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Background: Benign hypertrophy of prostate is common disorder and benign neoplasm of man above 50 years of age. Around 30% patients with benign hypertrophy of prostate lower urinary tract symptoms (LUTS) but all symptoms may not be due to benign hypertrophy of prostate (BHP). Present study has been designed for comparative evaluation of the outcome of medical and surgical management of symptoms, due to benign prostatic hyperplasia by using IPSS (international prostate score) and quality of life score as tool.Methods: In present study patients with LUTS, clinically diagnosed by per rectal digital examination and transrectal ultrasonographically confirmed cases of enlargement of prostate are enrolled for this study. Patients enrolled were divided equally in three groups.Results: After six month the mean IPSS score in silodosin (Sd) group was 6.55±0.86 and in Sd+Dutasteride (Dt) group it was 5.09±1.12. After six months mean IPSS score in Sd+Dt group was 5.09±1.12 and in TURP group it was 2.44±0.59.Conclusions: Single drug treatment with silodosin is associated with slow and less improvement in IPSS score in comparison with silodosin and dutasteride. But the response to TURP was better and faster than medical management.
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Background: Transurethral resection of prostate syndrome (TURP) syndrome is an iatrogenic complication caused by absorption of the irrigating fluid which is used to distend the bladder during surgery.Methods: A total of 100 patients with benign prostatic hyperplasia (BPH) were taken for study. Study was done in tertiary care centre in Gujarat from January 2016 to December 2017. They were evaluated pre-operative and post-operative for sodium concentration.Results: In this study most of the patients i.e. 32 were seen in age group 61- 65 years.31% cases have developed hyponatremia out of 6% were having serum sodium level <125 mEq/l. 56% of cases were having prostate gland <40 cc. In 70% cases, TURP was completed within 60 minutes, while 30% cases required more than 60 minutes time. 13 were seen in age group 51 to 60 years, means 40.62% patients of this age group (13/32) and 12 patients were seen in age group 71-80 years, means 52.17% patients of this age group (12/23) were having post-operative hyponatremia. Out of 31 patients, 20 patients (64.52%) were having prostate size more than 60 cc and 11 patients (35.48%) were having prostate size between 46 to 60 cc.Conclusions: From present study, it is concluded that electrolyte derangement occurs in older patients, with larger amount of tissue and longer time of resection and higher volume of irrigation fluid. It was also noticed that chances of electrolyte derangement are higher in patients with co-morbid conditions.
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Objective@#To observe the analgesic and sedative effect of epidural dexmedetomidine injection in patients undergoing transurethral resection of prostate (TURP) and its effect on postoperative cognitive function.@*Methods@#A total of 60 patients undergoing TURP under combined spinal-epidural anesthesia (CSEA) were randomly divided into dexmedetomidine group and normal saline group. Patients in the dexmedetomidine group were given 0.1 μg/kg of dexmedetomidine injection after epidural anesthesia, and 0.9 μg/kg of dexmedetomidine was added into epidural analgesia pump after operation; patients in the normal saline group were given the same dose of normal saline. The vital signs, visual analogue scale (VAS) and Ramsay sedation score of patients in the two groups at different time points[before intervention (T0), after intervention for 15 min (T1), after intervention for 30 min (T2), after intervention for 45 min (T3), after intervention for 60 min (T4), after surgery for 12 h (T5), after surgery for 36 h (T6)] were recorded. The mini mental state examination (MMSE) of patients in the two groups 1 d before operation and 3 d after operation were recorded.@*Results@#Compared with normal saline group, the VAS scores of patients in dexmedetomidine group were significantly lower at T1-T6 (P < 0.05), and the Ramsay scores were significantly higher (P < 0.05). There was no significant difference of MMSE total score [25.00(23.50, 27.50) scores] in the patients of dexmedetomidine group 3 d after operation but the memory ability score [4.00(3.00, 5.00) scores] was significantly decreased (P < 0.05), and the language ability score [9.00(8.00, 9.00) scores] was significantly increased (P < 0.05). There was no significant difference in MMSE score between the two groups in comparison with that 1 d before operation.@*Conclusions@#Epidural dexmedetomidine injection (1 μg/kg) enhancesd the analgesic effect of ropivacaine and producesd sedative effect. Although there was is no significant effect on the overall cognitive function, it might have some effect on memory function.
