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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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Patankar SB, Narkhede MM, Padasalagi G, Thakare K. Prospective randomized study correlating intra-operative urethral mucosal injury with early period after transurethral resection of the prostate stricture urethra: A novel concept. Asian J Urol 2024; 11:466-472. [PMID: 39139541 PMCID: PMC11318446 DOI: 10.1016/j.ajur.2024.02.006] [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: 05/29/2023] [Accepted: 08/15/2023] [Indexed: 08/15/2024] Open
Abstract
Objective To investigate the incidence of urethral stricture during the early period after transurethral resection of the prostate (TURP) and correlate its incidence with intra-operative urethral mucosal injury during TURP. Also to compare the other established risk factors affecting the development of urethral stricture among patients undergoing monopolar or bipolar TURP over a period of 6 months follow-up as the prospective randomized study. Methods One hundred and fifty men older than 50 years with lower-urinary tract symptoms associated with benign prostatic hyperplasia were randomized to undergo either standard monopolar TURP with glycine as the irrigation fluid or bipolar TURP with normal saline as irrigant. The prostate size, operative time, intra-operative mucosal rupture, catheter time, catheter traction duration, uroflowmetry, and post-operative stricture rate were compared. Results A total of 150 patients underwent TURP, including 74 patients undergoing monopolar TURP (one patient was excluded as his post-operative histopathological examination report was of adenocarcinoma prostate) and 75 patients undergoing bipolar-TURP, all of which were performed using a 26 Fr sheath resectoscope. The mean International Prostate Symptom Score and maximum urinary flow rate score at post-operative 3 months and 6 months were comparable between the groups. Out of 149 patients, nine patients (6.0%) developed urethral stricture. The severity of the injury (urethral mucosal injury) correlated with the likelihood of developing a subsequent complication (stricture urethra). Patients with stricture had significantly larger prostate volume than patients without stricture (65.0 mL vs. 50.0 mL; p=0.030). Patients with stricture had longer operative time than patients without stricture (55.0 min vs. 40.0 min; p=0.002). In both procedures, formation of post-operative stricture urethra was independently associated with intra-operative mucosal injury. Conclusion Intra-operative recognition of urethral mucosal injury helps in prediction of stricture urethra formation in early post-operative period.
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Affiliation(s)
- Suresh B. Patankar
- Department of Urology, Ace Hospital, Pune, ASP Medical Foundation, Sripad Medisearch PVT LTD, India
| | - Mayur M. Narkhede
- Department of Urology, Ace Hospital, Pune, ASP Medical Foundation, Sripad Medisearch PVT LTD, India
| | - Gururaj Padasalagi
- Department of Urology, Ace Hospital, Pune, ASP Medical Foundation, Sripad Medisearch PVT LTD, India
| | - Kashinath Thakare
- Department of Urology, Ace Hospital, Pune, ASP Medical Foundation, Sripad Medisearch PVT LTD, India
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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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Qian X, Tao X, Liu H, Ran C, Gong Y, Feng Y. One rare case of posterior urethral hemangioma and review of the literature. Urol Case Rep 2022; 45:102190. [PMID: 36051620 PMCID: PMC9424351 DOI: 10.1016/j.eucr.2022.102190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 08/01/2022] [Accepted: 08/14/2022] [Indexed: 10/26/2022] Open
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Gaur AS, Tarigopula V, Mandal S, Das MK, Nayak P. Re: Mannem SR, Mallikarjuna C, Bhavatej E, Taif NB, Ravichander O, Syed MG. Incidence of urethral stricture following bipolar transurethral resection of prostate: A single-center study. Indian J Urol 2022;38:146-50. Indian J Urol 2022; 38:244-245. [PMID: 35983108 PMCID: PMC9380448 DOI: 10.4103/iju.iju_107_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 05/20/2022] [Indexed: 12/02/2022] Open
