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Chen IH, Fong CM, Chang HHS, Ni YJ, Chiu KN, Lee KW. Application of root cause analysis and TEAMSTEPPS post intravesical gas explosion during transurethral resection of the prostate: a rare case report. BMC Urol 2024; 24:139. [PMID: 38965501 PMCID: PMC11225426 DOI: 10.1186/s12894-024-01520-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 06/19/2024] [Indexed: 07/06/2024] Open
Abstract
BACKGROUND An intravesical gas explosion is a rare complication of transurethral resection of the prostate (TURP). It was first reported in English literature in 1926, and up to 2022 were only forty-one cases. Injury from an intravesical gas explosion, in the most severe cases appearing as extraperitoneal or intraperitoneal bladder rupture needed emergent repair surgery. CASE PRESENTATION We present a case of a 75-year-old man who suffered an intravesical gas explosion during TURP. The patient underwent an emergent exploratory laparotomy for bladder repair and was transferred to the intensive care unit for further observation and treatment. Under the medical team's care for up to sixty days, the patient recovered smoothly without clinical sequelae. CONCLUSIONS This case report presents an example of a rare complication of intravesical gas explosion during TURP, utilizing root cause analysis (RCA) to comprehend causal relationships and team strategies and tools to improve performance and patient safety (TeamSTEPPS) method delivers four teamwork skills that can be utilized during surgery and five recommendations to avoid gas explosions during TURP to prevent the recurrence of medical errors. In modern healthcare systems, promoting patient safety is crucial. Once complications appear, RCA and TeamSTEPPS are helpful means to support the healthcare team reflect and improve as a team.
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Affiliation(s)
- I-Hung Chen
- Department of Internal Medicine, National Defense Medical Center, Taipei City, Taiwan.
- Institute of Medical Science and Technology, National Sun Yat-sen University, Kaohsiung City, Taiwan.
- Department of Business Management, National Sun Yat-sen University, Kaohsiung City, Taiwan.
- Kaohsiung Armed Forces General Hospital, Kaohsiung City, Taiwan.
| | - Cher-Min Fong
- Department of Business Management, National Sun Yat-sen University, Kaohsiung City, Taiwan
| | - Hsing-Hua Stella Chang
- International Master of Business Administration, National Taichung University of Education, Taichung City, Taiwan
| | - Ying-Jui Ni
- Department of Urology, Kaohsiung Armed Forces General Hospital, Kaohsiung City, Taiwan
| | - Kon-Ning Chiu
- Institute of Medical Science and Technology, National Sun Yat-sen University, Kaohsiung City, Taiwan
| | - Kai-Wen Lee
- Department of Medicine, Kaohsiung Armed Forces General Hospital, Kaohsiung City, Taiwan
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2
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Shao D, Zang Z, Li Z, Zhang H, Sun D, Diao T, Wang Z, Zhang K, Fu Q. Efficacy and Safety of 1470 nm Diode Laser Enucleation of the Prostate in Elderly Benign Prostatic Hyperplasia Patients. J Endourol 2023; 37:700-705. [PMID: 37016816 DOI: 10.1089/end.2022.0705] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2023] Open
Abstract
Objective: The aim of this study was to evaluate efficacy and safety of 1470 nm diode laser enucleation of the prostate (DiLEP) and plasmakinetic resection of the prostate (PKRP) in elderly benign prostatic hyperplasia (BPH) patients with lower urinary tract symptoms. Methods: A total of 123 elderly patients with BPH were randomized to undergo either 1470 nm DiLEP or PKRP by means of a random number table from September 2020 to April 2022. The perioperative and postoperative data were studied during a 3- and 6-month follow-up. Results: The patients treated with 1470 nm DiLEP had significantly decreased operation time (74.6 ± 17.0 vs 98.8 ± 18.9 minutes, p < 0.001), hemoglobin loss (1.06 ± 0.49 vs 1.59 ± 0.60 g/dL, p < 0.001), bladder irrigation time (22.1 ± 8.1 vs 33.9 ± 10.0 hours, p < 0.001), catheter duration (3.2 ± 1.3 vs 5.8 ± 1.0 days, p < 0.001), and hospital stay (7.6 ± 1.4 vs 9.6 ± 1.3 days, p < 0.001) compared with the PKRP group. Besides, International Index of Erectile Function-5 score of 1470 nm DiLEP group at postoperative 3- and 6-month follow-up was significantly higher than PKRP group. No differences achieving statistical significance were identified in total prostate-specific antigen, maximum urinary flow rate, International Prostate Symptom Score, quality-of-life score, and the postvoid residual urine volume, transient incontinence, urethral stricture, bladder neck contracture, and retrograde ejaculation at 3- and 6-month follow-up. Conclusions: 1470 nm DiLEP is safer than PKRP, with a smaller effect on sexual function, and it is comparable with the efficacy of PKRP, thus making it more suitable for elderly BPH patients. Clinical Trial Registration number: S2021-463-01.
