoms Score of 5.3 ± 3. This lower urinary tract symptoms relief was further maintained at 6 and 12 months after surgery. A significant postoperative improvement in uroflowmetry parameters was described, being the 6 and 12 months mean Qmax of 23.4 ± 10.6 mL/s and 18.8 ± 9.2 mL/s, respectively (P < .001). Overall, 14 postoperative complications were reported by 13 of 47 (27.6%) patients: most of them were minor complications (Clavien-Dindo Grade I-II), whereas 1 patient reported capsule perforation during surgery, requiring interruption of the procedure and its further completion (Clavien-Dindo IIIb). CONCLUSION mTUEPA is a safe and effective technique, merging the principles of laser enucleation and the advantages of mechanical enucleation with standard monopolar transurethral resection of the prostate equipment.
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Affiliation(s)
- Vito Pansadoro
- Laparoscopic and Oncological Urology Centre, Fondazione Vincenzo Pansadoro, "Pio IX" Hospital, Rome, Italy
| | - Paolo Emiliozzi
- Laparoscopic and Oncological Urology Centre, Fondazione Vincenzo Pansadoro, "Pio IX" Hospital, Rome, Italy
| | - Gianluca Del Vecchio
- Laparoscopic and Oncological Urology Centre, Fondazione Vincenzo Pansadoro, "Pio IX" Hospital, Rome, Italy
| | - Marco Martini
- Laparoscopic and Oncological Urology Centre, Fondazione Vincenzo Pansadoro, "Pio IX" Hospital, Rome, Italy
| | - Paolo Scarpone
- Laparoscopic and Oncological Urology Centre, Fondazione Vincenzo Pansadoro, "Pio IX" Hospital, Rome, Italy
| | - Francesco Del Giudice
- Department of Urology, "La Sapienza" University of Rome, Policlinico Umberto I, Rome, Italy
| | - Domenico Veneziano
- Department of Urology and Kidney Transplantation, O.O. Riuniti BMM, Reggio Calabria, Italy
| | - Aldo Brassetti
- Department of Urology, Sant'Andrea Hospital, "La Sapienza" University of Rome, Rome, Italy.
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Okorie CO. Is continuous bladder irrigation after prostate surgery still needed? World J Clin Urol 2015; 4:108-114. [DOI: 10.5410/wjcu.v4.i3.108] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Revised: 09/10/2015] [Accepted: 11/17/2015] [Indexed: 02/06/2023] Open
Abstract
Continuous bladder irrigation (CBI) is commonly prescribed after certain prostate surgeries to help prevent the clot formation and retention that are frequently associated with these sometimes hemorrhagic surgeries. However, it remains unknown how effective CBI is in preventing clot formation/catheter blockage because these complications still frequently occur in the presence of CBI. On the other hand, the outcome of prostate surgeries has significantly improved over the years, and these surgeries have generally become much safer and, in many hands, less hemorrhagic. Newer surgical options such as holmium laser enucleation of the prostate with associated improved hemorrhagic control have also been introduced, further creating the opportunity to eliminate CBI. Furthermore, there is a lack of review articles on CBI. Hence, this article will review the evolution and contemporary role of CBI in prostate surgeries. To eliminate CBI after prostate surgeries, it is important to achieve good hemostasis during the surgeries. Having in place a policy of non-irrigation after prostate surgeries is also important if less CBI is to be the norm. A non-irrigation policy will hopefully help reduce those cases of CBI prescribed out of long-standing surgical tradition while allowing for cases prescribed out of compelling necessity. The author’s policy of a consistent non-CBI during prostate surgeries over the last 9 years will be highlighted.