Affiliation(s)
| | | | | | - Manoj K. Das
- Department of Urology, AIIMS, Bhubaneshwar, Odisha, India
| | - Prasant Nayak
- Department of Urology, AIIMS, Bhubaneshwar, Odisha, India
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Mannem SR, Mallikarjuna C, Bhavatej E, Taif NBM, Ravichander O, Syed MG. Author reply Re: Mannem SR, Mallikarjuna C, Bhavatej E, Taif NB, Ravichander O, Syed MG. Incidence of urethral stricture following bipolar transurethral resection of prostate: A single-center study. Indian J Urol 2022;38:146-50. Indian J Urol 2022; 38:245-246. [PMID: 35983106 PMCID: PMC9380451 DOI: 10.4103/iju.iju_203_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 06/23/2022] [Indexed: 12/02/2022] Open
Affiliation(s)
- Srinath Reddy Mannem
- Department of Urology, Asian Institute of Nephrology and Urology, Hyderabad, Telangana, India
| | - Chiruvella Mallikarjuna
- Department of Urology, Asian Institute of Nephrology and Urology, Hyderabad, Telangana, India
| | - Enganti Bhavatej
- Department of Urology, Asian Institute of Nephrology and Urology, Hyderabad, Telangana, India
| | | | - Oleti Ravichander
- Department of Urology, Asian Institute of Nephrology and Urology, Hyderabad, Telangana, India
| | - M. Ghouse Syed
- Department of Urology, Asian Institute of Nephrology and Urology, Hyderabad, Telangana, India
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Bandini M, Yepes C, Joshi PM, Basile G, Naranjo D, Bhadranavar S, Alrefaey A, Bafna S, Montorsi F, Kulkarni SB. Which are the commonest sites and characteristics of post- transurethral prostate surgery (TPS) strictures in a high-volume reconstructive center? J Endourol 2022; 36:1309-1316. [PMID: 35699078 DOI: 10.1089/end.2022.0130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Urethral stricture is a well-known complication after transurethral prostate surgery (TPS) and it is usually considered an easy-to-treat condition. We aimed to examine characteristics of post-TPS urethral stricture cases that were referred for urethroplasty at our tertiary center. METHODS We identified 201 patients with TPS-induced stricture treated with urethroplasty at our institution from 2017-2021. First, stricture length and location were evaluated during preoperative assessment. Second, multiple sets of multivariable logistic regression (MLR) analyses were run to assess whether clinical variables were associated with the location of the stricture. RESULTS Median stricture length was 5 cm (4-7). 141 (70.1%) patients received previous no-invasive treatments (dilatation and/or DVIU). Proximal bulbar urethra was the commonest site for stricture, while panurethral stricture (≥10cm) was diagnosed in 41 (20.4%) patients. Lichen sclerosus was more common in patients with penile stricture location, compared to patients with other involved segments (26% vs 19%, p=0.03), and it was the only predictor of penile and mid bulbar urethra location at MLR. Surgical approaches were augmented urethroplasty in 94% of patients, especially for patients with previous treatment including urethroplasty (95.8% vs 82.5% for naïve, p=0.004). Dorsal onlay was the preferred approach for bulbar (53.4%) and penile urethra (90.7%), while ventral onlay (38.2%) and double face augmentation (20.6%) were the preferred approach in membranous strictures. CONCLUSIONS The majority of patients that were referred for TPS-induced stricture attempted previous non-invasive managements. Referred TPS-induced urethral stricture were long and frequently involving multiple segments of urethra. Augmentation urethroplasty was our preferred surgical approach due to the characteristics and complexity of these strictures. The presence of lichen may increase the risk of post-TPS stricture in specific segment of urethra, namely the penile and mid-bulbar urethra.