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Affiliation(s)
- Dingchang Shao
- Department of Urology, Shandong Provincial Hospital, Shandong University, Jinan, Shandong, China
| | - Zhenjie Zang
- Department of Urology, Shandong Provincial Hospital, Shandong University, Jinan, Shandong, China
| | - Ziheng Li
- Second Department of Surgery, Shandong Rongjun General Hospital, Jinan, Shandong, China
| | - Hui Zhang
- Department of Urology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
- Engineering Laboratory of Urinary Organ and Functional Reconstruction of Shandong Province, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Dingqi Sun
- Department of Urology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
- Engineering Laboratory of Urinary Organ and Functional Reconstruction of Shandong Province, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Tongxiang Diao
- Department of Urology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
- Engineering Laboratory of Urinary Organ and Functional Reconstruction of Shandong Province, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Zhenqing Wang
- Department of Urology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
- Engineering Laboratory of Urinary Organ and Functional Reconstruction of Shandong Province, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Keqin Zhang
- Department of Urology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
- Engineering Laboratory of Urinary Organ and Functional Reconstruction of Shandong Province, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Qiang Fu
- Department of Urology, Shandong Provincial Hospital, Shandong University, Jinan, Shandong, China
- Department of Urology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
- Engineering Laboratory of Urinary Organ and Functional Reconstruction of Shandong Province, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
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3
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Mathieu R, Doizi S, Bensalah K, Lebacle C, Legeais D, Madec FX, Phe V, Pignot G, Irani J. Les complications chirurgicales en urologie adulte : chirurgie de la prostate. Prog Urol 2022; 32:953-965. [DOI: 10.1016/j.purol.2022.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 09/05/2022] [Indexed: 11/21/2022]
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4
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Bo S, Yong O, Shaoxian C, Shangqing R. Case report and empirical review of intravesical explosion during transurethral resection of prostate. Asian J Surg 2022; 45:2320-2321. [PMID: 35599120 DOI: 10.1016/j.asjsur.2022.05.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 05/06/2022] [Indexed: 11/29/2022] Open
Affiliation(s)
- Shi Bo
- Department of Urology, Xinjin District People's Hospital, Chengdu, 611430, China
| | - Ou Yong
- Department of Robotic Minimally Invasive Surgery Center, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital & Affiliated Hospital of the University of Electronic Science and Technology of China, Chengdu, 610072, China; School of Medicine, University of Electronic Science and Technology of China, Chengdu, 610051, China
| | - Cai Shaoxian
- Department of Urology, Xinjin District People's Hospital, Chengdu, 611430, China
| | - Ren Shangqing
- Department of Robotic Minimally Invasive Surgery Center, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital & Affiliated Hospital of the University of Electronic Science and Technology of China, Chengdu, 610072, China.
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5
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Surgical Complications in the Management of Benign Prostatic Hyperplasia Treatment. Curr Urol Rep 2022; 23:83-92. [PMID: 35262855 DOI: 10.1007/s11934-022-01091-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2022] [Indexed: 01/20/2023]
Abstract
PURPOSE OF REVIEW There are a variety of treatment options for men with symptomatic benign prostatic hyperplasia (BPH); transurethral resection of the prostate (TURP) remains the gold standard surgical treatment. The field continues to evolve with the introduction of new energy and laser technologies, increasing adoption of enucleation techniques, in addition to the advent of minimally invasive surgical technologies (MIST) that enable office-based treatments. The choice in surgical management has become very nuanced depending on a variety of patient and anatomic factors. There continues to be high success rates for surgical treatment of BPH; however, the risk profiles vary across the various surgical treatments. We sought to evaluate contemporary series and summarize the experience of complications associated with BPH treatment and management of these complications. RECENT FINDINGS A comprehensive literature review was performed, and identified 79 manuscripts, published between 2005 and 2021 characterizing the diagnosis and management of complications following BPH surgery. Commonly cited issues included bleeding, ureteral orifice injury, bladder neck injury, rectal injury, TURP syndrome, bladder neck contractures, urethral stricture disease, refractory OAB symptoms, and complications unique to new modalities of treatment. The practicing urologist has multiple surgical options to choose from in treating patients with symptomatic BPH. The surgical management of BPH is generally well tolerated with high objective success rates that allow for significant improvement in urinary quality of life. It is critical to understand the potential complications associated with these various treatment options, which will enable trainees and practicing urologists to better counsel patients and manage these potential complications.
