1
|
Nakamura M, Ikeda K, Uezono S. Metabolic acidemia due to saline absorption during transurethral and transcervical surgery: a report of 2 cases. BMC Anesthesiol 2024; 24:62. [PMID: 38341531 PMCID: PMC10858605 DOI: 10.1186/s12871-024-02437-5] [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: 10/24/2023] [Accepted: 01/28/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND The development of endoscopic systems that include bipolar electrocautery has enabled the use of normal saline irrigation in transurethral or transcervical endoscopic surgery. However, excessive saline absorption can cause hyperchloremic metabolic acidosis. CASE PRESENTATION Patient 1: A 76-year-old man was scheduled for transurethral resection of the prostate with saline irrigation. Approximately 140 min after the surgery, abdominal distension and cervical edema were observed. Abdominal ultrasound examination indicated a subhepatic hypoechoic lesion, which suggested extravasation of saline. Arterial blood gas analysis revealed hyperchloremic metabolic acidosis. The patient was extubated 2 h after the operation with no subsequent airway problems, and the electrolyte imbalance was gradually corrected. Patient 2: A 43-year-old woman was scheduled for transcervical resection of a uterine fibroid with saline irrigation. When the drape was removed after the operation was finished, notable upper extremity edema was observed. Arterial blood gas analysis revealed hyperchloremic metabolic acidosis. The patient's acidemia, electrolyte imbalance, and neck edema gradually resolved, and the patient was extubated 16 h after the operation without subsequent airway problems. CONCLUSIONS Anesthesiologists should be aware of acidemia, cardiopulmonary complications, and airway obstruction caused by excessive saline absorption after saline irrigation in endoscopic surgery.
Collapse
Affiliation(s)
- Mizuyuki Nakamura
- Department of Anesthesiology, The Jikei University School of Medicine, Nishi-Shimbashi 3-25-8, Minato-ku, Tokyo, 105-8461, Japan
| | - Kohei Ikeda
- Department of Anesthesiology, The Jikei University School of Medicine, Nishi-Shimbashi 3-25-8, Minato-ku, Tokyo, 105-8461, Japan.
| | - Shoichi Uezono
- Department of Anesthesiology, The Jikei University School of Medicine, Nishi-Shimbashi 3-25-8, Minato-ku, Tokyo, 105-8461, Japan
| |
Collapse
|
2
|
Dey A, Mamoulakis C, Hasan N, Yuan Y, Shakil A, Omar MI. Emerging Technologies for the Surgical Management of Lower Urinary Tract Symptoms Secondary to Benign Prostatic Obstruction. A Systematic Review. Eur Urol Focus 2023:S2405-4569(23)00201-8. [PMID: 37741783 DOI: 10.1016/j.euf.2023.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 08/23/2023] [Accepted: 09/06/2023] [Indexed: 09/25/2023]
Abstract
CONTEXT Surgical management of lower urinary tract symptoms (LUTS)/benign prostatic obstruction (BPO) aims at ablating prostate adenoma by resection, enucleation, or vaporisation. Apart from established ablation modes according to the European Association of Urology guidelines, various technologies have emerged as safe/effective alternatives but remain under investigation. OBJECTIVE To explore short-term benefits/harms of emerging technologies for surgical management of LUTS/BPO. EVIDENCE ACQUISITION A systematic literature search was conducted using MEDLINE, EMBASE, and CENTRAL via Ovid up to June 18, 2022. We included randomised controlled trials (RCTs) exploring aquablation, prostatic arterial embolisation (PAE), Rezum, prostatic urethral lift (PUL), and temporary implantable nitinol device (iTIND) versus sham/transurethral resection of the prostate (TURP). EVIDENCE SYNTHESIS We included ten RCTs (1108 men). Aquablation versus TURP: insignificant change in International Prostate Symptoms Score (IPSS; mean difference [MD] 0.0, 95% confidence interval [CI] -2.44 to 2.44), quality of life (QoL; MD 0.30, 95% CI -0.81 to 0.21), maximum urinary flow rate (Qmax; MD -0.30, 95% CI -3.71 to 3.11), retreatment (risk ratio [RR] 0.18, 95% CI 0.02-1.66), and urinary incontinence (UI; RR 0.71, 95% CI 0.26-1.95). PAE versus monopolar TURP (M-TURP): insignificant change in IPSS (MD 3.33, 95% CI -28.39 to 35.05), QoL (MD 0.12, 95% CI -0.30 to 0.54), International Index of Erectile Function (IIEF-5; MD 3.07, 95% CI -1.78 to 7.92), and UI (RR 0.15, 95% CI 0.01-2.86), and significant change in Qmax (MD -9.52, 95% CI -14.04 to -5.0), favouring