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Affiliation(s)
| | - Christian Yepes
- Kulkarni EndoSurgery Institute and Reconstructive Urology Centre, 80252, Pune, Maharashtra, India;
| | - Pankaj M Joshi
- Kulkarni EndoSurgery Institute and Reconstructive Urology Centre, 80252, Pune, Maharashtra, India;
| | | | - David Naranjo
- Kulkarni EndoSurgery Institute and Reconstructive Urology Centre, 80252, Pune, Maharashtra, India;
| | - Shreyas Bhadranavar
- Kulkarni EndoSurgery Institute and Reconstructive Urology Centre, 80252, Pune, Maharashtra, India;
| | - Ahmed Alrefaey
- Kulkarni EndoSurgery Institute and Reconstructive Urology Centre, 80252, Pune, Maharashtra, India;
| | - Sandeep Bafna
- Kulkarni EndoSurgery Institute and Reconstructive Urology Centre, 80252, Pune, Maharashtra, India;
| | | | - Sanjay B Kulkarni
- Kulkarni EndoSurgery Institute and Reconstructive Urology Centre, 80252, Pune, Maharashtra, India;
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Analysis of Risk Factors and Nursing Strategies for Postoperative Hemorrhage of Benign Prostatic Hyperplasia. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:4205015. [PMID: 35646136 PMCID: PMC9135509 DOI: 10.1155/2022/4205015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 05/02/2022] [Accepted: 05/12/2022] [Indexed: 11/17/2022]
Abstract
This study is to investigate the risk factors analysis and nursing strategies for postoperative bleeding of benign prostatic hyperplasia (BPH). Totally, 240 BPH patients after surgical excision admitted to Hengshui People's Hospital between January 2019 and January 2020 were recruited. Of the 240 BPH patients, 20 had postoperative bleeding, accounting for 8.3% of all enrollments. Risk factors for postoperative bleeding included large prostate, diabetes, hypertension, urinary tract infection within 1 week before surgery, and the absence of epidural analgesia pumps. There were 87 patients receiving routine nursing (routine group) and 153 patients receiving routine nursing plus hemorrhage prevention care (study group). The study group had fewer cases of postoperative bleeding than the routine group. The influencing factors of postoperative bleeding in patients with prostatic hyperplasia include systemic and local factors, and corresponding hemorrhage prevention care should be performed based on the principle of evidence-based care to reduce the risk of postoperative bleeding.
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Analgesic Effects of Dexmedetomidine Combined with Spinal and Epidural Anesthesia Nursing on Prostate Hyperplasia Patients after Transurethral Resection of Prostate by Intelligent Algorithm-Based Magnetic Resonance Imaging. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:4243244. [PMID: 35637847 PMCID: PMC9148224 DOI: 10.1155/2022/4243244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 04/13/2022] [Accepted: 04/23/2022] [Indexed: 11/17/2022]
Abstract
To analyze the investigation of the application effects of different doses of dexmedetomidine (Dex) with combined spinal and epidural anesthesia nursing on analgesia after transurethral resection of prostate (TURP) by intelligent algorithm-based magnetic resonance imaging (MRI), MRI imaging segmentation model of mask regions with convolutional neural network (Mask R-CNN) features was proposed in the research. Besides, the segmentation effects of Mask R-CNN, U-net, and V-net algorithms were compared and analyzed. Meanwhile, a total of 184 patients receiving TURP were selected as the research objects, and they were divided into A, B, C, and D groups based on random number table method, each group including 46 cases. Patients in each group were offered different doses of Dex, and visual analogue scale (VAS) and Ramsay scores of different follow-up visit time, use of other analgesics, the incidence of postoperative cystospasm, and nursing satisfaction of patients in four groups were compared. The results demonstrated that Dice similarity coefficient (DSC) value, specificity, and positive predictive value of Mask R-CNN algorithm were
, 98.61%, and 69.57%, respectively, all of which were higher than those of U-net and V-net algorithms. Pain VAS scores and the incidence of cystospasm at different time periods of groups B and C were both significantly lower than those of group D (
). Ramsay scores of groups B and C at 8 hours, 12 hours, 24 hours, and 48 hours after the operation were all remarkably higher than those in group D (
). Besides, nursing satisfaction of groups B and C was obviously superior to that in group D, and the difference demonstrated statistical meaning (
). The differences revealed that Dex showed excellent analgesic and sedative effects and could effectively reduce the incidence of complications after TURP, including cystospasm and nausea. In addition, it helped improve nursing satisfaction and patient prognosis.