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Yan P, Cui Y, Huang Y, Che X, Zhou Z, Feng F. Intraoperative and postoperative outcomes of thulium laser enucleation versus bipolar resection in the transurethral treatment of benign prostatic hyperplasia: a meta-analysis. Lasers Med Sci 2022; 37:2517-2525. [PMID: 35147840 DOI: 10.1007/s10103-022-03519-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Accepted: 01/27/2022] [Indexed: 11/28/2022]
Abstract
To compare the intraoperative and postoperative outcomes of thulium laser enucleation of the prostate (ThuLEP) vs bipolar transurethral resection of the prostate (B-TURP) in treating patients with benign prostatic hyperplasia (BPH). Clinical trials of ThuLEP and B-TURP in treating BPH were searched systematically by using PubMed, Cochrane Library databases, and EMBASE (until May 2021). The Preferred Reporting Items for Systematic Reviews and Meta-analyses checklist was followed. The datum was calculated by Review Manager version 5.3.0. Four articles including 782 patients were studied in this analysis. The analysis discovered that there was no significant difference in operative time and percentage of tissue removed between ThuLEP and B-TURP. But the intraoperative irrigated volume and postoperative hemoglobin (Hb) decrease in the ThuLEP group was significantly less compared with the B-TURP group. The catheterization time and hospitalization duration in the B-TURP group was significantly longer than that in the ThuLEP group. Compared with those before treatment, the micturition indexes of the two groups improved significantly. But no significant difference was identified between ThuLEP and B-TURP for the variation of international prostate symptom score, quality of life, maximum flow rate, and post-void residual. By analyzing the postoperative complications, there were no significant discrepancies between ThuLEP and B-TURP in the incidence of blood transfusion, recatheterization, transient incontinence, bladder neck contracture, and urethral stricture. The micturition indexes and clinical symptoms were significantly improved after ThuLEP and B-TURP for patients with BPH. However, ThuLEP was more effective than B-TURP in terms of intraoperative irrigated volume, postoperative Hb decrease, catheterization time, and hospitalization duration.
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Affiliation(s)
- Pihong Yan
- Laboratory Medicine, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, China
| | - Yuanshan Cui
- Department of Urology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, No. 20 East Yuhuangding Road, Yantai, 264000, Shandong, China
- Department of Urology, Beijing Tiantan Hospital, Capital Medical University, No.119 South 4th Ring West Road, Fengtai District, Beijing, 100070, China
| | - Yongjin Huang
- Department of Urology, Beijing Tiantan Hospital, Capital Medical University, No.119 South 4th Ring West Road, Fengtai District, Beijing, 100070, China
| | - Xuanyan Che
- Department of Urology, Beijing Tiantan Hospital, Capital Medical University, No.119 South 4th Ring West Road, Fengtai District, Beijing, 100070, China
| | - Zhongbao Zhou
- Department of Urology, Beijing Tiantan Hospital, Capital Medical University, No.119 South 4th Ring West Road, Fengtai District, Beijing, 100070, China.
| | - Fan Feng
- Department of Urology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, No. 20 East Yuhuangding Road, Yantai, 264000, Shandong, China.
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7
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Ureteric orifice obstruction by catheter balloon Post-TURP: A rare cause of obstructive uropathy. Urol Case Rep 2021; 40:101948. [PMID: 34849349 PMCID: PMC8607207 DOI: 10.1016/j.eucr.2021.101948] [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: 11/06/2021] [Revised: 11/12/2021] [Accepted: 11/15/2021] [Indexed: 11/30/2022] Open
Abstract
A 50-year-old male underwent small volume TURP for median lobe prostatic hypertrophy. Post-procedure, a 3-way urethral catheter was placed. He subsequently developed flank pain, anuria and creatinine rise. CT demonstrated bilateral obstructive uropathy. In the absence of obstructing lesions, it was suspected that the catheter balloon may have caused obstruction of bilateral ureteric orifices. Balloon deflation (from 30 to 10 mL) and catheter repositioning resulted in rapid resolution of pain and resumption of urine output. Urologists should consider the catheter balloon as a cause of obstructive uropathy, especially after procedures where normal trigonal anatomy is disrupted.