M-TURP. PAE versus bipolar TURP: insignificant change in IPSS (MD -2.80, 95% CI -6.61 to 1.01), QoL (MD -0.69, 95% CI -1.46 to 0.08), Qmax (MD -3.51, 95% CI -8.08 to 1.06), UI (RR 0.14, 95% CI 0.01-2.51), and retreatment (RR 1.91, 95% CI 0.19-19.63). PUL versus TURP: insignificant change in QoL (MD 0.40, 95% CI -0.29 to 1.09), UI (RR 0.13, 95% CI 0.02-1.05), and retreatment (RR 0.48, 95% CI 0.12-1.86), and significant change in IPSS (MD 3.40, 95% CI 0.22-6.58), and IIEF-5 (MD 3.00, 95% CI 0.41-5.59) and Qmax (MD -9.60, 95% CI -13.44 to -5.76), favouring PUL and TURP, respectively. Rezum and iTIND have not been evaluated in RCTs against TURP to date. CONCLUSIONS Supporting evidence for clinical use of aquablation, PAE, PUL, Rezum, and iTIND is very limited. Benefits/harms should be investigated further in high-quality RCTs. PATIENT SUMMARY This review summarises the evidence for the clinical use of aquablation, prostatic arterial embolisation (PAE), prostatic urethral lift (PUL), Rezum, and temporary implantable nitinol device (iTIND) to manage lower urinary tract symptoms secondary to benign prostatic obstruction. The supporting evidence for the clinical usage of aquablation, PAE, PUL, Rezum, and iTIND is very limited. Benefits and harms should be investigated further in high-quality randomised controlled trials.
Collapse
Affiliation(s)
- Anirban Dey
- Academic Urology Unit, University of Aberdeen, Aberdeen, UK
| | - Charalampos Mamoulakis
- Department of Urology, University General Hospital of Heraklion, University of Crete, Medical School, Heraklion, Crete, Greece
| | | | - Yuhong Yuan
- Division of Gastroenterology and Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Ambreen Shakil
- Institute of Education in Healthcare and Medical Sciences, University of Aberdeen, UK
| | - Muhammad Imran Omar
- Academic Urology Unit, University of Aberdeen, Aberdeen, UK; Guidelines Office, European Association of Urology, Arnhem, The Netherlands.
| |
Collapse
|
3
|
Bipolar TURP in a patient undergoing redo prostate surgery and the use of PlasmaButton for vaporisation and coagulation. UROLOGY VIDEO JOURNAL 2022. [DOI: 10.1016/j.urolvj.2022.100152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
|
4
|
Watson G, Niang L, Chandresekhar S, Natchagande G, Payne SR. The feasibility of endourological surgery in low-resource settings. BJU Int 2022; 130:18-25. [PMID: 35524768 DOI: 10.1111/bju.15770] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
One of the widest variations in contemporary surgical practice between high and low, or low-middle, income countries is the utilisation of endoscopy as a means of treating urological pathology. The endoscopic management of lower urinary tract problems such as benign prostatic hypertrophy, bladder cancer and urethral strictures was established in the UK in the late 1970s, whilst its adoption into everyday practice in sub-Saharan Africa has been significantly retarded. It is still neither a major feature of urological training in those countries nor widely available to the patients established consultants treat. Likewise, the explosion of less invasive technologies for treating upper tract stone disease in the 1980s, particularly the management of renal stone disease, has also lagged behind practice established in the UK over the last 40 years. This is not due to a lack of patients who could be treated endoscopically, or restricted by the abilities of the surgeons in sub-Saharan Africa. The restraint in assumption of these less-invasive management options is rather due to the physical availability of trained specialist surgeons, their access to basic infrastructure such as electricity and water, access to endoscopes and the peripheral equipment necessary to successfully deploy them and the ability of patients to afford the disposable items required for less-invasive forms of management. Some endoscopic procedures are viable in resource-poor settings. They are, however, largely dependent upon the supply of equipment from non-governmental organisations in high income countries, frugal innovation to reduce individual procedure costs, adequately skilled mentors, and maintenance and supply chains to make them a durable option in patient management. Urolink and the Medi Tech Trust present their experience of how endoscopic surgery can be taught, and used sustainably, in a resource-poor healthcare environment.