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Objective To observe the analgesic and sedative effect of epidural dexmedetomidine injection in patients undergoing transurethral resection of prostate (TURP) and its effect on postoperative cognitive function. Methods A total of 60 patients undergoing TURP under combined spinal-epidural anesthesia (CSEA) were randomly divided into dexmedetomidine group and normal saline group. Patients in the dexmedetomidine group were given 0.1 μg/kg of dexmedetomidine injection after epidural anesthesia, and 0.9 μg/kg of dexmedetomidine was added into epidural analgesia pump after operation;patients in the normal saline group were given the same dose of normal saline. The vital signs, visual analogue scale (VAS) and Ramsay sedation score of patients in the two groups at different time points [before intervention (T0), after intervention for 15 min (T1), after intervention for 30 min (T2), after intervention for 45 min (T3), after intervention for 60 min (T4), after surgery for 12 h (T5), after surgery for 36 h (T6)] were recorded. The mini mental state examination (MMSE) of patients in the two groups 1 d before operation and 3 d after operation were recorded. Results Compared with normal saline group, the VAS scores of patients in dexmedetomidine group were significantly lower at T1-T6 (P<0.05), and the Ramsay scores were significantly higher (P<0.05). There was no significant difference of MMSE total score [25.00(23.50, 27.50) scores] in the patients of dexmedetomidine group 3 d after operation but the memory ability score [4.00(3.00, 5.00) scores] was significantly decreased (P<0.05), and the language ability score [9.00(8.00, 9.00) scores] was significantly increased (P < 0.05). There was no significant difference in MMSE score between the two groups in comparison with that 1 d before operation. Conclusions Epidural dexmedetomidine injection (1 μg/kg) enhancesd the analgesic effect of ropivacaine and producesd sedative effect. Although there was is no significant effect on the overall cognitive function, it might have some effect on memory function.
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OBJECTIVE@#To compare the effectiveness of abdominal placement of indwelling Foley catheter (IFC)versus thigh traction in the prevention of bleeding and pain after transurethral resection of the prostate(TURP).@*PATIENTS AND METHODS@#This randomized, controlled trial involves 91 patients who underwent TURP atJRRMMC. After TURP, 46 patients were inserted with a urethral catheter which was then anchoredto the thigh and placed on traction, while the catheter was anchored to the abdomen without applicationof any traction in the remaining 45. A simple dipstick test was used to check for the presence of bloodin urine on the 12th and 24th hour after the surgery. Intensity of pain from the catheter was assessedprior to discharge using a visual analogue score (VAS).@*RESULTS@#There were no significant differences between the two groups in terms of the amount of bloodin the urine at the 12th hour (p=1.00) and 24th hour (p=0.427) after TURP. The mean VAS score wassignificantly higher for the thigh traction group (5.17 vs 1.51, p=0.0001). Additionally, there weremore patients in the IFC thigh traction group who complained of moderate (65% vs 4.4%, p= 0.0001)and severe (20% vs 4.4%, p= 0.0001) pain.@*CONCLUSION@#Abdominal placement of IFC post TURP is an effective, safe and comfortable way incontrolling post-operative bleeding post-TURP. This method can provide better pain control.
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Objective To evaluate the efficacy and safety of transurethral laser shovel type vaporresection-enucleation of the prostate (LS-VREP) based on the inter-layer of surgical capsule for the treatment of benign prostatic hyperplasia (BPH),which was less 80 g weight.Methods From September 2013 to August 2016,a retrospective study was performed including 1 369 cases of BPH patients,who were treated by 120-160 W transurethral laser (straight green-light) shovel type vapor-resection-enucleation of the prostate (LS-VREP group,n =1 008) and transurethral resection of the prostate (TURP group,n =361).The preoperative data,including average age,prostate weight,IPSS,QOL,Qmax and PVR was reviewed.There was no significant difference of the above data between the two groups (P ＞ 0.05).Operative time,changes of hemoglobin and serum sodium concentration,postoperative bladder irrigation time,catheter indwelling duration,hospital stay,pre-and 3 months post-operative IPSS,QOL,Q PVR were recorded.In addition,complications were monitored.Results Mean operation time of LS-VREP group was (46.1 ± 18.6) min,while TURP group was (48.2 ± 15.2) min,and there was no difference between the two groups (P ＞ 0.05).Post-operative mean hemoglobin concentration and serum sodium concentration of LS-VREP group decreased (1.6 ± 1.2) g/L and (1.2 ± 0.6) mmol/L respectively,while those of TURP group decreased (5.7 ± 3.6) g/L and (3.2 ± 1.2) mmol/L,and the differences were statistically significant (P ＜ 0.05).Mean post-operative catheter indwelling time,and post-operative hospital stay of LS-VREP group was (42.9 ± 12.7) h and (3.2 ± 0.6) d,while TURP group was (65.7 ± 15.4) h and (5.4 ± 1.2) d,and the differences were statistically significant (P ＜ 0.05).Comparatively IPSS,QOL,Qmax and PVR were all improved significantly in both groups at 3 months after operation (P ＜ 0.05),but no significant difference was found between the two groups (P ＞ 0.05).After three months' follow-up of post-operation,as for the complication rate,including TURS,bleeding requiring reoperation,incontinence,dysuria and erectile dysfunction,LS-VREP group (15/1 008) was less than that of TURP group (30/361,P ＜ 0.05).Conclusions The LS-VREP based on the inter-layer of surgical capsule is safe and effective for the treatment of BPH patients whose prostate weight was less than 80 g.LS-VREP showed less intraoperative bleeding,faster postoperative recovery,and high safety,which is considered a safe,effective and optimized minimally invasive surgery.