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Yagi K, Horiguchi A, Shinchi M, Ojima K, Hirano Y, Takahashi E, Kimura F, Ito K, Azuma R. Urethral reconstruction for iatrogenic urethral stricture after transurethral prostate surgery: An analysis of surgical and patient‐reported outcomes. Int J Urol 2022; 29:995-1001. [DOI: 10.1111/iju.14923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Accepted: 04/19/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Kota Yagi
- Department of Urology National Defense Medical College Saitama Japan
| | - Akio Horiguchi
- Department of Urology National Defense Medical College Saitama Japan
| | - Masayuki Shinchi
- Department of Urology National Defense Medical College Saitama Japan
- Department of Urology, National Hospital Organization Nishisaitama‐Chuo Hospital Saitama Japan
| | - Kenichiro Ojima
- Department of Urology National Defense Medical College Saitama Japan
| | - Yusuke Hirano
- Department of Urology National Defense Medical College Saitama Japan
| | - Eiji Takahashi
- Department of Urology, National Hospital Organization Nishisaitama‐Chuo Hospital Saitama Japan
| | - Fumihiro Kimura
- Department of Urology, National Hospital Organization Nishisaitama‐Chuo Hospital Saitama Japan
| | - Keiichi Ito
- Department of Urology National Defense Medical College Saitama Japan
| | - Ryuichi Azuma
- Department of Plastic Surgery National Defense Medical College, Tokorozawa Saitama Japan
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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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Puche-Sanz I, Sabio-Bonilla A, Vila-Braña P, Nogueras-Ocaña M, Vicente-Prados J. Bulbomembranous urethral strictures after transurethral resection of the prostate. Ventral oral mucosal graft non-transecting urethroplasty technique. UROLOGY VIDEO JOURNAL 2022. [DOI: 10.1016/j.urolvj.2022.100136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Gür A, Sönmez G, Demirtaş T, Tombul ŞT, Halitgil K, Demirtaş A. Risk Factors for Early Urethral Stricture After Mono-Polar Transurethral Prostate Resection: A Single-Center Experience. Cureus 2021; 13:e19663. [PMID: 34976457 PMCID: PMC8680018 DOI: 10.7759/cureus.19663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2021] [Indexed: 11/21/2022] Open
Abstract
Aim This study aimed to investigate the incidence of urethral stricture during the early period after transurethral resection of the prostate (TURP) and the risk factors affecting the development of urethral stricture in patients treated in our clinic. Material and methods This retrospective study included patients who underwent TURP due to benign prostate hyperplasia (BPH) and had complete postoperative follow-up data of at least 12 months. Univariate and multivariate logistic regression analyses were performed to evaluate the relationship between urethral stricture and eight parameters (age, body mass index [BMI], prostate volume, number of comorbidities, amount of tissue removed, operative time, perioperative blood loss, and catheterization duration). Results Of the 3069 patients who underwent TURP in our clinic during the study period, 1740 patients with complete clinical data were included in the study. Mean age was 67.83 ± 5.80 years and mean body mass index (BMI) was 27.63 ± 4.31 kg/m2. Median preoperative prostate volume was 50.0 (range, 41.0-62.0) mm3 and the average amount of tissue removed during surgery was 20.0 (range, 12.0-30.0) g. Urethral stricture was detected in 3.9% (67/1740) of the patients during a minimum of 12 months of follow-up period after TURP. In multivariate analysis, prolonged operative time and high comorbidity burden were found to be risk factors for urethral stricture (p<0.001 for both). Conclusion Early urethral stricture remains an important complication of TURP. Our results show that prolonged operative time and high comorbidity burden are factors that increase the risk of urethral stricture.