Collapse
Affiliation(s)
- Graham Watson
- East Sussex Hospitals NHS Trust, Eastbourne, UK.,Medi Tech Trust, Eastbourne, UK
| | | | | | | | | |
Collapse
|
5
|
Fukazawa T, Ito H, Takanashi M, Shinoki R, Tabei T, Kawahara T, Keeley FX, Drake MJ, Kobayashi K. Short-term efficacy and safety of second generation bipolar transurethral vaporization of the prostate (B-TUVP) for large benign prostate enlargement: Results from a retrospective feasibility study. PLoS One 2021; 16:e0261586. [PMID: 34914804 PMCID: PMC8675650 DOI: 10.1371/journal.pone.0261586] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 12/05/2021] [Indexed: 11/19/2022] Open
Abstract
Background To investigate the efficacy and safety of a second-generation bipolar transurethral electro vaporization of the prostate (B-TUVP) with the new oval-shaped electrode for large benign prostatic enlargement (BPE) with prostate volume (PV) ≥100ml. Materials and methods 100 patients who underwent second-generation B-TUVP with the oval-shaped electrode for male lower urinary tract symptom (LUTS) or urinary retention between July 2018 and July 2020 were enrolled in this study. The patients’ characteristics and treatment outcome were retrospectively compared between patients with PV <100ml and ≥100ml. Results 17/41 (41.5%) cases of PV ≥100ml and 24/59 cases (40.7%) of PV <100ml were catheterised due to urinary retention. The duration of post-operative catheter placement and hospital-stay of PV ≥100ml (3.1±1.3 and 5.6±2.3 days) were not different from PV <100ml (2.7±1.2 and 5.0±2.4 days). In uncatheterised patients (N = 59), post-void residual urine volume (PVR) significantly decreased after surgery in both groups, however, maximum uroflow rate (Qmax) significantly increased after surgery only in PV <100ml but not in PV ≥100ml. Voiding symptoms and patients’ QoL derived from International Prostate Symptom Score (IPSS), IPSS-QoL (IPSS Quality of Life Index) and BPH Impact Index (BII) scores, significantly improved after B-TUVP in both groups. Catheter free status after final B-TUVP among patients with preoperative urinary retention was achieved in 18/24 (75.0%) and 14/17 (82.1%) cases in patient with <100ml and ≥100ml, respectively. There was no significant difference in post-operative Hb after B-TUVP, which was 97.0±5.4% of baseline for PV <100ml and 96.9±6.1% for PV ≥100ml and no TUR syndrome was observed. Conclusions This is the first study investigating short-term efficacy and safety of second-generation B-TUVP with the oval-shaped electrode on large BPE. B-TUVP appears to be effective and safe for treating moderate-to-severe lower urinary tract symptoms and urinary retention in patients with large BPE.