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8
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Sekar H, Palaniyandi V, Krishnamoorthy S, Kumaresan N. Post-transurethral resection of prostate urethral strictures: Are they often underreported? A single-center retrospective observational cohort study. Urol Ann 2021; 13:329-335. [PMID: 34759641 PMCID: PMC8525477 DOI: 10.4103/ua.ua_165_19] [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: 12/09/2019] [Revised: 02/27/2020] [Accepted: 11/27/2020] [Indexed: 11/04/2022] Open
Abstract
Objectives Post-transurethral resection of prostate urethral stricture (PTS) is a well-documented delayed complication following transurethral resection of the prostate (TURP). The aim is to analyze various risk factors of PTS and see if the overall incidence is underreported. Materials and Methods A retrospective study was conducted in our institution between January 2017 and December 2018 in men who underwent TURP. Data obtained from the medical records department were analyzed. Statistical analysis was done using Fisher's exact test. A two-tailed P < 0.05 is considered statistically significant. Results Of the 447 men who underwent TURP, 57 developed PTS. Fifteen of 334 patients who underwent calibration before the procedure developed stricture compared to 42 of 137 without calibration (P < 0.01). There was a significantly lesser incidence of stricture with 24 Fr resectoscope compared with 26 Fr sheath (P < 0.04). Two patients with 24 Fr Foley and 30 of 35 (86%) patients with 22 Fr Foley catheter developed stricture of urethra. Distal bulbar urethra was the most common site of narrowing following TURP. Eighteen patients had Salvaris swab placed for traction and 12 patients required full-thigh traction, of which majority developed meatal stenosis. Conclusions TURP is one of the common surgical procedures performed by urologists. Meatitis and meatal stenosis, if included as complications of TURP, would increase the overall incidence of PTS. Factors such as the size of resectoscope sheath used, size of catheter inserted, placement of Salvaris swab traction, and preoperative calibration of urethra have a significant impact on the ultimate outcome.
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Affiliation(s)
- Hariharasudhan Sekar
- Department of Urology, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Velmurugan Palaniyandi
- Department of Urology, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Sriram Krishnamoorthy
- Department of Urology, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Natarajan Kumaresan
- Department of Urology, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
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9
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Zhang W, Zhang W, Guo Q, Chen L, Meng Z, Xu Y, Cao N, Hu B, Qian B. The Design and Rationale of a Multicentre Randomised Controlled Trial Comparing Transperineal Percutaneous Laser Ablation With Transurethral Resection of the Prostate for Treating Benign Prostatic Hyperplasia. Front Surg 2021; 8:755957. [PMID: 34733883 PMCID: PMC8558367 DOI: 10.3389/fsurg.2021.755957] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 09/22/2021] [Indexed: 11/17/2022] Open
Abstract
Background: Transurethral resection of the prostate (TURP) is regarded as the “gold standard” for the treatment of benign prostatic hyperplasia (BPH) in elderly men. However, ~15% of patients who had undergone TURP had intraoperative and postoperative complications, such as bleeding, urinary incontinence and urethral stricture. Transperineal percutaneous laser ablation (TPLA) is a method that places the optical fibre directly into the prostate with the guidance of ultrasound imaging, and the percutaneous transperineal approach is performed distal to the urethra and rectum to protect these structures and reduce urethral or postoperative infection. Several studies on TPLA for BPH treatment have been reported recently; however, high-quality randomised controlled trial (RCT) to evaluate its efficacy, safety, and long-term follow up remain absent. Methods: This study is a multicentre, open-label RCT to assess the efficacy and safety of TPLA vs. TURP to treat BPH. We hypothesise that the TPLA has non-inferior efficacy to TURP in the International Prostate Symptom Score (IPSS) at 3 months changing from the baseline and lower incidence of post-surgery complications. One hundred and fourteen patients with BPH will be recruited at 19 sites and randomly assigned at 1:1 to TPLA or TURP groups. The patients will be followed up at 1, 3, 6, 12, and 24 months after the procedure. Discussion: The study will be the first multicentre clinical trial including 16 participating centres in China, Italy, Switzerland, and Poland with relatively large sample size 114. By comprehensively compare the safety and efficacy of TPLA with TURP in patients with BPH, especially concerning the improvement of lower urinary tract symptoms (LUTS) and complication incidence, the study will help to illustrate the clinical value of TPLA and provide a beneficial alternative treatment for BPH patients. Clinical Trial Registration: The study has been registered on Chinese Clinical Trial Registry (http://www.chictr.org.cn), identifier [ChiCTR1900022739].