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Objective To systematically review and evaluate the perioperative indicators and surgical curative effect of 980 nm diode laser vaporization of prostate and transurethral resesction of prostate (TURP) in treating benign prostatic hyperplasia (BPH). Methods Retrieved published comparative studies 980 nm diode laser vaporization of prostate versus transurethral resesction of prostate in treating benign prostatic hyperplasia, and pooled the data from eligible studies. The statistical analysis was performed using Revman 5.3 software. Results Six trials including 839 patients were eligible to the criteria (450 in 980 nm diode laser group and 389 in TURP group). The baseline of patients characteristics were comparable in all the studies. Meta analysis showed that: the operative time was not significantly different between the 980 nm diode laser group and TURP group [SMD = 0.11, 95 ~ CI (-0.52,0.74), P > 0.05]; Compared with TURP group, 980 nm diode laser group has shorter hospital stays [SMD = -1.95, 95%CI (-3.42, -0.48), P 0.05], QOL [SMD = 0.00, 95%CI (-0.57, 0.57), P > 0.05] and Qmax [SMD = 0.06, 95%CI (-0.26, 0.37), P > 0.05]. Conclusion 980 nm diode laser vaporization of prostate is safe and effective in treating benign prostatic hyperplasia, and compared with TURP, it has advantages in shorter hospital stays and shorter catheterization time.
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Objective To explore the availability and safety of conducting low-pressure TURP assisted by a home-made cystometry and warning system.Methods 167 benign prostatic hyperplasia (BPH) patients admitted from Jan 2014 to Jan 2016 were randomly assigned into cystostomy group (group A) and non-cystostomy group (group B). In group A (n = 85), 42 patients (group A1) were performed percutaneous cystostomy + TURP, and 43 (group A2) were performed continuous flushing sheath TURP. In group B (n = 82), 42 patients (group B1) were received percutaneous cystostomy + TURP, and 40 (group B2) were received continuous lfushing sheath TURP. In group A, bladder pressure was monitored in real time with a cystometry and was monitored by bladder puncture using a home-made siphon, ensuring low bladder pressure throughout TURP. Serum Na+ levels were measured before and after operation in all four groups. The operation time, the intraoperative bleeding, the weight of resected prostates and the time before which urine turned clear were recorded. The IPSS, maximum lfow rate (Qmax), postvoid residual volume (PVR) and life quality score (QOL) were evaluated.Results While no significant differences were found between group A1 and A2, there were significant differences between group B1 and B2, indicating cystostomy group was safer than non-cystostomy group. When compared group A1 with B1, or group A2 with B2, it showed that the safe operation time to perform prostate tissue resection was longer in cystostomy group; the weight of the resected prostates was heavier; the time before which urine turned clear were shorter; and the IPSS improvement was better. These findings presented better therapeutic effects in cystostomy group than in non-cystostomy group.Conclusions This home-made cystometry and warning system could timely detect high bladder pressure state during TURP, making it possible to avoid of high pressure, ensuring low bladder pressure lfushing during the operation, lengthening the safe operation time, increasing tissue resection ratio, reducing transurethral resection syndrome, thus helping TURP to be safer.
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@#<p style="text-align: justify;"><strong>INTRODUCTION:</strong> Hematuria is a common complication of transurethral electrosurgical procedures in the postoperative period. Presently, there is no standard diagnostic tool that will determine the degree of hematuria among postoperative catheterized patients. An innovative way of assessing the degree of hematuria is through the use of Hematuria Meter Application, a mobile device software program.<br /><strong>OBJECTIVE:</strong> The objective of this study was to determine the reliability of the Hematuria Meter Application as a diagnostic tool to assess the degree of hematuria in post-TURP and post-TURBT patients. This study aimed to determine if there is agreement between the Hematuria Meter Application readings and the RBCs counter per high power field by Direct Manual Quantitative Microscopy method and to determine if there is inter-observer agreement in using the Hematuria Meter Application between the patient or relative, nurse, intern and resident urologist.<br /><strong>METHODS:</strong> Using the Hematuria Meter Application, the color of the urine was graded by the patient or relative, resident, intern and nurse. Urine was then collected and sent to the laboratory for quantitative manual RBC counting under the microscope. Intraclass correlation coefficient (ICC) was used to determine teh agreement of the applicatin readings with RBC/hpf and inter-observer agreement among the observers.<br /><strong>RESULTS:</strong> From July 2014 to December 2015, a total of 159 eligible patients were included in this study. The average age was 69. Majority were males (91%). 118 patients out of 159 (74%) underwent TURP, while 41 patients (26%) underwent TURBT. The median age of patients who underwent TURP was 68 while the median age was 66 for patients who underwent TURBT.<br />The agreements of the Hematuria Meter Application readings with RBCs/hpf counted with Direct Manual Quantitative Microscopy method were almost perfect. ICC was 0.743 (p-value 0.000) in day 0 post-operative and 0.985 (p-value 0.000) in day 2 post-operative. Similarly, inter observer agreement was almost perfect and increasing at each period of assessment. In the immediate post-operative period, ICC was 0.832 (p-value 0.000). On second post operative day, ICC was 0.999 (p-value 0.000).<br /><strong>CONCLUSION:</strong> The Hematuria Meter Application is a reliable diagnostic tool in assessing the degree of hematuria in post-TURP and post-TURBT patients. There is inter-observer agreement in using this application.</p>