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Mohyelden K, Abdel-Kader O. Open prostatectomy with a rectal balloon: A new technique to control postoperative blood loss. Arab J Urol 2015; 13:100-6. [PMID: 26413329 PMCID: PMC4561921 DOI: 10.1016/j.aju.2014.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Revised: 11/29/2014] [Accepted: 12/29/2014] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVES To evaluate a new technique, the rectal balloon (RB), to control blood loss after transvesical prostatectomy (TVP). PATIENTS AND METHODS Over 2 years 100 patients were prospectively randomised into two equal groups. All patients underwent TVP for their benign prostatic hyperplasia but a RB (a balloon fixed to a three-way Foley catheter tip by a plaster strip, making it airtight) was used in group 2. The RB was placed in the rectum opposing the prostate and inflated (pressure controlled) for 15 min. Haemoglobin levels were assessed before and after TVP. Blood transfusion, the amount of saline used for irrigation, duration of catheterisation, hospital stay, and rectal complaints were recorded. Patients were followed up at 1 and 3 months after TVP. RESULTS The enucleated adenoma weight was 102 g in group 1 and 106 g in group 2. There was a significant difference between groups 1 and 2 in haemoglobin loss within the first 24 h after TVP, and in total loss, of 0.9 g and 0.2 g (P = 0.008), and 1.9 g and 1 g (P = 0.001), respectively. There was also a significant difference between the groups in the saline volume used for irrigation (11.4 vs. 2.5 L), catheter duration (5.7 vs. 4.3 days), and hospital stay (6.2 vs. 5.1 days), favouring group 2. Blood transfusions were needed in four patients in group 1 and one in group 2. There were no rectal complaints. CONCLUSION The use of an inflated RB after TVP is a simple and safe procedure with no specific operative technique, that reduces postoperative blood loss, the incidence of blood transfusion, the volume of saline for irrigation, and shortens the catheterisation period and hospital stay, with no rectal complications.
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Long RM, Thomas AZ, Browne C, Alsinnawi M, Ul-islam J, McDermott TED, Grainger R, Thornhill JA. A 30-year experience of Millin's retropubic prostatectomy: Has this classic operation derived by a President of the College in Ireland stood the test of time? Ir J Med Sci 2014; 184:341-4. [PMID: 24729021 DOI: 10.1007/s11845-014-1115-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Accepted: 03/31/2014] [Indexed: 01/17/2023]
Abstract
INTRODUCTION In patients with large gland volume, open prostatectomy/adenoma enucleation remains a valuable surgical option in treating large obstructing prostates. We report our series of open prostatectomies spanning 32 years from a single institution. PATIENTS AND METHODS We retrospectively reviewed all patients who underwent open prostatectomy between 1980 and 2012. Patient demographical, clinical, pre- and postoperative data and final histology were retrieved from hospital in-patient enquiry system and chart review. RESULTS A total of 161 patients underwent Millin's prostatectomy by seven surgeons between 1980 and 2012. The mean blood loss was 1,381 mls (range 300-3,675 mls). One-third (34%) of patients (n = 55) received a blood transfusion. The mean weight of prostate tissue removed was 119 g (median 112 g, range 17-372 g). 6.6 % of pathological specimens revealed incidental prostate cancer, of which 78% were well differentiated (Gleason score ≤ 6). The mean weight of prostate tissue removed in patients who received a transfusion was 124 g. Trial of micturition (TOM) was performed at a mean of 9 days (median 9 days, range 5-25 days) with 94% of patients having a successful trial of voiding. 6% of cases early in the series failed to void initially, but did so at later removal of catheter while still in hospital. 45 patients (28%) of patients developed peri- or postoperative complications. There were three deaths (1.9%). CONCLUSION Open Millin's prostatectomy popularized over half a century ago continues to be a valuable option for the surgical treatment of high-volume prostate glands with excellent outcomes for patients.
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Affiliation(s)
- R M Long
- Department of Urology, The Adelaide and Meath Incorporating the National Children's Hospital (AMNCH), Tallaght, Dublin 24, Ireland
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Sergi F, Falavolti C, Bove AM, Buscarini M. Robotic-assisted laparoscopic simple prostatectomy and bladder diverticulectomy with temporary clamping of internal iliac arteries. J Robot Surg 2014; 8:81-3. [PMID: 27637244 DOI: 10.1007/s11701-012-0390-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2012] [Accepted: 12/13/2012] [Indexed: 11/26/2022]
Abstract
The minimally invasive approach for benign prostatic hyperplasia (BPH) is replacing open surgery. Laparoscopic and robotic techniques have benefits in treatment of BPH especially for large prostatic adenoma. We present a case of laparoscopic robotic-assisted simple prostatectomy with bilateral transient occlusion of internal iliac arteries. This could be an optional surgical technique when a significant blood loss is expected, for example in patients with an estimated volume of BPH larger than 100 ml or in patients who cannot suspend antiaggregant therapy. In this case we temporarily occluded the internal iliac arteries bilaterally with Bulldog clamps and the adenoma was enucleated according to Sotelo's laparoscopic robotic-assisted technique. We had optimal results in terms of intraoperative and postoperative outcomes.