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Affiliation(s)
- Wei Zhang
- Department of Ultrasound in Medicine, Shanghai Jiao Tong University Affiliated 6th People's Hospital, Shanghai, China.,Shanghai Institute of Ultrasound in Medicine, Shanghai Jiao Tong University Affiliated 6th People's Hospital, Shanghai, China
| | - Weituo Zhang
- Clinical Research Institute, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qian Guo
- Department of Ultrasound in Medicine, Shanghai Jiao Tong University Affiliated 6th People's Hospital, Shanghai, China.,Shanghai Institute of Ultrasound in Medicine, Shanghai Jiao Tong University Affiliated 6th People's Hospital, Shanghai, China
| | - Lei Chen
- Department of Ultrasound in Medicine, Shanghai Jiao Tong University Affiliated 6th People's Hospital, Shanghai, China.,Shanghai Institute of Ultrasound in Medicine, Shanghai Jiao Tong University Affiliated 6th People's Hospital, Shanghai, China
| | - Zheying Meng
- Department of Ultrasound in Medicine, Shanghai Jiao Tong University Affiliated 6th People's Hospital, Shanghai, China.,Shanghai Institute of Ultrasound in Medicine, Shanghai Jiao Tong University Affiliated 6th People's Hospital, Shanghai, China
| | - Yanjun Xu
- Department of Ultrasound in Medicine, Shanghai Jiao Tong University Affiliated 6th People's Hospital, Shanghai, China.,Shanghai Institute of Ultrasound in Medicine, Shanghai Jiao Tong University Affiliated 6th People's Hospital, Shanghai, China
| | - Nailong Cao
- Department of Urology, Shanghai Jiao Tong University Affiliated 6th People's Hospital, Shanghai, China
| | - Bing Hu
- Department of Ultrasound in Medicine, Shanghai Jiao Tong University Affiliated 6th People's Hospital, Shanghai, China.,Shanghai Institute of Ultrasound in Medicine, Shanghai Jiao Tong University Affiliated 6th People's Hospital, Shanghai, China
| | - Biyun Qian
- Hongqiao International Institute of Medicine, Shanghai Tong Ren Hospital, Shanghai, China
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10
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Wroclawski ML, Castellani D, Heldwein FL, Teles SB, Cha JD, Zhao H, Herrmann T, Chan VWS, Teoh JYC. Shedding light on polypragmasy of pain after transurethral prostate surgery procedures: a systematic review and meta-analysis. World J Urol 2021; 39:3711-3720. [PMID: 33787985 DOI: 10.1007/s00345-021-03678-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Accepted: 03/17/2021] [Indexed: 02/08/2023] Open
Abstract
PURPOSE AND OBJECTIVE To evaluate and compare the incidences of post-operative pelvic pain (PPP) in patients undergoing ablation, enucleation and conventional transurethral resection of the prostate (TURP). METHODS A systematic review and meta-analysis was conducted according to the PRISMA guidelines. Using MEDLINE via PubMed and Cochrane CENTRAL, randomised control trials (RCTs) and observational studies reporting PPP rates post-ablation, enucleation or TURP were identified. The risk of biases (RoB) in RCTs and observation studies were assessed using the Cochrane RoB1.0 tool and the Newcastle-Ottawa Scale, respectively. RESULTS 62 studies were included for qualitative analysis, while 51 of them reported number of patients with PPP post-intervention. Three observational studies and 13 RCTs compared the rates of PPP in patients undergoing ablation, enucleation or TURP. The most reported types of PPP are dysuria, abdominal pain and irritative symptoms. The pooled incidence of PPP at 1-month follow-up in patients undergoing ablation, enucleation and TURP were 0.15 (95% CI 0.10-0.22), 0.09 (95% CI 0.04-0.19 and 0.10 (95% CI 0.06-0.15), respectively. PPP is no longer prevalent at 3-months and onwards post-operatively. Ablation is associated with a higher risk of PPP than enucleation (RR 2.19, 95% CI 1.04-4.62) and TURP (RR 2.40, 95% CI 1.03-5.62) in observational studies but not RCTs; and there were no significant differences in the rates of PPP upon comparison of other modalities. CONCLUSION PPP is common after transurethral benign prostatic hyperplasia surgery. Patients undergoing ablation had a higher rate of post-intervention PPP than those undergoing enucleation and TURP in observational studies.