Subject(s)
Humans , Male , Microscopy , Hematuria , Reproducibility of Results , Electrosurgery , Transurethral Resection of Prostate , Urologists , Erythrocyte Count , PhysiciansABSTRACT
@#<p style="text-align: justify;"><strong>INTRODUCTION:</strong> Erythrocyte Sedimentation Rate (ESR) is an acute phase reactant and an indirect measure of inflammation inside the body. Transurethral electrosurgical Resection of the Prostate (TURP) is the current gold standard for management of patients with Benign Prostatic Hyperplasia (BPH) with moderate to severe lower urinary tract symptoms. The success of operation is determined when after resection of the prostate following removal of indwelling Foley catheter several days postoperative, the patient is able to avoid freely without catheter. It is not mentioned whether the edema of the postoperative site or the persistent inflammation of the prostate after resection may cause the failureof trial of voiding without catheter (TWOC).<br /><strong>OBJECTIVE:</strong> The primary objective of this study was to determine if ESR can be a reliable predictor of success of in patients who underwent TURP for BPH.<br /><strong>METHODS:</strong> On the day of planned catheter removal , 4 milliliters of blood was extracted from the patient, placed in an Ethylenediaminetetraacetic acid (EDTA) tube and sent to laboratory for ESR determination. One milliliterof EDTA-anticoagulated blood was placed in the Westergren tube. After 60 minutes, measurements were taken of the distance the red cells traveled to settle at the bottom of the tube. After catheter removal, patients were observed whether they can avoid freely without catheter or not. Patients who were not able to void within 4 to 6 hours were re-catheterized.<br /><strong>RESULTS:</strong> From January 2015 to April 2016, 135 patients with BPH who underwent TURP in East Avenue Medical Center were included in the analysis. Success of trial voiding without catheter was observed in 117 of 135 patients (87%; p=0.000). Patients ages varied varied from 49 to 80 years, overall. Among these patients, the average ESR was significantly lower (48 mm versus 56 mm, range = 17-109 mm; p=0.012). Presence of urinary retention (61%), history of cigarette smoking (56%), hypertension (61%), diabetes mellitus (50%), trabeculations in cystoscopy and prostate size less than 20 grams (17%) were more common among patients with unsuccessful TWOC. ESR (p=0.012) was an independent significant predictor of TWOC. Based on univariate analysis, Diabetes Mellitus (DM) (p=0.003), trabeculations in cystoscopy (p=0.000) and UTI (p=0.000) were also significantlyassociated with TWOC. Among the significant independent covariates, DM was a significant factor affecting the success rate of TWOC (p=0.005) based on multivariate analysis. Patients without DM were about 16 times more likely to have a successful TWOC (OR=15.750, 95% CI=2.335, 106.227).<br /><strong>CONCLUSION:</strong> Erythrocyte Sedimentation Rate was significantly lower in patients with success of trial voiding without catheter. ESR is a reliable predictor of success of TWOC in patients who underwent TURP for BPH.</p>
Subject(s)
Humans , Male , Aged , Middle Aged , Adult , Urinary Retention , Prostatic Hyperplasia , Edetic Acid , Transurethral Resection of Prostate , Urinary Catheterization , Lower Urinary Tract Symptoms , UrinationABSTRACT
INTRODUCTION: Hematuria is a common complication of transurethral electrosurgical procedures in the postoperative period. Presently, there is no standard diagnostic tool that will determine the degree of hematuria among postoperative catheterized patients. An innovative way of assessing the degree of hematuria is through the use of Hematuria Meter Application, a mobile device software program.OBJECTIVE: The objective of this study was to determine the reliability of the Hematuria Meter Application as a diagnostic tool to assess the degree of hematuria in post-TURP and post-TURBT patients. This study aimed to determine if there is agreement between the Hematuria Meter Application readings and the RBCs counter per high power field by Direct Manual Quantitative Microscopy method and to determine if there is inter-observer agreement in using the Hematuria Meter Application between the patient or relative, nurse, intern and resident urologist.METHODS: Using the Hematuria Meter Application, the color of the urine was graded by the patient or relative, resident, intern and nurse. Urine was then collected and sent to the laboratory for quantitative manual RBC counting under the microscope. Intraclass correlation coefficient (ICC) was used to determine teh agreement of the applicatin readings with RBC/hpf and inter-observer agreement among the observers.RESULTS: From July 2014 to December 2015, a total of 159 eligible patients were included in this study. The average age was 69. Majority were males (91%). 118 patients out of 159 (74%) underwent TURP, while 41 patients (26%) underwent TURBT. The median age of patients who underwent TURP was 68 while the median age was 66 for patients who underwent TURBT.The agreements of the Hematuria Meter Application readings with RBCs/hpf counted with Direct Manual Quantitative Microscopy method were almost perfect. ICC was 0.743 (p-value 0.000) in day 0 post-operative and 0.985 (p-value 0.000) in day 2 post-operative. Similarly, inter observer agreement was almost perfect and increasing at each period of assessment. In the immediate post-operative period, ICC was 0.832 (p-value 0.000). On second post operative day, ICC was 0.999 (p-value 0.000).CONCLUSION: The Hematuria Meter Application is a reliable diagnostic tool in assessing the degree of hematuria in post-TURP and post-TURBT patients. There is inter-observer agreement in using this application.