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Affiliation(s)
- F Sergi
- Department of Urology, Campus Bio-Medico University of Rome, Via Alvaro del Portillo, 200, 00128, Rome, Italy.
| | - C Falavolti
- Department of Urology, Campus Bio-Medico University of Rome, Via Alvaro del Portillo, 200, 00128, Rome, Italy
| | - A M Bove
- Department of Urology, Campus Bio-Medico University of Rome, Via Alvaro del Portillo, 200, 00128, Rome, Italy
| | - M Buscarini
- Department of Urology, Campus Bio-Medico University of Rome, Via Alvaro del Portillo, 200, 00128, Rome, Italy
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Matei DV, Brescia A, Mazzoleni F, Spinelli M, Musi G, Melegari S, Galasso G, Detti S, de Cobelli O. Robot-assisted simple prostatectomy (RASP): does it make sense? BJU Int 2012; 110:E972-9. [PMID: 22607242 DOI: 10.1111/j.1464-410x.2012.11192.x] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
UNLABELLED Study Type - Therapy (case series) Level of Evidence 4. What's known on the subject? and What does the study add? The open simple prostatectomy (OSP) is the 'gold standard' for high-volume prostate adenomas. It shows very good functional results despite its invasiveness. Minimally invasive approaches, e.g. laparoscopy or holmium laser enucleation of the prostate, have been 'tested' but none have proved a substitute for the OSP. The robot-assisted approach provides optimal functional results and is easy to perform for experienced robotic surgeons. Extending the indication of robotics to low-incidence pathologies can take advantage of the opportunity to 'see the procedure' using available information technology, e.g. Youtube™ that presents as an unexpectedly useful tool. OBJECTIVE • To evaluate the outcome, feasibility and reproducibility of a robot-assisted (RA) approach for simple prostatectomy (SP) in cases of high-volume symptomatic benign prostatic hyperplasia (HVS-BPH). PATIENTS AND METHODS • In all, 35 consecutive patients underwent RASP for HVS-BPH using a previously described technique. • The mean prostate volume on preoperative transrectal ultrasonography was 106.6 mL. • All but two patients (with bladder calculi) had an adenoma volume of >65 mL and 27 (77.1%) >80 mL. Nine patients (25.7%) had an indwelling catheter. • The mean International Prostate Symptom Score (IPSS) was 28. RESULTS • The median operative duration was 180 min and the mean hospital stay was 3.17 days. • The mean catheter duration was 7.4 days and discontinuous or continuous catheter irrigation was required in two and seven patients, respectively (25.1%). • In all, 10 patients (28.6%) had practically no blood loss. No patients had a transfusion. • The mean postoperative peak urinary flow was 18.9 mL/s (P < 0.001), while the mean IPSS was 7 (P < 0.001). • For costs, while superficially RASP appeared more expensive than open SP (OSP), when considering the higher costs of hospitalisation for OSP, RASP was cheaper. Also, bipolar-TURP costs in patients with large-volume prostates had rather similar costs to RASP. CONCLUSIONS • RASP is a feasible and reproducible procedure with outcome advantages when compared with the open or with other minimally invasive techniques (laser or laparoscopy). As a result, a RA approach is worth considering in cases of high-volume prostate adenomas. • Extending the indication of the RA approach, to the SP, requires firstly that the surgeon be proficient in RA surgery and secondly that as the incidence rate of HVS-BPH is low, the surgeon has had the opportunity to 'see the procedure'.
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Affiliation(s)
- Deliu V Matei
- Departments of Urology, IEO European Institute of Oncology, Saint Joseph Hospital, Milan, Italy.