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Affiliation(s)
- Marcelo Langer Wroclawski
- Hospital Israelita Albert Einstein, São Paulo, Brazil. .,BP-a Beneficência Portuguesa de São Paulo, São Paulo, Brazil. .,Faculdade de Medicina Do ABC, Santo André, Brazil.
| | - Daniele Castellani
- Urology Division, Azienda Ospedaliero-Universitaria Ospedali Riuniti Di Ancona, Università Politecnica Delle Marche, Ancona, Italy
| | - Flavio L Heldwein
- Department of Urology, Federal University of Santa Catarina, Florianópolis, Brazil
| | | | | | - Hongda Zhao
- S.H. Ho Urology Centre, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Thomas Herrmann
- Department of Urology, Spital Thurgau AG, Frauenfeld, Switzerland.,Department of Urology, Hanover Medical School (MHH), Hanover, Germany
| | - Vinson Wai-Shun Chan
- School of Medicine, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - Jeremy Yuen-Chun Teoh
- S.H. Ho Urology Centre, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
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11
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MRI Evaluation of Patients Before and After Interventions for Benign Prostatic Hyperplasia: An Update. AJR Am J Roentgenol 2021; 218:88-99. [PMID: 34259037 DOI: 10.2214/ajr.21.26278] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Transurethral resection of the prostate is the most commonly performed procedure for the management of patients with lower urinary tract symptoms attributed to benign prostatic hyperplasia (BPH). However, in recent years, various minimally invasive surgical therapies have been introduced to treat BPH. These include laser-based procedures such as holmium laser enucleation of the prostate and photoselective vaporization of the prostate as well as thermal ablation procedures such as water vapor thermal therapy (Rezūm), all of which result in volume reduction of periurethral prostatic tissue. In comparison, a permanent metallic device (UroLift) can be implanted to pull open the prostatic urethra without an associated decrease in prostate size, and selective catheter-directed prostate artery embolization results in a global decrease in prostate size. The goal of this article is to familiarize radiologists with the underlying anatomic changes that occur in BPH as visualized on MRI and to describe the appearance of the prostate on MRI performed after these procedures. Complications encountered on imaging after these procedures are also discussed. Although MRI is not currently used in the routine preprocedural evaluation of BPH, emerging data support a role for MRI in predicting postprocedure outcomes.
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12
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Madersbacher S, Oelke M, Häcker A, Bschleipfer T. [Sophisticated surgical management of distinctive patients with benign prostatic hyperplasia (BPH)]. Urologe A 2020; 59:1168-1176. [PMID: 32845346 DOI: 10.1007/s00120-020-01310-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Herein we describe four clinical scenarios. For the standard patient (prostate volume 30-80 ml, life expectancy >10 years) transurethral resection of the prostate (TURP) remains the standard of care, while endoscopic enucleation is a valuable alternative. Patients with a relevant middle lobe profit most from TURP, endourological enucleation procedures, or laser vaporization. In the case of the absence or a moderate-sized middle lobe and the absence of severe bladder outlet obstruction (BOO), minimally invasive procedures such as Rezūm®, UroLift® or prostate artery embolization (PAE) can be offered. Patients have to be informed that long-term data on this specific indication are lacking. Particularly younger men requiring BPH surgery are interested in preserving ejaculatory function. In the presence of severe BOO, ejaculatory-protective TURP or endoscopic enucleation by preserving the pericollicular region or aquablation are the methods of choice providing an antegrade ejaculation in 60-90% of cases. Rezūm®, AquaBeam®, and UroLift® enable preservation of ejaculation in almost 100%; data on PAE with this respect are more controversial. For patients with a small prostate and significant post void residual, a thorough preoperative work-up, including urodynamics and bladder/detrusor wall thickness measurement, is of great importance. Desobstructive surgery provides satisfactory short- and midterm outcome, yet the long-term outcome is disappointing and remains to be determined in greater detail. The broad spectrum of therapeutic options enables today an individualized minimally invasive or surgical management of BPH considering patient wishes, anatomical factors or urodynamic factors. The time of a "one therapy fits all" strategy is definitely history.
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Affiliation(s)
- S Madersbacher
- Abteilung für Urologie, Klinikum Favoriten, Kundratstraße 3, 1100, Wien, Österreich. .,Sigmund Freud Privatuniversität, Wien, Österreich.
| | - M Oelke
- Klinik für Urologie, St. Antonius-Hospital, Gronau, Deutschland
| | - A Häcker
- Marienhaus Klinikum Hetzelstift, Akademisches Lehrkrankenhaus der Johannes, Gutenberg-Universität Mainz, Stiftstraße 10, 67434, Neustadt a.d. Weinstraße, Deutschland
| | - T Bschleipfer
- Klinik für Urologie, Klinikum Weiden/Kliniken Nordoberpfalz, Weiden, Deutschland
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Park S, Kang HW. Temporal modulation of optical energy for enhanced photothermal hemostasis of intraoperative bleeding during laser treatment. JOURNAL OF BIOPHOTONICS 2020; 13:e202000086. [PMID: 32406184 DOI: 10.1002/jbio.202000086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 04/22/2020] [Accepted: 05/06/2020] [Indexed: 06/11/2023]
Abstract
Intraoperative bleeding during laser treatment of benign prostate hyperplasia (BPH) often impedes cystoscopic vision, necessitating the use of conventional hemostatic devices. This study proposes an optical technique to improve the efficacy of photothermal hemostasis of bleeders during laser prostatectomy by temporally modulating a 532 nm laser beam. A perfused porcine kidney model is established to quantitatively investigate various optical pulse patterns and irradiation modes. Thermal simulations demonstrate a high success rate of complete hemostasis achieved by the modulated 532 nm pulse pattern. In comparison to the irradiation modes typically employed for hemostasis, the modulated 532 nm mode exhibits a short coagulation time and minimal thermal injury. ex vivo and in vivo cystoscopic observations validate the clinical feasibility of the proposed optical energy modulation method to regulate intraoperative bleeding.