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Lower Urinary Tract Stenosis Following Surgery for Benign Prostatic Hyperplasia. Curr Urol Rep 2021; 22:55. [PMID: 34654970 DOI: 10.1007/s11934-021-01070-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE OF REVIEW This article reviews the mechanisms, risk factors, evaluation and current management options for iatrogenic lower urinary tract stenosis, including urethral stricture and bladder neck contracture, caused by surgery for benign prostatic hyperplasia (BPH). RECENT FINDINGS The incidence of iatrogenic stenosis following endoscopic BPH surgery ranges from 0 to 9.7%. New endoscopic techniques and technologies for treating BPH do not appear to substantially mitigate this risk. However, new advances in our understanding of urethral sphincter anatomy combined with both innovative open urethroplasty techniques and utilization of robotic surgery for bladder neck reconstruction, offer promise in improving treatment outcomes for this patient population. Treating patient with stenosis following BPH-related surgery can be challenging, especially in patients with recurrent disease. Optimizing outcomes and patient satisfaction relies on performing a thorough work-up and openly discussing treatment choices, risks and postoperative expectations with patients. Future research and emerging technology in both endoscopic BPH treatment surgical options and management of postoperative stenosis is critical to continuing to improve patient care.
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Multi-Institutional Study of Dorsal Onlay Urethroplasty of the Membranous Urethra after Endoscopic Prostate Procedures: Operative Results, Continence, Erectile Function and Patient Reported Outcomes. J Clin Med 2021; 10:jcm10173969. [PMID: 34501417 PMCID: PMC8432256 DOI: 10.3390/jcm10173969] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 08/22/2021] [Accepted: 08/23/2021] [Indexed: 11/16/2022] Open
Abstract
(1) Background: To critically evaluate dorsal onlay buccal mucosal graft urethroplasty (DOBMGU) for posterior urethral stenosis repair following transurethral resection and other endoscopic prostate procedures. (2) Methods: A retrospective multi-institutional review of patients with membranous or bulbomembranous urethral stenosis for whom treatment with DOBMGU was conducted after receipt of prostate endoscopic procedures. Baseline data, peri-operative care, post-operative care and patient-reported outcomes were analyzed. The primary outcomes were procedural failure and development of de novo stress urinary incontinence (SUI). The secondary outcomes were changes in voiding, sexual function and patient satisfaction. (3) Results: A total of 107 men with a mean age of 69 ± 9.5 years and stenosis length of 3.5 ± 1.8 cm were included. Prior endoscopic procedures among participants were 47 patients (44%) with monopolar TURP, 33 (30.8%) with bipolar TURP, 16 (15%) with Greenlight laser, 9 (8.4%) with Holmium laser enucleation and 2 (1.9%) with bladder neck incision. At a mean follow-up time of 59.3 ± 45.1 months, stenosis recurred in 10 patients (9.35%). Multivariate analysis confirmed that postoperative complications (OR 12.5; p = 0.009), history of radiation (OR 8.3; p = 0.016) and ≥2 dilatations before urethroplasty (OR 8.3; p = 0.032) were independent predictors of recurrence. Only one patient (0.9%) developed de novo SUI. Patients experienced significant improvement in PVR (128 to 60 cc; p = 0.001), Uroflow (6.2 to 16.8 cc/s; p = 0.001), SHIM (11.5 to 11.7; p = 0.028), IPSS (20 to 7.7; p < 0.001) and QoL (4.4 to 1.7; p < 0.001), and 87 cases (81.3%) reported a GRA of + 2 or better. (4) Conclusions: DOBMGU is an effective and safe option for patients with posterior urethral stenosis following TURP and other prostate endoscopic procedures. This non-transecting approach minimizes external urinary sphincter manipulation, thus limiting postoperative risk of SUI or erectile dysfunction.
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Andrich DE. Introduction to the 12 th Genitourinary Reconstructive Surgeons (GURS)-Masterclass special issue. Asian J Androl 2021; 22:123. [PMID: 32098933 PMCID: PMC7155791 DOI: 10.4103/aja.aja_147_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Daniela E Andrich
- Reconstructive Urology Unit, Institute of Urology, University College London Hospitals, London W1G 8PH, UK
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Andrich D. Introduction to the 12th Genitourinary Reconstructive Surgeons (GURS)-Masterclass special issue. Asian J Androl 2020. [DOI: 10.4103/1008-682x.279437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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