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Castillo O, Bolufer E, López-Fontana G, Sánchez-Salas R, Fonerón A, Vidal-Mora I, Degiovanni D, Campos R. [Laparoscopic simple prostatectomy (adenomectomy): experience in 59 consecutive patients]. Actas Urol Esp 2011; 35:434-7. [PMID: 21450371 DOI: 10.1016/j.acuro.2011.01.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2010] [Revised: 12/16/2010] [Accepted: 01/01/2011] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Laparoscopic adenomectomy 150 is a minimally invasive alternative to open surgery in large prostates. Our aim is to discuss our series of 59 patients treated by means of laparoscopic adenomectomy with precise vascular control. MATERIALS AND METHODS Between June 2003 and June 2006, a total of 59 patients with a mean age of 65.5 years (51 to 82), underwent laparoscopic extraperitoneal adenomectomy. All the patients had a history of lower urinary tract symptoms (LUTS) and benign prostatic hyperplasia (BPH). The mean International Prostate Symptom Score (IPSS) was 20 points (16-22). The information was collected prospectively in a database. The analysis was performed subsequently. RESULTS All 59 adenomas were completely removed laparoscopically without conversion to open surgery. The mean preoperative prostate volume by ultrasound was 108.5 cc (75-150). The average operating time was 123 minutes (90-180). The mean loss of blood was 415 ml (50-1500) and 4 patients (14.8%) required a blood transfusion. Two (7.4%) of the patients presented perioperative complications. The mean hospital stay and the bladder catheterization time were 3.5 (2-7) and 4.2 (3-7) days respectively. CONCLUSIONS Laparoscopic extraperitoneal simple prostatectomy is an effective procedure for the treatment of large prostatic adenomas. There seems to be less perioperative morbidity and, in our experience, this technique seems to be feasible and reproducible; however, its learning curve is a complicated matter to deal with.
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Castillo O, Bolufer E, López-Fontana G, Sánchez-Salas R, Fonerón A, Vidal-Mora I, Degiovanni D, Campos R. Laparoscopic simple prostatectomy (adenomectomy): Experience in 59 consecutive patients. ACTA ACUST UNITED AC 2011. [DOI: 10.1016/j.acuroe.2011.01.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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Abdel-Hakim AM, Habib EI, El-Feel AS, Elbaz AG, Fayad AM, Abdel-Hakim MA, Meshref AW. Holmium Laser Enucleation of the Prostate: Initial Report of the First 230 Egyptian Cases Performed in a Single Center. Urology 2010; 76:448-52. [DOI: 10.1016/j.urology.2009.12.035] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2009] [Revised: 12/14/2009] [Accepted: 12/16/2009] [Indexed: 11/28/2022]
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Okorie CO, Salia M, Liu P, Pisters LL. Modified suprapubic prostatectomy without irrigation is safe. Urology 2009; 75:701-5. [PMID: 19914705 DOI: 10.1016/j.urology.2009.06.109] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2009] [Revised: 05/20/2009] [Accepted: 06/28/2009] [Indexed: 12/15/2022]
Abstract
OBJECTIVES To determine whether postoperative bladder irrigation can be safely eliminated in the context of a modification to surgical technique. Post-operative irrigation is routinely used following suprapubic prostatectomy for benign prostatic hyperplasia (BPH). METHODS Single center retrospective study of 82 patients who underwent suprapubic prostatectomy for BPH comparing complications in those treated with irrigation to patients treated with surgical modification and no irrigation. These consecutive patients were divided into 2 groups: group 1 consisted of 43 patients who underwent suprapubic prostatectomy before June 2006 with post operative bladder irrigation and standard method of surgical hemostasis. Group 2 consisted of 39 patients who underwent suprapubic prostatectomy after June 2006 with no post operative irrigation and a modified bladder neck repair performed with the intent of improving hemostasis. The modified bladder neck repair is described. RESULTS Patient characteristics and prostate specimen weights are comparable in both groups. Clot retention was more common in the group 1 patients (11 patients in group 1 vs 2 patients in group 2, P = .01), and 2 patients with disruption of the anterior bladder wall closure were in group 1. CONCLUSIONS Suprapubic prostatectomy can be safely performed without the use of postoperative irrigation. The elimination of postoperative irrigation significantly reduces the economic burden on patients in our locality.