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Affiliation(s)
- Suhyun Park
- School of Electrical and Electronics Engineering, Chung-Ang University, Seoul, Republic of Korea
| | - Hyun Wook Kang
- Department of Biomedical Engineering and Center for Marine-Integrated Biomedical Technology (BK21 Plus), Pukyong National University, Busan, Republic of Korea
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14
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Ryang SH, Ly TH, Tran AV, Oh S, Cho SY. Bipolar enucleation of the prostate—step by step. Andrologia 2020; 52:e13631. [DOI: 10.1111/and.13631] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Revised: 04/04/2020] [Accepted: 04/12/2020] [Indexed: 01/04/2023] Open
Affiliation(s)
- Seung Hoon Ryang
- Department of Urology Seoul National University Hospital Seoul Korea
| | - Tam Hoai Ly
- Department of Urology Chợ Rẫy Hospital Ho Chi Minh City Vietnam
| | - Ahn Vu Tran
- Department of Urology Chợ Rẫy Hospital Ho Chi Minh City Vietnam
| | - Seung‐June Oh
- Department of Urology Seoul National University Hospital Seoul Korea
| | - Sung Yong Cho
- Department of Urology Seoul National University Hospital Seoul Korea
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15
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Franz P, Wang X, Zhu H, Chia R, Hasenberg T, Wang H. Detection of blackbody radiation during fiber guided laser-tissue vaporization. BIOMEDICAL OPTICS EXPRESS 2020; 11:791-800. [PMID: 32206396 PMCID: PMC7041439 DOI: 10.1364/boe.376141] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 12/29/2019] [Accepted: 01/03/2020] [Indexed: 06/10/2023]
Abstract
Laser-tissue vaporization through a fiber catheter is evolving into a major category of surgical operations to remove diseased tissue. Currently, during a surgery, the surgeon still relies on personal experience to optimize surgical techniques. Monitoring tissue temperature during laser-tissue vaporization would provide important feedback to the surgeon; however, simple and low-cost temperature sensing technology, which can be seamlessly integrated with a fiber catheter, is not available. We propose to monitor tissue temperature during laser-tissue vaporization by detecting blackbody radiation (BBR) between 1.6 µm-1.8 µm, a relatively transparent window for both water and silica fiber. We could detect BBR after passing through a 2-meter silica fiber down to ∼70°C using lock-in detection. We further proved the feasibility of the technology through ex vivo tissue studies. We found that the BBR can be correlated to different tissue vaporization levels. The results suggest that this simple and low-cost technology could be used to provide objective feedback for surgeons to maximize laser-tissue vaporization efficiency and ensure the best clinical outcomes.