Subject(s)
Humans , Male , Microscopy , Hematuria , Reproducibility of Results , Electrosurgery , Transurethral Resection of Prostate , Urologists , Erythrocyte Count , PhysiciansABSTRACT
INTRODUCTION: Erythrocyte Sedimentation Rate (ESR) is an acute phase reactant and an indirect measure of inflammation inside the body. Transurethral electrosurgical Resection of the Prostate (TURP) is the current gold standard for management of patients with Benign Prostatic Hyperplasia (BPH) with moderate to severe lower urinary tract symptoms. The success of operation is determined when after resection of the prostate following removal of indwelling Foley catheter several days postoperative, the patient is able to avoid freely without catheter. It is not mentioned whether the edema of the postoperative site or the persistent inflammation of the prostate after resection may cause the failureof trial of voiding without catheter (TWOC).OBJECTIVE: The primary objective of this study was to determine if ESR can be a reliable predictor of success of in patients who underwent TURP for BPH.METHODS: On the day of planned catheter removal , 4 milliliters of blood was extracted from the patient, placed in an Ethylenediaminetetraacetic acid (EDTA) tube and sent to laboratory for ESR determination. One milliliterof EDTA-anticoagulated blood was placed in the Westergren tube. After 60 minutes, measurements were taken of the distance the red cells traveled to settle at the bottom of the tube. After catheter removal, patients were observed whether they can avoid freely without catheter or not. Patients who were not able to void within 4 to 6 hours were re-catheterized.RESULTS: From January 2015 to April 2016, 135 patients with BPH who underwent TURP in East Avenue Medical Center were included in the analysis. Success of trial voiding without catheter was observed in 117 of 135 patients (87%; p=0.000). Patients ages varied varied from 49 to 80 years, overall. Among these patients, the average ESR was significantly lower (48 mm versus 56 mm, range = 17-109 mm; p=0.012). Presence of urinary retention (61%), history of cigarette smoking (56%), hypertension (61%), diabetes mellitus (50%), trabeculations in cystoscopy and prostate size less than 20 grams (17%) were more common among patients with unsuccessful TWOC. ESR (p=0.012) was an independent significant predictor of TWOC. Based on univariate analysis, Diabetes Mellitus (DM) (p=0.003), trabeculations in cystoscopy (p=0.000) and UTI (p=0.000) were also significantlyassociated with TWOC. Among the significant independent covariates, DM was a significant factor affecting the success rate of TWOC (p=0.005) based on multivariate analysis. Patients without DM were about 16 times more likely to have a successful TWOC (OR=15.750, 95% CI=2.335, 106.227).CONCLUSION: Erythrocyte Sedimentation Rate was significantly lower in patients with success of trial voiding without catheter. ESR is a reliable predictor of success of TWOC in patients who underwent TURP for BPH.
Subject(s)
Humans , Male , Aged , Middle Aged , Adult , Urinary Retention , Prostatic Hyperplasia , Edetic Acid , Transurethral Resection of Prostate , Urinary Catheterization , Lower Urinary Tract Symptoms , UrinationABSTRACT
Background: Patients who are candidates for TURP are elderly with cardiovascular and respiratory diseases with anticipated problems during spinal anesthesia. Aim: To compare three different doses (5mg, 7.5mg and 10mg) of Bupivacaine after adding 25 mcg of fentanyl during spinal anesthesia in transurethral resection of prostate surgeries. Methods: Single blinded Randomized clinical study conducted in 75 patients. The subjects were allocated in to three groups. Group A - received Inj. 0.5% Bupivacaine 5 mg, Group B- received Inj. 0.5% Bupivacaine 7.5 mg, Group C - received Inj.0.5% Bupivacaine 10 mg added with 25 mcg of Fentanyl. Baseline and intraoperative vital parameters, time to sensory block at t10, maximum sensory height, time to two segment sensory regression, total duration of sensory blockade, grading of motor blockade and total duration of motor blockade were recorded. Results: Maximum sensory level achieved in Group A was T9, Group B T7 and in Group C it was T5. Time to T10 level in Group A was 7.88 ±0.80 minutes, Group B 5.41 ±0.50 minutes and Group C 3.33 ±0.65 minutes. Two segment sensory regression times in Group A was 56.8±13.61 minutes, Group B 79.58 ±25.32 minutes, and Group C was 116.25 ±9.35 minutes. Total duration of pain free interval in Group A was 84.6 ±20.41 minutes, Group B 104.12 ±45.89 minutes. Group C was 194.20 ±41.53 minutes. Conclusion: Low dose of Bupivacaine (5mg) with addition of Fentanyl 25μg can be used for painless TURP surgeries when compared to higher doses (7.5mg and 10 mg) without any major side effects and facilitates early discharge.