Collapse
Affiliation(s)
- Takeshi Fukazawa
- Department of urology, Yokosuka Kyosai Hospital, Yokosuka, Japan
| | - Hiroki Ito
- Department of urology, Yokosuka Kyosai Hospital, Yokosuka, Japan
- Department of Urology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
- * E-mail:
| | - Masato Takanashi
- Department of urology, Yokosuka Kyosai Hospital, Yokosuka, Japan
| | - Risa Shinoki
- Department of urology, Yokosuka Kyosai Hospital, Yokosuka, Japan
- Department of Urology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Tadashi Tabei
- Department of urology, Yokosuka Kyosai Hospital, Yokosuka, Japan
| | - Takashi Kawahara
- Department of Urology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Francis X. Keeley
- Bristol Medical School and Bristol Urological Institute, Southmead Hospital, Bristol, United Kingdom
| | - Marcus J. Drake
- Bristol Medical School and Bristol Urological Institute, Southmead Hospital, Bristol, United Kingdom
| | - Kazuki Kobayashi
- Department of urology, Yokosuka Kyosai Hospital, Yokosuka, Japan
| |
Collapse
|
6
|
Franco JVA, Jung JH, Imamura M, Borofsky M, Omar MI, Escobar Liquitay CM, Young S, Golzarian J, Veroniki AA, Garegnani L, Dahm P. Minimally invasive treatments for benign prostatic hyperplasia: a Cochrane network meta-analysis. BJU Int 2021; 130:142-156. [PMID: 34820997 DOI: 10.1111/bju.15653] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Revised: 11/12/2021] [Accepted: 11/18/2021] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To assess the comparative effectiveness and ranking of minimally invasive treatments (MITs) for lower urinary tract symptoms (LUTS) in men with benign prostatic hyperplasia (BPH). MATERIALS AND METHODS We searched multiple databases up to 24 February 2021. We included randomized controlled trials assessing the following treatments: convective radiofrequency water vapour thermal therapy (WVTT; or Rezūm); prostatic arterial embolization (PAE); prostatic urethral lift (PUL; or Urolift); temporary implantable nitinol device (TIND); and transurethral microwave thermotherapy (TUMT) compared to transurethral resection of the prostate (TURP) or sham surgery. We performed a frequentist network meta-analysis. RESULTS We included 27 trials involving 3017 men. The overall certainty of the evidence of most outcomes according to GRADE was low to very low. Compared to TURP, we found that PUL and PAE may result in little to no difference in urological symptoms, while WVTT, TUMT and TIND may result in worse urological symptoms. MITs may result in little to no difference in quality of life, compared to TURP. MITs may result in a large reduction in major adverse events compared to TURP. We were uncertain about the effects of PAE and PUL on retreatment compared to TURP, however, TUMT may result in higher retreatment rates. We were very uncertain of the effects of MITs on erectile function and ejaculatory function. Among MITs, PUL and PAE had the highest likelihood of being the most efficacious for urinary symptoms and quality of life, TUMT for major adverse events, WVTT and TIND for erectile function and PUL for ejaculatory function. Excluding WVTT and TIND, for which there were only studies with short-term (3-month) follow-up, PUL had the highest likelihood of being the most efficacious for retreatment. CONCLUSIONS Minimally invasive treatments may result in similar or worse effects concerning urinary symptoms and quality of life compared to TURP at short-term follow-up.
Collapse
Affiliation(s)
- Juan Victor Ariel Franco
- Associate Cochrane Centre, Instituto Universitario Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Jae Hung Jung
- Department of Urology, Yonsei University Wonju College of Medicine, Wonju, South Korea.,Center of Evidence-Based Medicine, Institute of Convergence Science, Yonsei University, Seoul, South Korea
| | - Mari Imamura
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Michael Borofsky
- Department of Urology, University of Minnesota, Minneapolis, MN, USA
| | - Muhammad Imran Omar
- Guidelines Office, European Association of Urology, Arnhem, The Netherlands.,Academic Urology Unit, University of Aberdeen, Aberdeen, UK
| | | | - Shamar Young
- Department of Radiology, Division of Interventional Radiology & Vascular Imaging, University of Minnesota, Minneapolis, MN, USA
| | - Jafar Golzarian
- Department of Radiology, Division of Interventional Radiology & Vascular Imaging, University of Minnesota, Minneapolis, MN, USA
| | - Areti Angeliki Veroniki