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Affiliation(s)
- Paris Franz
- Department of Chemical, Paper and Biomedical Engineering, Miami University, OH 45056, USA
- Currently with Department of Applied Physics, Stanford University, CA, USA
| | - Xiaomei Wang
- Department of Computer Science, Shanghai Normal University, China
| | - Hui Zhu
- Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, OH 44125, USA
| | - Ray Chia
- Boston Scientific, MA 01752, USA
| | | | - Hui Wang
- Department of Chemical, Paper and Biomedical Engineering, Miami University, OH 45056, USA
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16
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Maron SZ, Sher A, Kim J, Lookstein RA, Rastinehad AR, Fischman A. Effect of Median Lobe Enlargement on Early Prostatic Artery Embolization Outcomes. J Vasc Interv Radiol 2020; 31:370-377. [PMID: 31956004 DOI: 10.1016/j.jvir.2019.11.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 11/12/2019] [Accepted: 11/14/2019] [Indexed: 01/17/2023] Open
Abstract
PURPOSE To evaluate outcomes after prostatic artery embolization (PAE) in patients with severe intravesical prostatic protrusion (IPP). MATERIALS AND METHODS This was a retrospective, single health system, 2-hospital study from April 2015 to December 2018 of 54 patients who underwent elective PAE procedures (age mean 67.5 years; standard deviation [SD] 8.5). The cohort had a mean ellipsoid prostate volume of 100.1 cm3 (SD 56.7), a mean baseline International Prostate Symptom Score (IPSS) of 18.7 (SD 8.2), a mean baseline quality of life (QOL) score of 4.1 (SD 1.4), and a median follow-up of 38 days (range 10-656 days). Outcomes including IPSS and QOL score reduction (where a lower QOL score indicates an improvement in QOL), and clinical success were compared between severe (≥10 mm) and nonsevere (<10 mm) IPP patients. A linear regression model was used to examine the impact of IPP on these outcomes. RESULTS No significant differences in patient characteristics were found between nonsevere (n = 17) and severe (n = 37) IPP patients. Both cohorts showed IPSS reduction (nonsevere 6.0, P = .0397; severe 8.2, P < .0001) and QOL score reduction (nonsevere 1.0, P = .102; severe 2.0, P < .0001). No significant differences in IPSS or QOL score reduction were found between the cohorts (P = .431 and P = .127). Linear regression found that baseline IPP was not a significant contributor to the outcomes (IPSS: R2 = .5, P < .0001; IPP: P = .702; QOL: R2 = .5, P = .0003; IPP: P = .108). CONCLUSIONS There were no significant differences in early outcomes in PAE between patients with severe and nonsevere IPP.
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Affiliation(s)
- Samuel Z Maron
- Department of Radiology, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, One Gustave L. Levy Place, Box 1234, New York, New York 10029. https://twitter.com/MaronSamuel
| | - Alex Sher
- Department of Radiology, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, One Gustave L. Levy Place, Box 1234, New York, New York 10029
| | - Jeremy Kim
- Charlotte Radiology, Charlotte, North Carolina
| | - Robert A Lookstein
- Department of Radiology, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, One Gustave L. Levy Place, Box 1234, New York, New York 10029
| | - Ardeshir R Rastinehad
- Department of Radiology, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, One Gustave L. Levy Place, Box 1234, New York, New York 10029
| | - Aaron Fischman
- Department of Radiology, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, One Gustave L. Levy Place, Box 1234, New York, New York 10029.
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17
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Kim SW, Hwang J, Xuan J, Hasenberg T, Kang HW. Enhanced photothermal hemostasis using dual wavelengths in an in vivo leporine kidney model. BIOMEDICAL OPTICS EXPRESS 2019; 10:5198-5206. [PMID: 31646041 PMCID: PMC6788610 DOI: 10.1364/boe.10.005198] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 09/03/2019] [Accepted: 09/10/2019] [Indexed: 06/10/2023]
Abstract
The current study investigated the hemostatic effect of dual wavelengths on in vivo leporine kidney tissue using 532-nm and 980-nm laser systems. Three irradiation modes, 532 nm, 980 nm, and dual (532 and 980 nm) modes, were compared to test non-contact photothermal hemostasis on 36 bleeders in the kidney models. Each bleeder was flushed with saline during the irradiation. The dual mode achieved complete hemostasis more rapidly than the single modes (4.0 ± 1.4 s for dual vs. no hemostasis for 532 nm and 10.0 ± 1.3 s for 980 nm; p < 0.001). Application of 60 W from the dual wavelengths expanded the surface area of the thermal lesion (up to 60%). In vivo dual-wavelength irradiation achieved more rapid and complete hemostasis with ∼2 mm coagulation depth than the single-wavelength irradiation.
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Affiliation(s)
- Sung won Kim
- Department of Otolaryngology-Head and Neck Surgery, Kosin University College of Medicine, Busan, South Korea
| | - Jieun Hwang
- Interdisciplinary Program of Marine-Bio, Electrical & Mechanical Engineering, Pukyong National University, Busan, South Korea
| | - Jason Xuan
- UroPH R&D, Boston Scientific Corp., San Jose, CA 95134, USA
| | | | - Hyun Wook Kang
- Interdisciplinary Program of Marine-Bio, Electrical & Mechanical Engineering, Pukyong National University, Busan, South Korea
- Department of Biomedical Engineering and Center for Marine-Integrated Biomedical Technology (BK21 Plus), Pukyong, National University, Busan, South Korea
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18
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Need for upper urinary tract stenting in cases of ureteral orifice injury during laser enucleation of the prostate. Int Urol Nephrol 2018; 50:2173-2177. [DOI: 10.1007/s11255-018-2007-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 10/08/2018] [Indexed: 10/28/2022]
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