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Objective To investigate the clinical efficacy of modified YV-plasty for refractory bladder neck contracture (BNC) caused by transurethral resection of prostate (TURP).Methods From June 2013 to March 2016,11 patients with BNCs secondary to TURP were included in this study.Their mean age was 63.7 years (range,56-73 years).All patients presented voiding difficulty and failed after 2 or more prior endoscopic treatments.Modified YV-reconstruction of bladder neck was performed,by incising the anterior wall of bladder neck in a T-shaped manner,and creating two well-vascularized and tension-free flaps,which offer the possibility to reconstruct a wide bladder neck.Results After a mean follow-up of 14.6 months (ranging 3-24 months),successful outcome was achieved in 9 patients without incontinence secondary by surgery.Recurrent voiding difficulty developed in 2 patients,which was cured after a following endoscopic treatment.Conclusion A wider bladder neck can be obtained through modified YV-reconstruction of bladder neck,while avoiding external urethral sphincter injury.It is an available option for refractory bladder neck contracture.
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Background: Benign prostatic hyperplasia (BPH) is the commonest urological condition affecting men over 50 years of age. Medical therapy is usually the first line management of BPH. Finasteride is a 5-alpha reductase inhibitor (5ARI), which blocks the conversion of testosterone into the more potent dihydrotestosterone (DHT). Materials and methods: We prospectively enrolled 54 BPH patients with prostate size ranging from 30-60 gm based on ultrasound, who were undergoing elective TURP at Gandhi Hospital for a period of 2 years from January 2013 to Jan 2015. BPH patients with hematuria, bothersome symptoms and refractory retention were included in the study. Results: Totally 54 BPH patients were enrolled in our study, 30 were randomized to finasteride group and 24 to controlled group. There was significantly less (p value <0.01) mean blood loss in irrigation fluid in the finasteride group compared to the control group (54.27 gm in finasteride group Vs 82.45gms in the control group; p value < 0,01) for each transurethral resection of prostate. Conclusion: Finasteride give daily for 2 weeks before transurethral prostate resection decreased bleeding preoperatively, thereby decreasing the requirement of blood transfusions, post operative episodes of hematuria and clot retention.
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Background: Spinal anesthesia is most frequently used for transurethral prostatectomy (TURP), because it permits early recognition of transurethral resection of prostate (TURP) syndrome and bladder perforation. In this study, we compared the effects of low dose bupivacaine (5 mg) with fentanyl (25μg) and conventional dose of bupivacaine (7.5 mg) in elderly patients undergoing TURP. This comparative study was conducted to evaluate the efficacy of addition of fentanyl 25 μg intra thecally to bupivacaine 5 mg and bupivacaine 7.5 mg alone for transurethral prostatectomy. Material and methods: The patients were randomly allocated into 2 groups, each having 30 patients. Group-A: Inj. Bupivacaine 5 mg (0.5%) (1ml) + Inj. Fentanyl 25 μg (0.5 ml). Group-B: Inj.Bupivacaine 7.5 mg (0.5%) (1.5 ml). A standard subarachnoid block was performed in L2-L3 / L3-L4 Space in sitting / lateral position with 22G/23G BD spinal edle (Quinky type, 3.5 inch long) under all aseptic and antiseptic precautions after local infiltration of skin and subcutaneous tissue with 2 cc 2 % lignocaine. Drugs were injected after checking of free flow of CSF and according to group selected. All the observations were recorded and all the results were analyzed statistically. Results: The mean time of onset sensory blockade was significantly shorter in group A than group B. Group A took less time to reach the peak sensory level (3.57 min) as compared to group B (5.8 min). Onset of motor blockade was delayed in group B as compared to group-A, and differences were statistically significant. Changes in pulse rate of all groups are statically not significant and comparable. The incidence of hypotension and shivering was significantly higher in group B as compared to group A. Conclusion: It was observed that intra thecal bupivacaine 5 mg combined with fentanyl 25 μg provided adequate anesthesia for TURP in elderly patients and is associated with lower incidence of hypotension and shivering than a conventional dose of bupivacaine. The addition of fentanyl improves the quality of block, increases duration of sensory block and makes the blockade hemodynamically more stable than conventional dose of bupivacaine.