- Department of Primary Education, School of Education, University of Ioannina, Ioannina, Greece
| | - Luis Garegnani
- Associate Cochrane Centre, Instituto Universitario Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Philipp Dahm
- Urology Section, Minneapolis VA Health Care System, Minneapolis, MN, USA
| |
Collapse
|
7
|
Castellani D, Di Rosa M, Pace G, Rubilotta E, Gubbiotti M, Pirola GM, Gasparri L, Antonelli A, Dellabella M. Comparison between thulium laser vapoenucleation and plasmakinetic resection of the prostate in men aged 75 years and older in a real-life setting: a propensity score analysis. Aging Clin Exp Res 2021; 33:1757-1763. [PMID: 33907993 DOI: 10.1007/s40520-021-01868-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 04/21/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Urologists may hesitate to offer transurethral resection of the prostate (TURP) because of increased morbidity in elderly patients. AIMS We aimed to compare data on postoperative outcomes of elderly men undergoing bipolar transurethral resection of the prostate (B-TURP) as compared to thulium laser vapoenucleation of the prostate (ThuVEP). METHODS We retrospectively reviewed data of all patients aged ≥ 75 years who underwent benign prostatic hyperplasia surgery. Differences between interventions were estimated using propensity scores (PS) to adjust for different patients characteristics. RESULTS Between 2017 and 2020, 275 men were included in the analysis. Propensity score retrieved 65 patients in each group. Median age was 78 (4) years in B-TURP group and 78 (6) in ThuVEP group. Median prostate volume was 63 (35) ml and 54 (24) ml in B-TURP group and ThuVEP group, respectively. Only American Society of Anesthesiologists score was significantly higher in ThuVEP group (p = 0.006). Median operation time, catheterization time, and hospital stay were similar in both groups (55 min, 2 and 3 days). Overall, 84.6% of men had no complications, with no significant differences between the groups (p = 0.234). Only one patient in B-TURP group experienced a Clavien grade IIIb complication. By 1 year, there were a statistically significant differences in International Prostate Symptom Score (p = 0.000) in favor of B-TURP group and in maximal urine flow rate (p = 0.000) in favor of ThuVEP group. DISCUSSION AND CONCLUSIONS Both procedures showed excellent functional improvements one year after surgery with a low rate of major complications in men aged ≥ 75 years with small-to-medium sized prostates.
Collapse
Affiliation(s)
- Daniele Castellani
- Department of Urology, IRCCS INRCA, Via della Montagnola 83, 60127, Ancona, Italy.
| | - Mirko Di Rosa
- Geriatric Pharmacoepidemiology Lab, IRCCS INRCA, Ancona, Italy
| | - Gianna Pace
- Department of Urology, ULSS 3 Serenissima, Dolo, Italy
| | - Emanuele Rubilotta
- Department of Urology, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Marilena Gubbiotti
- Department of Urology, Usl Toscana Sud Est, San Donato Hospital, Arezzo, Italy
| | | | - Luca Gasparri
- Department of Urology, IRCCS INRCA, Via della Montagnola 83, 60127, Ancona, Italy
| | - Alessandro Antonelli
- Department of Urology, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Marco Dellabella
- Department of Urology, IRCCS INRCA, Via della Montagnola 83, 60127, Ancona, Italy
| |
Collapse
|
8
|
The state of TURP through a historical lens. World J Urol 2021; 39:2255-2262. [PMID: 33772604 DOI: 10.1007/s00345-021-03607-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Accepted: 01/15/2021] [Indexed: 10/21/2022] Open
Abstract
In 1926 Maximilian Stern introduced a new instrument to treat obstructions at the vesical orifice and baptized it resectoscope. With reference to astonishing historical statements about the new instrument and surgical technique made by the pioneers and their critics we will value why transurethral resection of the prostate (TURP) remains the gold standard for most men suffering from lower urinary tract symptoms (LUTS) due to benign prostatic enlargement. TURP is currently challenged by recently introduced new instruments and techniques claiming advantages over TURP. However, TURP offers an excellent balance between high efficacy in symptom relieve and low morbidity along with low costs and favorable long term outcome compared to other treatment options. We will outline these arguments demonstrating that even after a century has elapsed, since its introduction into the urologists armamentarium, TURP continues to stand the passage of time.
Collapse
|