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Affiliation(s)
- Chukwudi O Okorie
- Pan African Academy of Christian Surgeons, Banso Baptist Hospital, Kumbo, NWP, Cameroon.
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Shahapurkar VV, Khare N, Deshmukh AV. Modified technique in Freyer's prostatectomy to achieve hemostasis. Indian J Urol 2009; 25:332-4. [PMID: 19881126 PMCID: PMC2779955 DOI: 10.4103/0970-1591.56189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
This study is an attempt to develop a technique by which complete hemostasis can be achieved on table by giving traction to the Foley's catheter thereby compressing the venous plexus and the avulsed prostatic arteries at the bladder neck by the inflated balloon. A total of 170 cases of BPH were operated by Freyer's Suprapubic Trans-vesicle prostatectomy. In the technique, bladder mucosa is reposited below the balloon and the balloon is inflated to 60 ml of normal saline. The balloon is kept at the bladder neck and traction is applied to the catheter. Traction is maintained by strapping the catheter to the thigh of the patient with sticking plaster for 24–48 h. The average blood loss was 18.9 ml which proves that the Foley's balloon pressure traction method at the bladder neck is effective in achieving hemostasis in patients undergoing open prostatectomy.
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Urethral Catheter Traction Reduces Bleeding Compared With Suturing of Prostatic Vesical Junction During Suprapubic Prostatectomy: A Randomized Clinical Trial Study. Urology 2009; 74:137-41. [DOI: 10.1016/j.urology.2008.11.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2008] [Revised: 10/25/2008] [Accepted: 11/13/2008] [Indexed: 11/24/2022]
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Verger-Kuhnke AB, Reuter MA, Epple W, Ungemach G. [The low hydraulic pressure transurethral resection of the prostate results in 340 patients with great adenomas]. Actas Urol Esp 2007; 30:896-904; discussion 904. [PMID: 17175929 DOI: 10.1016/s0210-4806(06)73555-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
INTRODUCTION the transurethral resection of prostate TURP is the elective treatment for the small and medium adenomas. In this study they analyse the effectiveness, the results and the postoperative morbidity in the resection of the great adenomas. PATIENTS AND METHOD We study 340 patients with great adenomas and symptomatic infravesical obstruction that were operated with the low hydraulic pressure RTUP between August of 1999 and June of 2006. RESULTS Average Age of the patients 69 years (range 51-89). Prostate volume by TRUS, 107 ml (70-204). PSA 7,94 ng/ml (0,71-26,4). Weight of the resected fragments: 74,5gr. (50-160), time of the intervention 65 min. (35-155), postoperative urethral catheterisation 1.7 days (1-8), suprapubic derivation 6.5 days (5-15), the duration of hospital stay after surgery were 8 days (7-16), peak flow pre-op. 11.2 ml/sec. (5-15,7), post-operative 19.7 ml/sec. (7-41,3). There were no cases of TURP syndrome in this group. Operative complications: Urinary infection without fever (bacteria >100.000) 95 patients (27.9%), bladder derivation by preoperative urinary retention 53 patients (15,6%). 18 patients (5,3%) with postoperative urinary retention. 11 patients (3,2%), with infection and fever >38 degrees C. 7 patients (2%) with postoperative bladder bleeding, 2 patients (0,6%) with urethral lesion. 1 patient (0.3%), with massive scrotal hematoma (after vasectomy). Control of the pre and post operative hemoglobin: Hemoglobin pre-op 15 g/dl (12-19,3), hemoglobin post-op 11,5 g/dl (7,6-16,4), difference of (- 3,5g/dl) 23,3%. In only 29 patients (8.5%) it was necessary to carry out a sanguineous transfusions (heterolog) of 2 to 4 EC (500 ml), the TRUS was 125 ml, weight of the fragments 90 gr. (52-140), the hemoglobin pre-op was 14,72g/dl and post-op of 8,8g/dl with a difference of (- 5,92g/dl) 40.2%. CONCLUSIONS The video assisted low hydraulic pressure TURP, is an effective method in the surgical treatment of great prostate adenomas. The severe postoperative complications are little, and in 311 patients (91.5%) it was not necessary sanguineous transfusion. The stationary treatment and the urethral catheterisation is smaller in comparison with the open adenomectomy.