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Objective To evaluate the clinical efficiency and complications of deferred limited TURP for treating urinary retention after 125I seed implantation.Methods From Jan.2006 to Jan.2014,36 prostate cancer patients with severely dysuria or retention were performed with deferred limited TURP 6 months after 125I seed implatation.The average age was 66 (57 to 82) years.The average PSA was 8.5 (3.5 to 25.6) μg/L before seed implantation.The average prostate volume was 78 (45 to 110) ml.Before limited TURP,the average IPSS was 16.5 (13 to 32),the average QOL score was 5.5 (5 to 6),the Qave was 5.6 (2 to 9) ml/s,the average PVR was 285 (120 to 550) ml.The urination state,QOL and complications were evaluated the second day after catheter removal and one,three and six months after limited TURP.Results Limited TURP was successfully performed in all 36 patients.The average operation time was 45 (35 to 60) min.The average fellow-up time was 42 (6 to 84) mon.The second day after catheter removal,the average IPSS was 4.5 (3 to 6),the average QOL score was 2 (1 to 3),the Qave was 14.5 (12 to 21) ml/s,the average PVR was 35 (20 to 50) ml.One month later,the average IPSS was 3.5 (2 to 5),the average QOL score was 2.0 (1 to 3),the Qave was 15.5 (12 to 23) ml/s,the average PVR was 30 (20 to 40) ml.Three months later,the parameters continued to improve and stabilized.The second day after catheter removal and one,three and six months after limited TURP,all parameters had significant improvement compared with those before limited TURP with statistical significance (P ＜ 0.05).Four cases had mild incontinence,no case had urethral ischemia and necrosis.Conclusions 6 months after 125I seed implatation,prostate cancer patients with severely dysuria or retention can be safely and effectively treated with limited TURP.
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Objective To investigate clinical value of transurethral bipolar plasma cutting and transurethral resection for benign prostatic hyperplasia,to provide a reference for clinical treatment.Methods 100 cases with benign prostatic hyperplasia were selected,according to surgical treatment,they were divided into control group and observation group.50 patients in the control group received TURP surgical treatment,50 patients in the observation group were given TUPKP surgical treatment.The patients were followed up for 3 months,the indwelling catheter time, weight and other clinical indicators of glandular tissue were compared,serum sodium and hemoglobin levels were observed,the quality of life index,international Prostate Symptom Score,complications and other indicators were compared. Results In the observation group,operative time was (60.54 ±8.37)min,blood loss was (108.43 ±21.27)mL, hospital stay was (7.09 ±2.25)d,which were shorter than those of the control group (70.24 ±12.22)min,(188.76 ± 21.36)mL,(8.63 ±2.76)d,the differences were statistically significant (t =5.441,P =0.012;t =8.326,P =0.001;t =6.216,P =0.006).In the observation group after three months,maximum flow rate was (18.95 ±4.11)mL/s, residual urine volume was (28.74 ±4.55)mL,IPSS was (5.12 ±1.27)points,QOL was (1.43 ±0.24)scores, which were better than those of the control group (14.24 ±3.77)mL/s,(20.85 ±5.11)mL,IPSS(6.95 ±1.44)points, QOL(2.03 ±0.32)points,the differences were statistically significant (t =8.763,P =0.000;t =7.616,P =0.003;t =5.472,P =0.011;t =8.044,P =0.002).The incidence rate of complication in the observation group was 10.00%, which was significantly lower than 22.00% in the control group,the difference was statistically significant (χ2 =5.437,P =0.012).Conclusion TUPKP treatment for benign prostatic hyperplasia has significant clinical effect, which can effectively improve the clinical symptoms and quality of life with good safety,it is worthy of clinical application.
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Objective To investigate the effect of multiple treatments on cystospasm after transurethral resection of prostate(TURP). Methods From 2006 to 2013, 663 patients who had received TURP for BPH were civided into 6 groups:2 were treated by kieselgel or lac-toprene urethral catheter,defined as catheter observe group. 2 were treated by warmed or ordinary temperature douche,defined as temperature observe group. 2 were treated by dicaine mixed or normal douche,defined as mixed douche observe group. The incidence rates and duration of cystospasm and visual analogue scores of pain were observed and the diversities were measured by statistics within each pair groups. Results The incidence rates and duration of cystospasm and visual analogue scores of pain of groups treated by kieselgel urethral catheter,warmed douche and dicaine mixed douche were obviously lower than the groups treated by lactoprene urethral catheter,ordinary temperature douche and normal douche. The kieselgel urethral catheter and warmed douche decreasing the irritation on mucous membrane of bladder,the dicaine decreasing the sensibility of bladder nerves may be the mechanism. Conclusion The incidence rates and duration of cystospasm and visual analogue scores of pain can be obviously decreased by treatments of kieselgel urethral catheter,warmed douche and dicaine mixed douche.
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Background: The duration of the spinal block is a concern for anesthetists. Low dose intrathecal lidocaine has vasodilatory effects and increases the local anesthetic clearance from the intrathecal space. The aim was to investigate whether this effect of lidocaine can be used to increase the resolution of levobupivacaine spinal anesthesia. Method: After obtaining ethical approval and informed patient consent, 40 patients underwent transurethral prostate resection were studied. Patients were randomized into two groups and patients received either levobupivacaine 6.75 mg + 0.3 mL 2% lidocaine (Group L) or levobupivacaine 6.75 mg + saline (Group C). The main outcome measures were the difference between groups regarding the duration of the spinal block and PACU stay. Secondary outcome measures were the difference between groups in onset and resolution of the spinal block, adverse events and treatments were also investigated. Results: Spinal block resolved faster in Group L than Group C; 162.43 ± 39.4 min vs 219.73 ± 37.3 min (p = 0.000). PACU time was shorter in Group L (109 ± 49.9 min in Group L vs 148 ± 56.8 min in Group C) (p = 0.036). There was no difference between groups with respect to the incidence of adverse events and treatments. Groups were also similar regarding complications. PDPH and TNS were not observed in any group. Conclusion: Addition of low dose lidocaine to hyperbaric levobupivacaine reduces the duration of the intrathecal block provided by hyperbaric levobupivacaine. This technique can be used to reduce the spinal block duration for relatively short procedures like TUR-P. .
Justificativa e objetivo: a duração do bloqueio espinhal é uma preocupação para os anestesistas. Lidocaína intratecal em dose baixa tem efeito vasodilatador e aumenta a eliminação do anestésico local do espaço intratecal. O objetivo deste estudo foi analisar se esse efeito da lidocaína pode ser usado para aumentar a resolução da anestesia espinhal com levobupivacaína. Método: após obter aprovação do Comitê de Ética e consentimento informado, 40 pacientes submetidos à ressecção transuretral da próstata foram incluídos no estudo. Os pacientes foram randomizados em dois grupos e receberam6mgde levobupivacaína + 0,3 mL de lidocaína a 2% (Grupo L) ou6,75mgde levobupivacaína + solução salina (Grupo C). O desfecho primário foi a diferença entre os grupos em relação à duração do bloqueio espinhal e a permanência na sala de recuperação pós-anestésica (SRPA). Os desfechos secundários foram a diferença entre os grupos em relação ao início e à resolução do bloqueio espinhal; eventos adversos e tratamentos também foram investigados. Resultados: a resolução do bloqueio espinhal foi mais rápida no Grupo L do que no Grupo C: 162,43 ± 39,4 min vs. 219 ± 37,3 min (p = 0,000). O tempo na SRPA foi menor no Grupo L do que no Grupo C: 109 ± 49,9 min vs. 148 ± 56,8 min (p = 0,036). Não houve diferença entre os grupos em relação à incidência de eventos adversos e tratamentos. Os grupos também foram semelhantes no que diz respeito a complicações. Cefaleia pós-punção dural (CPPD) e sintomas neurológicos transitórios (SNT) não foram observados em nenhum grupo. Conclusão: a adição ...
Justificación y objetivo: la duración del bloqueo raquídeo es una preocupación para los anestesistas. La lidocaína intratecal en dosis baja tiene un efecto vasodilatador y aumenta la eliminación del anestésico local del espacio intratecal. El objetivo de este estudio fue analizar si ese efecto de la lidocaína puede ser usado para aumentar la resolución de la anestesia raquídea con levobupivacaína. Método: después de obtener la aprobación del Comité de Ética y el consentimiento informado del paciente, fueron incluidos en el estudio 40 pacientes sometidos a resección transuretral de próstata. Los pacientes fueron aleatorizados en 2 grupos y recibieron 6 mg de levobupivacaína + 0,3 mL de lidocaína al 2% (grupo L) o 6,75 mg de levobupivacaína + solución salina (grupo C). El objetivo primario fue analizar la diferencia entre los grupos con relación a la duración del bloqueo raquídeo y la permanencia en la sala de reanimación postanestesia. El secundario fue la diferencia entre los grupos con relación al inicio y al término del bloqueo raquídeo. También se investigaron los eventos adversos y los tratamientos. Resultados: la resolución del bloqueo raquídeo fue más rápida en el grupo L que en el grupo C (162,43 ± 39,4 min vs. 219,73 ± 37,3 min [p = 0,000]). El tiempo en la sala de reanimación postanestesia fue menor en el grupo L que en el grupo C (109 ± 49,9 min vs. 148 ± 56,8 min [p = 0,036]). No hubo diferencia entre los grupos con relación a la incidencia de eventos adversos y tratamientos. Los grupos también fueron similares en lo que respecta a las complicaciones. No se observó en ningún grupo ni cefalea pospunción dural ni síntomas neurológicos transitorios. Conclusión: la adición de una ...