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Affiliation(s)
- A B Verger-Kuhnke
- Reuter Klink, Servicio de Urología, Hospital Karl-Olga, Hospital Escuela Dependiente de la Universidad de Ulm, Stuttgart Alemania.
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Dall'Oglio MF, Srougi M, Antunes AA, Crippa A, Cury J. An improved technique for controlling bleeding during simple retropubic prostatectomy: a randomized controlled study. BJU Int 2006; 98:384-7. [PMID: 16879682 DOI: 10.1111/j.1464-410x.2006.06236.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To compare two techniques of open prostatic adenectomy (OPA) for controlling bleeding, as OPA is the most effective surgical method for alleviating obstructive symptoms related to benign prostatic hyperplasia (BPH) but there is always a risk of peri-operative bleeding. PATIENTS AND METHODS The study comprised a prospective and randomized analysis of 62 men with BPH who consecutively had OPA between January 2002 and September 2004. Two techniques were used: in group 1, patients had the Millin modified retropubic prostatectomy, and in group 2 they had a classical transvesical prostatectomy. Blood loss during and after surgery was analysed. RESULTS The median (range) blood loss during surgery was 362 (50-700) and 640 (200-1500) mL for groups 1 and 2, respectively (P = 0.007). The mean (sd) decrease in haemoglobin level from before to 1 day after surgery was 1.76 (0.31) and 3.15 (0.33) g/dL for groups 1 and 2, respectively (P < 0.001). When comparing the first and third days after surgery, there were no further significant decreases in levels for group 1, at 0.15 (0.31) g/dL (P = 0.175), but there was a significant decrease for group 2, at 0.74 (0.33) g/dL (P = 0.031). There was a similar decrease in haematocrit levels. While three patients from group 2 required a blood transfusion, only one from group 1 had to be transfused. CONCLUSION The Millin technique, as modified by one of the present authors, can significantly control bleeding during and after surgery, and reduce transfusion rates, when compared to the classic transvesical prostatectomy.
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Affiliation(s)
- Marcos F Dall'Oglio
- Division of Urology, University of Sao Paulo Medical School, Sao Paulo, Brazil
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Cancho Gil MJ, Díz Rodríguez R, Virseda Chamorro M, Alpuente Román C, Cabrera Cabrera JA, Paños Lozano P. [Assessment of effectiveness and security of bladder neck cerclage after transvesical prostatectomy]. Actas Urol Esp 2006; 30:53-6. [PMID: 16703730 DOI: 10.1016/s0210-4806(06)73396-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
INTRODUCTION The Bladder neck cerclage diminishes the risk of bleeding after transvesical prostatectomy, but it increases the risk of suffering postoperative bladder neck sclerosis. Our objective is to value the effectiveness and therapeutic security of the temporary bladder neck cerclage after transvesical prostatectomy. MATERIAL AND METHODS It was carried out a prospective and longitudinal study in a cohort of 25 age patients mean age 68,5 years (standard deviation, 2,6 years), subjected to transvesical prostatectomy (Freyer) with bladder neck cerclage using polipropilene number 1 suture, that was retired at the 24 hours of the surgery. To value the hemostatic utility of bladder neck cerclage, it was measured the hematocrit and hemoglobin concentration at the 24 hours of the intervention. To evaluate the appearance of obstructive sequels, the maximum urinary flow was measured three months after the surgery. RESULTS It was observed a mean hematocrit at the 24 hours of surgery of 7,3%, and a mean decrease of the hemoglobin at the 24 hours of the surgery of 2,7 gr/dl. In any cases the postoperative hemoglobin concentration was inferior to 8 mg/dl, therefore, it was not necessary transfusion. The uroflowmetry carried out at 3 months of surgery showed that 24 of the 25 intervened patients presented a maximum flow superior to 15 ml/sg. CONCLUSIONS The temporary bladder neck cerclage is a good hemostatic technique. The precocious cercalge retreat avoids the late sequels (bladder neck sclerosos), that originates the permanent cerclage.
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Affiliation(s)
- M J Cancho Gil
- Servicio de Urología, Hospital Central de la Defensa, Madrid
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